Reichert LJM, Koene RAP, Wetzels JFM
Urinary excretion of beta-2-microglobulin predicts renal
outcome in patients with idiopathic membranous nephropathy
J Am Soc Nephrol
(Dec) 6:1666-1669 1995
It would be useful to know in advance which patients with membranous
nephropathy
will develop progressive renal insufficiency and might therefore benefit from
cytotoxic drug therapy. Previously employed predictors include level of
proteinuria, renal function, and gender. Histologically, interstitial
fibrosis
correlates with disease progression. The investigators hypothesized that a
marker for impaired tubular function would be an early and sensitive marker
for
poor prognosis. B2-microglobulin is filtered and then metabolized by the
proximal tubule. Impaired proximal tubule function results in increased
B2-microglobulin excretion. Patients with membranous nephropathy had
B2-microglobulin excretion measured and were observed for changes in renal
function.
Retrospective analysis suggested that B2-microglobulin excretion
greater than 500 ng/min (in patients with initially normal GFR and
proteinuria
greater than 3.5 g/24 h) was a valuable marker for poor prognosis. 11/14 of
patients with excretion greater than 500 ng/min, but only 2/16 patients with
B2-microglobulin excretion less than 500 ng/min doubled their creatinine
during
approximately 4 years of observation.
Comment: If this observation holds up during
prospective observation of a much larger group of patients with membranous
nephropathy, it could become a useful clinical tool. It will also be
important
to use regression analysis to ascertain whether B2-microglobulin excretion is
a
better prognostic feature than those variables previously identified.
(Paller)
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Proteinuria/Hematuria :
Membranous GN