Diagnostic Value Of Urinary N-acetyl-β-（D）-glucosaminidase, Urinary β₂-microglbulin And Serum Cystatin C In Primary Nephrotic Syndrome Complicated By Acute Kidney Injury

Objective: To investigate the risk factors for primary nephrotic syndrome(PNS)complicated by acute kidney injury(AKI),and explore the predictive value of urinary N-acetyl-β-D-glucosaminidase,Urinary β2-microglbulin and serum cystatin C in PNS patients with AKI.Methods: A total of 89 PNS patients with AKI(AKI group,n=28)or without AKI(non-AKI group,n=61)who were admitted in the nephrology department of the Second Affiliated Hospital of Dalian Medical University were enrolled.Clinical data collected included gender,age,infection,severe edema in both group.In addition,peripheral white blood cell(WBC)count,hemoglobin(Hb),serum total cholesterol(CHOL),serum triacylglycerol(TG),high density lipoprotein(HDL),low density lipoprotein(LDL),serum creatinine(Scr),blood urea nitrogen(BUN),serum albumin(ALB),serum cystatin C(CysC),urinary N-acetyl-β-D-glucosaminidase(NAG),Urinary β2-microglbulin(β2-MG)were determined.All patients were performed percutaneous renal biopsy and the clear pathological diagnosis was got.All statistical analyses were performed using SPSS v22.0(Statistical Product and Service Solutions version 22.0),P values<0.05 were considered as statistically significant.Results: 1.Among the 89 patients,28 PNS patients were complicated by AKI(31.5%).Furthermore,the incidence of AKI in male,infection and severe edema PNS patients was significantly higher than that in female PNS patients and patients without infection,edema(P<0.05).Compared with non-AKI group,AKI significantly increased the levels of HB,CHOL,TG,LDL,BUN,CysC,urinary protein quantity in 24 hours,urinary β2-MG,urinary NAG,but obviously decreased the levels of serum ALB and HDL(P<0.05).2.From multiple logistic regression models showed that the increase of urinary β2-MG,urinary NAG,serum CysC were the independent predictors of PNS patients complicated by AKI.Urinary β2-MG,urinary NAG and serum CysC are all comparatively ideal biomarkers to predict the occurrence of AKI in PNS patients.The area under the receiver operating characteristic curve(AUCROC)for urinary NAG was 0.972,with a positive value of >67.5IU/L,a diagnostic sensitivity of 0.929 and a diagnostic specificity of 0.885 for PNS complicated by AKI.Conclusions: Urinary β2-MG,urinary NAG and serum CysC can predict the occurrence of AKI in PNS patients.Among them,urinary NAG is the comparatively ideal biomarkers with high sensitivity and perfect accuracy.