Correlation Analysis Of Kim-1 With Patients Of Primary Chronic Kidney Disease With Renal Tubular Interstitial Damage

Objective:Kim-1 concentrations in the urine of patients with renal tubular interstitial injury of primary chronic kidney disease(CKD)group and healthy controls group were analyzed,aims to explore whether the Kim-1 can be used as a marker of the severity of renal tubular interstitial damage in primary chronic kidney disease.Methods: Choose between January 2015 and February 2016 in the first hospital affiliated to Dalian medical university renal medicine by renal biopsy of 38 patients,removal of 13 cases according to the inclusion criteria,25 cases of primary chronic kidney disease with interstitial injury were selected as experimental group.Among them,14 cases were male and 11 were female.The mean age was 39.76±14.02 years old.The pathological types of renal biopsy in the patients were membranous nephropathy in 10 cases,IgA nephropathy in 8 cases,mesangial proliferative glomerulonephritis in 6 cases,membranous proliferative glomerulonephritis in 1 cases.Before the biopsy are unused glucocorticoid,immunosuppressants and low molecular heparin,ect.According to Mezzano classification criteria,the degree of renal tubular interstitial lesion was divided into mild,moderate-severe two groups.At the same period,seclected ten people as control,which was no statistically significant difference in gender and age.The expression levels of urine Kim-1 in three groups were detected by enzyme linked immunosorbent assay.All the research object to collect clinical indicators include: gender,age,blood glucose,albumin,creatinine,uric acid,24 hours urinary protein quantitative,urineβ2-microglobulin,NAG and so on.All the data using SPSS13.0 software for statistical analysis.Result:1.There were no differences in age,sex,blood sugar,urea and creatinine between the three groups(P<0.05);Compared with the control group,the serum triglyceride,cholesterol and uric acid were higher in the mild injury group,the albumin was lower in the mild injury group,the difference was statistically significant(P<0.05).There was no difference in triglyceride and cholesterol between moderate-severe injury group and the control group.But uric acid was higher、albumin was lower in the moderate-severe injury group,the difference was statistically significant(P<0.05).There were no differences in triglyceride,cholesterol,uric acid,albumin and 24 hours urinary protein between the mild injury group and the moderate-severe injury group(P>0.05).2.The expression of urinary Kim-1 in the normal control group was significantly lower,the level of Kim-1 in the urinary of primary chronic renal disease groups was obviously increased compared with the normal control group,moderate-severe group was significantly higher than the mild group,the difference is significant(P < 0.05).Urinary Kim-1 was positively correlated with the degree of renal tubular interstitial injury(r =0.858,P<0.05).There was a significant difference in the expression of Kim-1 in the renal interstitial with vascular wall thickening group compared with the non vessel wall thickening group(P<0.05).There was a positive correlation between urinary Kim-1 level and renal interstitial vessel wall thickening(r=0.548,P<0.01).The area under the ROC curve to diagnosis the renal tubular interstitial injury of primary chronic kidney disease(CKD)was 0.818,the optimal threshold value was 6.39 ng/mL,the sensitivity was 0.79,and the specificity was 0.64.3.Mild injury group compared with the control group,the NAG was significantly increased,the difference was statistically significant(P<0.05).Moderate-severe injury group compared with the control group,the NAG was increased,the difference was statistically significant(P<0.05).Mild injury group compared with Moderate-severe injury group,the NAG showed no significant difference(P=0.98).The urine beta 2-microglobulin has no significant difference in three groups(P=0.379).4.Relevance to clinical data:The expression level of Kim-1 in urine was positively correlated with uric acid(r=0.467,P<0.05),and negatively correlated with albumin(r=-0.505,P<0.05),but no correlation with blood glucose,triglyceride,cholesterol,creatinine and 24 hours urinary protein(P>0.05).5.Draw ROC curve analysis showed that urinary Kim-1 assess the renal tubular interstitial lesions,the area under the curve is superior to NAG,urine beta 2-microglobulin.The area under the ROC curve to diagnosis the renal tubular interstitial injury of primary chronic kidney disease(CKD)was 0.984,the optimal threshold value was 4.92 ng/mL,the sensitivity was 0.92,and the specificity was 0.90.Conclusion : 1.With the aggravation of tubulointerstitial damage,urinary Kim-1 expression was gradually increased.2.The level of Kim-1 expression was positively correlated with the degree of renal tubular interstitial damage in primary chronic kidney disease.3.Urine Kim-1 expression level have a certain correlation with renal interstitial vascular lesions.