The Diagnostic Value Of Urinary Trace Protein In The Early Renal Lesion Of Patients With Cirrhosis

Liver cirrhosis can involve kidney and cause renal failure, such as the hepatorenal syndrome(HRS).In general,HRS refers to functional renal failure caused by various grave liver diseases including severe hepatitis. As one of severe complications of grave hepatic disorders , HRS with incidence rate about 40-80% has a high fatality rate.Thus,it is crucial for timely therapy,improvement of life, good prognosis to predict HRS early. At present, laboratory diagnosis of renal impairment mainly depends on serum biochemistry and routine urine examination,while these methods are influenced by many factors and not sensitive enough to promptly detect the majority of renal damage and its diseased region, especially at the early stage. For example, when urinary albumin is positive , renal parenchyma injuries have already occurred. Therefore, the novel methods to discover the early and slight disorders are needed in order to help to guide the treatment and improve the prognosis.Abnormal urinary albumen excretion is one of the most important physiopathologic derangements in renal lesions due to primary renal and other related diseases,so proteuria is the significant feature of renal lesions.But because of the fact that the conventional examinations are difficult to detect slight renal damage, many researchers all over the world are focusing their attention on the trace albumin in urine. The microalbuminuria means subclinical increased protein and can be used to qualify the pathological phenomena difficult to be defined by conventional examinations. Detect ing microprotein is mainly used for testing glomerular membrane permeability as well as the secretion and reabsorption of renal tubules.And the test has already been introduced in the assessment of primary or secondary renal disorders such as diabetic and hypertensive nephropathy and contributed to the early diagnosis.However, there are not many studies on the change in trace protein as well as its relationship with HRS and much remains to be known. Our study was conducted in order to explore the diagnostic value of uric microprotein in the early renal impairment due to cirrhosis.The patients were enrolled from inpatients and outpatients between 2006,3—2007,2 and devided into diseased group including 64 cirrhosis patients and control involving 27 subjects. The serum levels ofα1-MG,mAlb,IgG and TRF were detected in all cases by immunity transmission turbidity.All participants were urine protein negative with normal urea nitrogen creatinine.And primary renal diseases, hypertension, diabetic cardiopathy were excluded.There was no significant difference between two groups(P>0.05).Results showed the levels of urine trace protein were higher than in the control(P<0.01);with the increasing grading, the urineα1-MG,mAlb,IgG and TRF gradually went up and were statistically significant in A,B,C cirrhosis gradings(P<0.05或P<0.01).Compared to control,mAlb,IgG andα1-MG(P<0.05)as well as TRF (P<0.01) in grading A increased significantly.The TRF in 56.3% patients with liver cirrhosis exceeded normal upper limit, compared to urine mAIb in 48.4% patients.This indicated that TRF was more sensitive than mAlb to reflect renal impairment. Besides,results showed the relationship between glomerular mAlb,TRF,IgG and renal tubularα1-MG was linear(P<0.01 ).This suggested that renal impairment caused by cirrhosis involved renal glomeruli and tubules and both correlated linearly.However, the levels of mAlb,TRF,IgG andα1-MG in urine increased obviously ,so we were unable to define whether the glomerular injury preceded tubular injury or vice versa.Each of the levels of mAlb,TRF,IgG andα1-MG had a low positive rate. Combining all the tests were much better (positive rate :78.1%). Besides,results showed that positive rate of TRF andα1-MG combined detection was more super the positive rate of TRF,P<0.05,There was significant difference between two groups. The highest positive rate of three combined detection was no significant higher than two combined detection(P>0.05). Combining all the tests were much better (78.1%)than two combined detection(73.4%),but it was no significant difference(P>0.05). Combinating expense and positive rate of detection,the investigation showed that it was most ideal to detect TRF andα1-MG,It could cut down expense meanwhile the influence of positive rate was little. Because TRF,mALB and IgG are to reflect membrane impaired proteinum,we think it don't affecting judgement of diseased region if we just to detect TRF andα1-MG.Conclusions: The levels of uric mAlb,TRF,IgG andα1-MG in cirrhosis group rose significantly compared to the control.With the aggravated hepatic functional lesions, the trace protein increased and it indicated that renal injury got worse. And TRF was more sensitive than mAlb to reflect renal impairment.The renal damage due to liver cirrhosis involved the tubules and glomeruli.On account of small size and the elevated microprotein to reflect both tubules and glomeruli, we couldn't judge whether the glomerular injury preceded tubular injury or vice versa.Testing mAlb,TRF,IgG andα1-MG all together was a sensitive method to evaluate early renal damage and systematically analyze the impaired part,but not any one of them.Therefore, detecting urine trace protein was helpful to discover the early renal disorder and the extent in cirrhosis.It also contributed to the prevention and cure of renal failure due to liver cirrhosis.