Clinical Value Of Combined Detection Of Urinary KIM-1 And NGAL In Idiopathic Membranous Nephropathy

Objective:In the present study,we aim to test the levels of urine neutrophil gelatinase-associated lipocalin(NGAL)and renal injury molecule-1(KIM-1)in patients with idiopathic membranous nephropathy(IMN)to explore their relationship with renal tubulointerstitial injury and IMN pathological stages,so as to assess its clinical value.Methods:A total of 81 patients who were diagnosed as idiopathic membranous nephropathy(IMN)by renal biopsy at our hospital from May 2017 to August 2018 were selected as the case group,and 55 healthy controls in our health examination center during the same period were selected.The general and clinical data of two groups were collected,and urine NGAL and KIM-1 were detected in all subjects.The case group were divided into stage I,stage I-II and stage II groups according to Ehrenreich-Churg staging method.In addition,according to the pathological evaluation criteria of Banff,the pathological degrees of renal tubulointerstitial were divided into mild,moderate and severe group.To compare and analyze urine NGAL and KIM-1 levels in different groups of patients,so as to explore the relationship among urine NGAL and KIM-1 and tubulointerstitial pathological injury in IMN patients and to analyse the correlation between urine NGAL or KIM-1 and clinical laboratory indexes related to renal tubulointerstitial injury,including α1 microglobulin(α1-MG),urine N-acetyl-β-D-glucosaminidase(NAG)and urine retinol binding protein(RBP).Results:There was no significant difference in demographic characteristics(including gender,age and body mass index)between the case group and the healthy control group(P>0.05).There was no significant difference in the demographic characteristics of IMN patients with different pathological stages(P>0.05),but the differences of renal tubulointerstitial injury score,urinary KIM-1 and NGAL levels were statistically significant(P<0.05),and the differences between intergroup were statistically significant(P<0.05).Spearman linear correlation analysis showed that urine KIM-1 and NGAL in IMN patients were positively correlated with urine RBP,urine α1-MG and urine NAG(P<0.05).The ROC curve results showed that the AUC of urine KIM-1,NGAL and their combination were 0.850,0.874,0.916,the specificity and sensitivity were 95.1% and63.6%,92.6% and 69.1%,92.7% and 75.3%.the AUC of urine RBP,urine α1-MG,and NAG were 0.712,0.636,0.719,with specificity and sensitivity of 51.9% and 81.8%,58.0% and 67.3%,59.3%,and 83.2%.Conclusion:Urinary KIM-1 and urinary NGAL are closely related to the severity of IMN renal tubular injury,and can reflect the severity of IMN pathological injury.Their combined detection has high clinical value in diagnosing IMN renal tubulointerstitial injury.