Analysis Of The Diagnostic Value Of Urine Microprotein Detection For Kidney Disease And Its Correlation With Rheumatism Syndrome

Objective Studies have shown that proteinuria and rheumatism in TCM syndrome can lead to the progression of kidney disease.The purpose of this study was to expand the sample size to explore the diagnostic value of urine trace protein detection for kidney disease and its correlation with TCM rheumatism syndrome,in order to provide a reference for the clinical diagnosis and treatment of kidney disease.Methods A total of 594 patients in this unit were retrospectively collected,including 425 cases of confirmed glomerular disease,including IgAN,diabetic nephropathy（DKD）,primary membranous nephropathy（IMN）,lupus nephropathy（LN）,minimal lesions（MCD）,focal segmental glomerulosclerosis（FSGS）,amyloid nephropathy（AN）.111 cases of tubular interstitial disease,including tubular interstitial nephritis（TIN）,IgG4-tubulointerstitial nephritis（IgG4-TIN）,gouty nephropathy（GKD）.58 cases of renal small vessel disease,including hypertensive nephropathy（HN）.Collect the patient’s general clinical data,including gender,age,BMI,blood pressure,renal function,kidney biopsy report,diagnosis at discharge,etc.,at the same time,patients were collected with urine trace protein detection data,including UIgG,UALb,UTRF,Ual-MG and their ratio to urinary creatinine correction.The study is divided into two parts,The first part evaluates the differences and correlations between the 3 groups of diseases and the urine IgG to urine creatinine ratio（IgGCR）,the urine microalbumin to urine creatinine ratio（ACR）,the urinary transferrin to urine creatinine ratio（TCR）,and the urine α1 microglobulin to urine creatinine ratio（α1CR）,and the subject’s work characteristic curve（ROC）is plotted to assess diagnostic capability.The second part analyzes the distribution of rheumatism syndrome in various kidney diseases and the differences and correlations of urine trace protein detection in TCM syndromes（mainly rheumatic and non-rheumatic syndromes）,and plots ROCs to evaluate its diagnostic effect.Results 1.In the comparison of glomerular,tubular interstitial and renal small blood vessel diseases,the IgGCR,ACR and TCR levels of the glomerular disease group were significantly higher than those of the tubulointerstitial and glomerular vascular disease groups,and theα1CR of the glomerular disease group was lower than that of the tubular interstitial disease group（the Bonferroni corrected P value was<0.001）,but there was no significant difference between the α1CR of the glomerular disease group and the group of renal small blood vessel disease,and the igGcR,ACR,TCR of the tubular interstitial disease group and the group of renal small blood vessel disease were IgGCR,ACR,TCR,There was no statistical difference in α1CR（Bonferroni corrected P-value>0.05）,while tubular interstitial disease and renal small blood vessel disease were combined into a non-glomerular disease group.2.The correlation between individual indicators and glomerular disease and ROC analysis showed that high levels of ACR,TCR,and IgGCR were associated with glomerular disease（r=0.531 vs 0.501 vs.0.419）,and low levels of α1CR were associated with glomerular disease（r=-0.208）.High levels of ACR,TCR,and IgGCR can better diagnose glomerular disease（AUC=0.944 vs 0.931 vs 0.938 vs.0.885）,low levels of α1CR are relatively less valuable for diagnosing glomerular disease（AUC=0.632）,and IgGCR,ACR,TCR,The analysis of α1CR into the Logistic regression model to adjust the confounding factors to predict glomerular disease showed that the predicted glomerular disease effect of the corrected confounding factor by the Logistic regression model was consistent with the effect of a single index in diagnosing glomerular disease.3.In the two-to-two comparison of various diseases in the glomerular disease group,it was found that in addition to the significant difference in IgGCR and TCR of IgAN and MCD,the IgGCR,ACR,TCR and α1CR of IgAN were lower than those of other types of glomerular diseases（Bonferroni corrected P value<0.001）,the alCR of DKD was significantly higher than IMN,and the α1CR of AN was significantly higher than that of LN.High levels of IgGCR,ACR,TCR,and α1CR were associated with non-IgAN glomerular disease（r=0.431 vs 0.482 vs 0.513 vs 0.54）.ROC analysis showed that high levels of alCR were better at diagnosing non-IgiAN glomerular disease regardless of whether Logistic regression was adjusted or not,and had a high degree of specificity in the diagnosis of DKD.4.In the comparison between diseases in the non-GD group,it was found that IgGCR was higher than that in the IgG4-TIN group,and the high level of IgGCR was associated with IgG4-TIN（r=0.305）,and ROC analysis showed that when IgGCR≥0.010 mg/mg.In Cr,the AUC for the diagnosis of IgG4-TIN was 0.686（sensitivity 35.8%,specificity 87.5%,P<0.008）.However,in the Logistic regression model,IgGCR had no significant influence relationship with IgG4-TIN.5.Rheumatism symptoms in Traditional Chinese medicine are more common in AN（96.1%）,followed by FSGS（91.9%）,MCD（90.9%）,DKD（85.9%）,IMN（81.1%）,LN（72.7%）,IgAN（40.0%）,and rheumatism certificates are mostly distributed in CKD2-3.There were significant differences between the rheumatic evidence group and the non-rheumatic evidence group in IgGCR,TCR,ACR,andα1CR（the P-value was<0.001）,and further Logistic regression model adjustment and ROC analysis found that the elevation of ACR,TCR,IgGCR,and alCR could predict rheumatic evidence.Conclusion 1.High levels of medium and large molecular urine protein（IgGCR,TCR,ACR）and low levels of small molecule urine protein alCR can diagnose glomerular diseases,verifying the traditional theory that "the increase in medium and large molecular urine protein is mostly glomerular-derived proteinuria".2.High levels of alCR can specifically identify non-IgAN glomerular disease,especially tubular damage of DKD,suggesting that the role of small molecule urine protein in the diagnosis of kidney disease cannot be ignored.3.Rheumatic symptoms are common in glomerular disease and are mostly distributed in CKD stages 2 to 3.4.IgGCR,TCR,ACR,α1CR are significantly higher than non-rheumatic certificates in rheumatic evidence,and high-level IgGCR,TCR,ACR,α1CR and rheumatism certificates are all correlated,and the effect of predicting rheumatic evidence is good,providing a modern basis for microscopic differentiation of proteinuria.