J. Tencer et al., Diagnostic and prognostic significance of proteinuria selectivity index inglomerular diseases, CLIN CHIM A, 297(1-2), 2000, pp. 73-83
The proteinuria selectivity index (SI) describes changes of the glomerular
permeability for macromolecules. In the present study, we examine the impli
cations of SI as a diagnostic (199 patients) and a prognostic (49 patients)
marker in glomerular diseases. Using SI based on cr-macroglobulin (alpha(2
)-M-SI) or on IgM (IgM-SI) we found that minimal change nephropathy could b
e discriminated by low SI values and crescentic necrotizing glomerulonephri
tis by high SI values compared to other diseases. SI based on IgG (IgG-SI)
was less useful in determining specific diagnoses. During a follow-up of 46
months creatinine clearance (Cr cl) decreased 36% in a group of patients w
ith high IgG-SI ( > 0.2) and 38% in a group of patients with high IgM-SI (
> 1.5(-3)) compared to only 8% in patients with low IgG-SI ( less than or e
qual to 0.2) or low IgM-SI ( less than or equal to 1.5(-3)). Furthermore, C
r cl decreased more than 30% in 12 (92%) out of thirteen patients with high
baseline levels of both IgG-SI and IgM-SI compared to three out of thirtee
n patients with low baseline values of both the indexes. The decline rate o
f Cr cl correlated significantly to the SI levels but not to the degree of
albuminuria. The findings of the study indicate that urinary excretion of h
igh-molecular-weight proteins, and not of albumin, is a potential prognosti
c marker in proteinuric glomerulopathies and it may also serve as valuable
diagnostic aid in these disorders. (C) 2000 Elsevier Science B.V. All right
s reserved.