A review on urinary proteins in outflow disease of the upper urinary tract

Introduction: No review articles on outflow disease of the upper urinary tr act discuss urinary protein excretion. Discussion: Following acute partial and/or complete ureteral obstruction (UO) or chronic partial UO, alpha-1-mi croglobulin excretion is significantly higher than in the reference populat ion ol patients with proven renal dilatation without obstruction, but is no t found to be diagnostic for these conditions as such. Chronic partial UO i s followed first by a destructive and then by a steady-state phase in renal damage. The observed increase in tubular proteinuria during the destructiv e phase correlates with the decrease in absolute dimercaptosuccinic acid (D MSA) uptake. If the destructive phase is not followed by a stable phase, a mixed tubular and glomerular proteinuria is seen. Urinary alpha-1-microglob ulin excretion is found to be diagnostically useful in vesico-ureteral refl ux (VUR) patients, increases with higher intravesical-intrapyelic pressure, correlates with the decrease in absolute DMSA uptake or with urinary epide rmal growth factor excretion (both markers of the number of functioning nep hrons) and predicts the outcome after treatment. Conclusion: alpha-1-Microg lobulin is useful in the detection of renal tubular damage in patients with outflow disease of the upper tract, is diagnostic for VUR but is not so fo r ureteral obstruction. (C) 2000 Elsevier Science B.V. All rights reserved.