title: Nephelometry in the clinical assessment of glomerular proteinuria and tubular function in diabetic nephropathy.
abstract: Urinary excretion rate and total clearances of albumin, IgG, IgA and alpha 1-microglobulin, together with selectivity index and proteinuria, were determined by computerized nephelometry in 187 IDDM and NIDDM diabetic out-patients and in 39 healthy subjects in order to perform a prompt clinical assessment of diabetic nephropathy. Significant correlations between nephelometric and RIA procedures were demonstrated for the urinary excretion of albumin (p < 0.001) and total IgG (p < 0.001) in diabetic patients and healthy subjects. Nephelometry allowed us to classify diabetic patients in different stages of nephropathy: non nephropathic, normoalbuminuric with hyperfiltration, with incipient (microalbuminuric) and overt nephropathy (macroalbuminuric). Thirty consecutive subjects were analyzed within 1 h from the beginning of the procedure. A normal tubular function was demonstrated in non nephropathic, hyperfiltering and in 34% of microalbuminuric diabetic patients. On the contrary, in 66% of microalbuminuric and in 93% of macroalbuminuric patients alpha 1-microglobulin urinary levels were found above the upper normal limit. Urinary excretion of IgA was significantly increased only in macroalbuminuric diabetic patients (p < 0.001); this marker might therefore characterise the stage of overt nephropathy. Computerized nephelometry can be considered as a prompt, reproducible and high sensitive approach in the clinical evaluation of proteinuria and tubular function in diabetic renal disease.
authors.affiliation: Department of Internal Medicine, University of Pavia, Italy.
authors.forename: S B
authors.initials: SB
authors.lastname: Solerte
authors.forename: S
authors.initials: S
authors.lastname: Severgnini
authors.forename: M
authors.initials: M
authors.lastname: Locatelli
authors.forename: N
authors.initials: N
authors.lastname: Cerutti
authors.forename: M
authors.initials: M
authors.lastname: Rondanelli
authors.forename: M A
authors.initials: MA
authors.lastname: Netti
authors.forename: E
authors.initials: E
authors.lastname: Ferrari
authors.forename: M
authors.initials: M
authors.lastname: Fioravanti
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000652:urine; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry / Q000379:methods; D011507:Proteinuria / Q000175:diagnosis; D011863:Radioimmunoassay; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity