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An early diagnosis of kidney involvement in immunologically-mediated multisystem diseases
E Matteucci1, P Migliorini, C Bertoni
1Istituto di Clinica Medica 2a, Istituto di Patologia Speciale Medica, Scuola di Specializzazione in Patologia Clinica, Universita degli Studi di Pisa, Italy.
Abstract:
Kidney involvement in immuno-mediated diseases is a life threatening complication to be early detected. Glomerulo-tubular functional indices, kidney-released enzymes and metabolic profiles were assessed in 21 patients with systemic lupus erythematosus, progressive systemic sclerosis and mixed cryoglobulinaemia, without overt nephropathy at a current laboratory examination, and in 31 age-sex-matched healthy controls. All patients had a urinary total protein excretion rate higher than controls (353.6 +/- 182.4 vs 243.0 +/- 108.2 mg/24 h, p < 0.01); 12 of them resulted albuminuric (775.5 +/- 1192.4 mg/24 h), while 9 were normoalbuminuric (16.6 +/- 7.6 mg/24 h). Urinary enzyme excretion rates (GGT and NAG) were significantly heightened compared to healthy subjects, both in albuminuric and in normoalbuminuric patients. Serum albumin resulted significantly lower in all patients, independent of their urinary albumin leakage. Finally, all subjects with connective tissue diseases had significantly higher triglycerides, lower HDL cholesterol and double serum fasting insulin than normals. In conclusion, all patients with collagen diseases show signs of subclinical nephropathy, not always detectable by albuminuria. They also provide evidence of insulin-resistance, a conceivable forerunner of cardiovascular complications.
Insights
Patients with connective tissue diseases often have early kidney damage (subclinical nephropathy) not always detected by albuminuria. These patients also show signs of insulin resistance, a risk factor for cardiovascular disease.
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Kidney involvement in immuno-mediated diseases is a serious complication requiring early detection.
- Subclinical nephropathy can occur in patients with systemic lupus erythematosus, progressive systemic sclerosis, and mixed cryoglobulinaemia.
Purpose of the Study:
- To assess kidney function and metabolic profiles in patients with specific autoimmune diseases without overt nephropathy.
- To identify early markers of kidney damage and metabolic alterations in these patient populations.
Main Methods:
- Compared urinary total protein, albumin excretion rates, and urinary enzyme levels (GGT, NAG) between patients and healthy controls.
- Analyzed serum albumin, lipid profiles (triglycerides, HDL cholesterol), and fasting insulin levels.
- Included 21 patients with systemic lupus erythematosus, progressive systemic sclerosis, and mixed cryoglobulinaemia, and 31 healthy controls.
Main Results:
- All patients exhibited higher urinary total protein excretion than controls.
- Elevated urinary GGT and NAG levels were observed in both albuminuric and normoalbuminuric patients.
- Patients showed lower serum albumin, higher triglycerides, lower HDL cholesterol, and increased fasting insulin compared to controls.
Conclusions:
- Patients with collagen diseases often present with subclinical nephropathy, which may not be indicated by albuminuria alone.
- These patients also display evidence of insulin resistance, suggesting a potential predisposition to cardiovascular complications.