Renal excretion of proteins and enzymes in workers exposed to cadmium

The proteinuria rate and the relative clearances of beta 2-microglobulin, orosomucoid, albumin, transferrin and IgG were measured in forty-two workers exposed to cadmium and in seventy-seven control workers. A tubular type proteinuria with an increased excretion of beta 2-microglobulin and often also a glomerular type proteinuria with an increased excretion of orosomucoid, albumin, transferrin and IgG were observed mainly in workers exposed to cadmium for more than 25 years and whose cadmium concentration in blood exceeded 1 microgram Cd/100 ml and that in urine 10 microgram Cd/g creatinine. The glomerular dysfunction was also suggested by an increased plasma level of beta 2-microglobulin and creatinine. Both tubular and glomerular impairments occurred with the same prevalence and were not necessarily associated. The increased release of beta-galactosidase by the kidney suggested that cadmium can damage some epithelial cells.     

Diuresis-dependent excretions of low-molecular mass proteins in urine: beta 2-microglobulin, lysozyme, and ribonuclease

An investigation was carried out into how the low-molecular mass proteins beta 2-microglobulin, lysozyme, and ribonuclease were excreted over 8 h after high fluid intake (22 ml/kg of body weight in 15 min). With increasing urine flow rate the amount of lysozyme excreted per hour or per millimole creatinine increased more markedly than that of beta 2-microglobulin while at the same time the excretion rate of ribonuclease decreased. The effect of urinary flow upon the excretion rates of the various low-molecular mass proteins has to be considered as a preanalytical factor when these proteins are used as indicators of tubular dysfunction.     

Differentiation of glomerular, tubular, and normal proteinuria: determinations of urinary excretion of β2-microglobulin, albumin, and total protein

A low molecular weight beta(2)-globulin (beta(2)-microglobulin), albumin, and total protein were measured in concentrated 24-hr urine specimens from 20 healthy subjects and 30 patients with clinical proteinuria of glomerular or tubular type. Classification of proteinuria was made on the basis of clinical diagnosis and size distribution of urinary proteins after gel chromatography. The molecular radii (Stokes' radii) of beta(2)-microglobulin and albumin, estimated by gel chromatography, were 15 A and 35 A.The average 24-hr urinary excretion in healthy subjects was 0.12 mg for beta(2)-microglobulin, 10 mg for albumin, and 80 mg for total protein. The patients with renal glomerular disorders had normal or only somewhat increased excretion of beta(2)-microglobulin, despite considerably increased excretion of albumin and total protein. Most of the patients with tubular dysfunction excreted large amounts of beta(2)-microglobulin, although they excreted normal or only slightly increased amounts of albumin and only moderately increased quantities of total protein. Consequently, the ratio or urinary albumin/urinary beta(2)-microglobulin was high in glomerular proteinuria (1100: 14,200), intermediate in normal proteinuria (33: 163), and low in tubular proteinuria (1.0: 13.3). Determinations of urinary clearances of beta(2)-microglobulin and albumin in four healthy subjects and 11 patients indicated that increased excretions of the two proteins were associated with increased clearances. The results suggest that quantitative determinations of urinary beta(2)-microglobulin and urinary albumin may be useful for detecting disorders of the renal handling of plasma proteins. The findings also seem to suggest a selective tubular reabsorption of the two proteins.Estimates on sera revealed a close correlation between serum levels of beta(2)-microglobulin and creatinine and also a greatly raised serum concentration of beta(2)-microglobulin after bilateral nephrectomy.     

A sandwich enzyme immunoassay of human growth hormone in serum using anti-human growth hormone IgG-beta-D-galactosidase conjugate

The specificity, sensitivity and stability of beta 2-microglobulin (beta 2-m) and retinol-binding protein (RBP) in urine as indices of tubular proteinuria were compared. In vitro experiments show that RBP in urine is stable down to pH 4.5, whereas beta 2-m degrades below pH 5.5. This was confirmed by the relationships between pH and the concentration of both proteins in the urines from 150 healthy subjects. Urinary RBP was independent of pH (r = 0.125) but in contrast at pH below 6, beta 2-m concentration was inversely correlated with pH (r = 0.54, p less than 0.05). The comparison of urinary excretion of RBP and beta 2-m in 68 patients with renal diseases shows that in absence of a pH effect, the sensitivity and specificity of both proteins as indices of tubular proteinuria are rather similar. Therefore, in view of its greater stability in urine, RBP appears to be a more practical and reliable index of proximal tubular function than beta 2-m.     

A radioimmunoassay for retinol-binding protein in serum and urine

In this radioimmunoassay for human retinol-binding protein (RBP), sample (serum, diluted as much as 3600-fold; or urine, diluted or undiluted) or calibrant (purified RBP in phosphate buffer containing bovine serum albumin) is incubated with 125I-labeled RBP and rabbit anti-human RBP antiserum for 24 h before separation with second antibody/polyethylene glycol. The assay's sensitivity is 5 micrograms/L, its useful working range 10 to 200 micrograms/L. The between-batch CV is 12.5% at 12 micrograms/L, 7% at 120 micrograms/L. Results correlate well (r = 0.99) with those by radial immunodiffusion. The reference interval for RBP in serum of men is 39-75 mg/L (mean 57), significantly (p less than 0.01) broader than for women (29-66 mg/L; mean 48). The 2.5-97.5 centile interval for RBP in urine is from less than 0.5 to 12.2 micrograms per millimole of creatinine (median 5.8). RBP in urine is unstable below pH 5.0 at 37 degrees C.     

Renal glomerular and tubular impairment during strenuous exercise in young women

Creatinine, total protein, albumin and beta2-microglobulin were measured in the urine of fifteen healthy women before and after strenuous short-term exercise. The heavy intermittent load produced an increased urinary excretion of total protein, albumin and beta2-microglobulin, while creatinine was unaffected. The renal clearance of albumin and beta2-microglobulin showed very high values after stopping the exercise. However, 45 min after the end of exercise, total protein returned to initial values while albumin and beta2-microglobulin remained high. The urinary ratio between beta2-microglobulin and albumin is higher in urine collected after exercise than in normal proteinuria. This implies that post-exercise proteinuria is of glomerular and tubular origin.     

Effect of renal insufficiency on the concentration of free retinol-binding protein in urine and serum

The concentration of retinol-binding protein (RBP) in urine was determined in 20 healthy individuals and 119 patients with various renal diseases involving tubular or glomerular dysfunction. The sera from 4 healthy individuals and 33 patients were chromatographed on Sephadex G-75 to measure the concentration of free (i.e. not prealbumin-bound) RBP. In healthy individuals, the mean concentration of free RBP in serum was 5.8 mg/l and represented 14% of total RBP; the renal clearance and the fractional tubular uptake of free RBP averaged 0.032 ml/min and 99.97%, respectively. In patients, the concentration of free RBP and the percentage of free RBP in serum were on logarithmic scales inversely correlated with the endogenous creatinine clearance (r = -0.80 and -0.76) and increased in parallel with the serum creatinine (r = 0.67 and 0.66) and beta 2-microglobulin concentrations (beta 2-m, r = 0.76 and 0.89). The semi-logarithmic plot of urine versus serum concentration of free RBP suggests a renal threshold for the tubular reabsorption of this protein at a concentration of about 25 mg/l in serum. The existence of this threshold is confirmed by the relationship between urinary RBP and serum beta 2-m showing that urinary excretion of RBP is invariably high when the serum level of beta 2-m exceeds 5 mg/l. The latter value corresponds precisely to the renal threshold for the tubular reabsorption of beta 2-m. The corresponding value for free RBP derived from the relationship between both proteins is 24 mg/l.(ABSTRACT TRUNCATED AT 250 WORDS)     

Urinary excretion of albumin and beta 2-microglobulin in a population from an area where Balkan nephropathy is endemic.

The urinary excretion of albumin and beta 2-microglobulin in a population of 294 persons, living in an area where Balkan nephropathy is endemic, has been studied. In fifty-six (about 19%) of the subjects the beta 2-microglobulin concentration was above the +2 SD level for a reference group of healthy individuals from non-endemic areas. Albumin elevation was found in forty-four (about 15%) of the cases. In twenty-one of the subjects the urinary concentration of both beta 2-microglobulin and albumin were increased, in sixteen of these cases the relationship between the two proteins was consistent with tubular proteinuria. An increased beta 2-microglobulin excretion is considered to be a sign of Balkan nephropathy. Radioimmunoassay of the protein is sensitive enough to detect tubular proteinuria at an early stage and is suggested as a suitable screening test for the disease.     

Epidemiology of renal tubular dysfunction in the inhabitants of a cadmium-polluted area in the Jinzu River basin in Toyama Prefecture

Urinary beta 2-microglobulin (beta 2-m), alpha 1-microglobulin (alpha 1-m), amino-nitrogen, glucose, calcium, phosphorus, cadmium concentrations, and pH values were analyzed in urine samples from 187 females aged 55-66 years in the Jinzu River basin, which is known to be a cadmium-polluted area, and from 32 controls living in two adjacent reference areas in 1983-1984. Mean urinary beta 2-m, alpha 1-m, amino-nitrogen, glucose, cadmium concentrations and pH values in the inhabitants of the Jinzu River basin were significantly higher than those in the adjacent reference areas. Sixty-four inhabitants in a cadmium-polluted area were found to have renal tubular dysfunction with urinary beta 2-m level exceeding 1 mg/g creatinine and urinary glucose level exceeding 100 mg/g creatinine. The severity of renal tubular dysfunction in several inhabitants were comparable to those of the patients with Itai-itai disease. Mean cadmium concentrations in rice (mean: 0.32-0.57 ppm) which has been daily consumed by the inhabitants of the Jinzu River basin were significantly higher than those in the reference areas (mean: 0.12-0.13 ppm). The close relationship between cadmium exposure and the degree of renal tubular dysfunction was well demonstrated by principal component analysis.     

Comparison of tubular proteinuria, using sodium dodecyl sulphate polyacrylamide gel electrophoresis, in patients during methotrexate or aminoglycoside treatment or with cadmium or Balkan nephropathy

The pattern of proteinuria found in patients during the administration of methotrexate (MTX) or aminoglycosides (AG) and in cadmium or Balkan nephropathy was investigated using the technique of sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). As renal tubular dysfunction increased, measured by the urinary concentration of 4 low molecular mass (LM_r) proteins, SDS-PAGE bands appeared in the following order of molecular mass (M_r): 59, 44, 31, then below 31 000. The presence of bands < 31 000 was not an early indicator of drug-induced renal damage. Tubular proteinuria could be monitored more easily by the serum and urinary measurement of any one of the LM_r proteins: -1-microglobulin (1m), retinol-binding protein (RBP), β-2-microglobulin (β2m), except -1-acid glycoprotein (AGP), than by SDS-PAGE.     

The relationship between the renal clearance of creatinine and the apparent renal clearance of beta-2-microglobulin in patients with normal and impaired kidney function

The renal clearances of creatinine and beta 2-microglobulin of patients with either normal or impaired kidney function were measured. The renal clearance of beta 2-microglobulin depends on the urinary pH and must be considered as an apparent renal clearance because after tubular reabsorption the compound is metabolized in the kidney. Impaired kidney function reduces the percentage of tubular reabsorption of beta 2-microglobulin.     

Measurement of beta 2-microglobulin, retinol-binding protein, alpha 1-microglobulin and urine protein 1 in healthy children using enzyme-linked immunosorbent assay.

Enzyme-linked immunosorbent assays (ELISA) have been developed for the measurement of beta 2-microglobulin (B2M), retinol-binding protein (RBP), alpha 1-microglobulin (A1M) and urine protein 1 (UP1) in children. Results from random urine samples in 43 children (31 for B2M) are, when corrected for urine creatinine (geometric mean (range)): B2M 9.8 (6.0-40.7) micrograms/mmol, RBP 8.1 (less than 1-24.5) micrograms/mmol, A1M 0.4 (0.1-2.2) mg/mmol and UP1 17.8 (less than 2-309.4) micrograms/mmol. Fractional excretions (FE) in 23 children (14 for B2M) are (geometric mean (range)): FEB2M 0.04% (0.02-0.10%) and FEUP1 0.10% (0.01-1.21%). Results in overnight urine collections are also presented. Our results extend existing data for normal ranges in adults to include children and provide data on UP1 concentrations.     

Plasma metallothionein antibody, urinary cadmium, and renal dysfunction in a Chinese type 2 diabetic population

OBJECTIVE: It has been reported that diabetes may increase the risk of cadmium-induced kidney damage. The presence of metallothionein antibody (MT-Ab) increased the susceptibility for tubular damage among cadmium workers. This study focused on the relationships between levels of MT-Ab, urinary cadmium, and kidney function in a Chinese type 2 diabetic population. RESEARCH DESIGN AND METHODS: A cross-sectional study was performed on 229 type 2 diabetic patients (92 men and 137 women) who were recruited from two community centers in one district of Shanghai City in China. Information was obtained from interviews, health records, and blood and urine samples. RESULTS: Levels of the tubular biomarker beta2-microglobulin increased significantly when the levels of MT-Ab and urinary cadmium were elevated in male and female subjects; in contrast, the levels of urinary albumin, a glomerular biomarker, did not display such a pattern. After adjusting for potential confounding covariates, logistic regression showed that the odds ratios (ORs) of tubular dysfunction increased upon 1) increasing the MT-Ab concentration from a low to high level (OR 5.56 [95% CI 2.25-13.73]) and 2) increasing the level of urinary cadmium from <1 to >or=1 microg/g creatinine (3.34 [1.17-9.53]); the OR of patients currently smoking was 3.51 (1.14-10.80) relative to that of those who had never smoked. CONCLUSIONS: This study proves that the presence of MT-Ab can potentiate tubular dysfunction among diabetic subjects and that patients with high MT-Ab levels are more prone to development of tubular damage.     

Relationship between the urinary excretion of albumin and retinol-binding protein in insulin-dependent diabetics

The glomerular and proximal tubular function of the diabetic kidney was investigated. The urinary excretion (relative clearance) of albumin, a marker of glomerular function, and retinol binding protein (RBP), a low molecular weight (LMW) protein and marker of proximal tubular function, was determined in insulin-dependent diabetics. No correlation between the relative clearances of albumin and RBP was observed. LMW proteinuria without microalbuminuria was observed in 27 patients which suggests that tubular dysfunction may be an early stage in the development of diabetic nephropathy. Microalbuminuria was found in 16 patients while a mixed type of proteinuria (microalbuminuria and LMW proteinuria) was present in 56 patients several of whom had advanced nephropathy with elevated serum levels of RBP and creatinine. It is suggested that a combination of tubular and glomerular malfunction may be responsible for some cases of mixed proteinuria.     

Determination of urinary lysozyme for potential detection of tubular dysfunction in diabetic nephropathy

Seeking to study whether measurement of lysozyme (EC 3.2.1.17) in urine by a reliable radioimmunoassay can provide a suitable index of renal tubular function and how lysozymuria develops in temporal relation to proteinuria in diabetic nephropathy, we have compared the urinary excretion of lysozyme and beta 2-microglobulin with the 15-min excretion rate of phenolsulfonphthalein in 39 patients with Type 2 (non-insulin-dependent) diabetes and investigated the temporal relation between the onset of lysozymuria and proteinuria in 15 patients with Type 1 (insulin-dependent) diabetes. The concentrations of lysozyme and beta 2-microglobulin in urine increased in proportion to the decrease in the rate of excretion of phenolsulfonphthalein in these patients. The coefficient of correlation between lysozyme concentration and the 15-min excretion rate of phenolsulfonphthalein (r = -0.70) was higher than that between beta 2-microglobulin concentration and the 15-min excretion rate of phenolsulfonphthalein (r = -0.46). Abnormally high lysozymuria, suggesting the existence of tubular dysfunction, was demonstrated in six of the patients with Type 1 diabetes who showed no proteinuria or only a slight increase in urinary protein excretion. Lysozymuria may thus be added to a list of the indicators for diabetic nephropathy.     

Urinary excretion of albumin in normal man: the effect of water loading

The urinary excretion of albumin and beta 2-microglobulin in response to two different types of oral water load was studied in 18 healthy subjects. Both acute water loading (1 litre of tap water given over 10 min) and chronic water loading (250 ml of water given every 20 min for the 4-h duration of the test) produced a short-lived but significant increase in the urinary excretion of albumin, but not in beta 2-microglobulin. Albumin excretion returned promptly to basal values in spite of high and sustained urine flow. The decrease in haematocrit, plasma osmolality, plasma sodium concentration and pulse rate and the increase in creatinine clearance suggest that the elevation in albumin excretion might be the result of a transient volume expansion associated with an increase in glomerular filtration rate and in filtration of albumin. However, a washout of proteins from the tubular lumen with preferential reabsorption of small molecular weight proteins (i.e. beta 2-microglobulin) during high tubular flow cannot be excluded. Studies investigating changes in urinary albumin excretion should be performed after baseline conditions of stable urinary excretion of albumin have been established.     

Liquid-chromatographic determination of dolichols in urine

A reversed-phase "high-performance" liquid chromatographic assay for dolichols-18, -19 and -20 in urine is described. Dolichols are extracted from urine by using C18 cartridges and are chromatographed with a mobile phase consisting of 2-propanol/methanol, the effluent being monitored at 210 nm. The useful lower limit of sensitivity for quantification is 4 pmol (5 ng) of each dolichol per 5-microL injection, corresponding to 1.6 nmol (2 ng) per liter of urine. Heneicosaprenol is satisfactory as the internal standard. Peak heights and the amounts of dolichols applied to the column are linearly related from 4 to 110 pmol. Mean analytical recovery was 71%. For three different concentrations the mean within-assay CV was 6.4%, the between-assay CV 11%. The normal reference interval of total dolichols found for healthy adults was 17-101 micrograms/24 h (n = 30) or 1.9-11 micrograms per millimole of creatinine (n = 39). I determined the distribution of the main dolichols in urine and applied the assay also for samples from alcoholics.     

Excretion of beta 2-glycoprotein I (apolipoprotein H) in renal tubular disease.

beta 2-Glycoprotein I (beta 2GI) was identified as a major urinary protein excreted by patients with several renal tubular diseases, including adult Fanconi syndrome, nephrocalcinosis associated with autoimmune diseases, Lowe's syndrome, and Dent's disease (a familial renal tubular disease). Sixteen patients excreted between 2 and 40 mg of beta 2GI per millimole of creatinine. In contrast, 18 healthy controls had undetectable amounts of beta 2GI in urine. Isoelectric focusing followed by immunoblotting demonstrated multiple forms of beta 2GI with pls between 6.4 and 8.2. These pls are higher than for several other "tubular proteins"; beta 2GI may therefore be less retarded than more-anionic proteins by the glomerular charge-barrier. This could explain why large quantities of beta 2GI are excreted despite its relatively high molecular mass (50 kDa). Excretion of beta 2GI was easily demonstrated by routine electrophoresis of urine proteins. beta 2GI migrates in the beta-gamma region and may be confused with Bence Jones protein. beta 2GI is stable for at least two years in urine frozen at -25 degrees C.     

Association between cadmium-induced renal dysfunction and mortality: further evidence.

Our previous follow-up study, carried out from 1979 to 1989, on 256 residents of Sasu, a cadmium (Cd)-polluted area located on Tsushima Island, Nagasaki Prefecture, Japan, showed a significant relationship between urinary beta 2-microglobulin (beta 2-m) excretion and mortality in men. To investigate the association between Cd-induced renal dysfunction and mortality more precisely, 275 residents in the same area aged 40-92 years, who had participated in a health survey conducted in May 1982, were followed to February 1989. The expected number of deaths was calculated on the basis of the sex- and 5-year-age-specific mortality rates for Tsushima Island in 1985. In both men and women with urinary beta 2-m concentrations greater than 1,000 micrograms/g creatinine, observed deaths were greater than the expected. However, the P value of the difference was less than 0.05 only in women. Analysis by the Cox proportional hazards model showed that, in both men and women, serum beta 2-m and creatinine, as well as urinary total protein and beta 2-m were significantly or marginally significantly related to mortality independent of age. In men, serum beta 2-m was more strongly related to mortality than urinary beta 2-m. The results provide further evidence for the causal association between Cd-induced renal dysfunction and mortality. The present report also discusses the role played by decreased glomerular filtration rate in the excess mortality of subjects with Cd-induced renal dysfunction.     

The use and mechanism of urinary clearance of cathodic trypsin-like immunoreactivity to creatinine clearance ratio in the diagnosis of pancreatic cancer

The ratio between urinary clearance of cathodic trypsin-like immunoreactivity and creatinine clearance (CTr/CCr ratio) was evaluated as a test for pancreatic cancer in patients with chronic pancreatic diseases and gastrointestinal diseases clinically mistakable for pancreatic cancer. The efficiency of the CTr/CCr ratio in the diagnosis of pancreatic cancer was no better than the urinary clearances of albumin and beta2-microglobulin to creatinine clearance (CA1b/CCr ratio and C beta 2m/CCr ratio). An overall positive association was found between the three ratios. Furthermore, there was a positive relationship between proteinuria and elevation of any of the ratios--as well as between proteinuria and the degree of cancer dissemination. The latter was positively associated with elevation of any of the three ratios. The results point to a changed renal handling of proteins due to cancer disease per se as the mechanism causing elevated CTr/CCr ratios in pancreatic cancer.