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Archives of Pediatric Infectious Diseases

The Official Journal of Pediatric Infections Research Center, SBMU

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https://doi.org/10.5812/pedinfect.4902

Urinary Beta 2-Microglobulin as a Prognostic marker in children with pyelonephritis Running title: Beta 2-Microglobulin a Prognostic marker

Author(s):
Mostafa SharifianMostafa Sharifian1,*, Abdollah KarimiAbdollah Karimi1, Masoumeh MohkamMasoumeh Mohkam1, Reza DaliraniReza Dalirani1, Sedigheh Rafiei TabatabaeiSedigheh Rafiei Tabatabaei1, Mahmood NourisafaMahmood Nourisafa1
1Pediatric Infections Research Center (PIRC), Shahid Beheshti University of Medical Sciences, [email protected], IR Iran
Archives of Pediatric Infectious Diseases:Vol. 1, issue 1; 18-22
Published online:Apr 02, 2013
Article type:Research Article
Received:Apr 01, 2012
Accepted:Jun 20, 2012
How to Cite:Sharifian M, Karimi A, Mohkam M, Dalirani R, Tabatabaei S, et al. Urinary Beta 2-Microglobulin as a Prognostic marker in children with pyelonephritis Running title: Beta 2-Microglobulin a Prognostic marker. Arch Pediatr Infect Dis. 2013;1(1):. doi: https://doi.org/10.5812/pedinfect.4902

Abstract

Background:

Urinary tract infection (UTI) is common in children. UTI with or without vesico-ureteral reflux (VUR) may result in renal scarring. Severe renal scarring impairs renal function and may result in hypertension, renal insufficiency, and end stage renal disease requiring dialyses or transplantation. Beta 2 micro-globulin (2MG) is a low molecular weight protein freely filtered by the glomeruli and then actively reabsorbed normally up to 99.9% in the proximal tubules; its urinary excretion is an indication of proximal tubular cell dysfunction.

Objectives:

The current study aimed to determine whether urinary 2MG excretion would be elevated in patients with various grades of renal scar, and also its relationship with renal outcome in long term follow-up.

Materials and Methods:

Urinary 2MG and Creatinine (Cr) were measured in 83 spot urine samples of patients that 53 of them did DMSA renal scan both at the time of admission to confirm pyelonephritis, and 6 month later to detect scars. 2MG was measured by radioimmunoassay method using 2MG 96-test kit (RADIM Company; Germany), and the creatinine was measurd by spectrophotometry and was recorded as microgram per mg creatinine. Twenty children had various grades of renal scars.Results were compared with the ratios of 19 children with low uptake scanning, 14 children with normal scanning after recovery from pyelonephritis, and 30 normal children served as controls. EXCEL and SPSS softwares were employed to compare the mean urinary 2MG in groups by student t-test, ANOVA, and Unpaired t-test at P,0.05 significance level. Subsequently patients were followed up for 6 years.\\r\\n

Results:

The mean urinary 2MG/Cr ratio was significantly higher in the scarring group (5.23 10.6) than in the normal group (0.19 0.2), and in low uptake group (0.49 0.86) (P < 0.05). When mean 2MG/Cr ratios were compared for each grade of scarring; patients with sever scar (grade III) had higher values (14.69 15.82) than grades I (0.36 0.35) and II (3.37 5.20) (P < 0.05). Patients without renal scar had a 2MG/Cr ratio below 0.46 microgram/mg Cr. The mean 2MG was also higher in the refluxing group (3.45 7.97) than nonrefluxing group (0.23 0.24) ug/mgCr (P = 0.01). Three patients who had the highest 2MG/Cr ratio values (33.3, 27, and 26.6 microgram/mg Cr) had sever scar that rapidly progressed to ESRD. They were transplanted 2 years later; after transplantation they still had recurrent UTIs. 2nd patient underwent native nephrectomy for renal abscess.\\r\\n

Conclusions:

Results of the current study revealed that mean 2MG/Cr ratio was higher in patients with renal scar and poor outcome. Measurement of Urinary 2MG may be useful in the early detection of tubular damage in refluxing patients and patients with renal scars and has prognostic significance.

Keywords
Beta 2-Microglobulin
Pyelonephritis
Prognosis
Child

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