Abstract：Objective To investigate the risk factors for primary nephrotic syndrome(PNS) complicated by acute kidney injury(AKI),and to explore the predictive value of urinary N-acetyl-β-(D)-glucosaminidase(NAG) in patients with AKI and PNS.Methods Seventy-eight PNS patients with AKI(AKI group,n=21) or without AKI(non-AKI group,n=57) were enrolled in this study.The age,gender,infection and applications of angiotensin-converting-enzyme inhibitors(ACEI)/angiotensin receptor antagonists(ARB) and non-steroid anti-inflammatory drugs(NSAIDS) were recorded in both groups.In addition,blood urea nitrogen(BUN),blood uric acid(BUA),serum creatinine(SCr),peripheral white blood cell(WBC) count,hemoglobin(Hb),serum albumin(Alb),serum total cholesterol(TC),serum triacylglycerol(TG),serum C-reactive protein(CRP),plasmic fibrinogen(Fbg),urinary N-acetyl-β-(D)-glucosaminidase(NAG),urinaryβ2-microglobulin(β2-MG) and 24-hour urine protein excretion were determined.Results Among the 78 patients,PNS was complicated by in 21(26.9%).Furthermore,the incidence of AKI in male PNS patients was significantly higher than that in female PNS patients(P<0.05).Compared with non-AKI group,AKI significantly increased the levels of BUN,BUA,plasma Fbg,urinary NAG,urinaryβ2-MG and 24-hour urine protein excretion,but obviously decreased the levels of serum Alb(P<0.05 or P<0.01).from univariate logistic regression models showed that male and high levels of blood BUA,plasma Fbg,urinary NAG and 24-hour urine protein excretion were the risk factors for PNS complicated by AKI.from multiple logistic regression models showed that urinary NAG increase was the independent predictor of PNS complicated by AKI [OR 1.059,OR(95%CI)1.005~1.115、P<0.01].The area under the receiver operating characteristic curve(AUCROC) for urinary NAG was 0.903(95% CI 0.826~0.936),with a positive value of >83 U·L-1,a diagnostic sensitivity of 0.789 and a diagnostic specificity of 0.979 for PNS complicated by AKI.Conclusion Urinary NAG is a sensitive and specific biomarker for early detection of AKI in INS patients.
2012, Vol. 52 
