Korean Journal of Nephrology 1998;17(6):872-878.

성인 미세변화신증후군 환자에서β2-Microglobulin 량에 의한 스테로이드 치료 반응의 예측 (Prediction of Steroid Responsiveness in Adult Minimal Change Nephrotic Syndrome Using Urinary β2-Microglobulin)

장광열, 우영석, 한경근, 배성진, 김성은, 김기현 (Kwang Yul Chang, Young Seok Woo, Kyung Geun Han, Sung Jin Bae, Seong Eun Kim and Ki Hyun Kim)

Abstract

Urinary protein per se causes renal tubular injury and stimulates immunologic reaction. The extent of proximal tubular injury can be estimated by measuring the amount of 24 hours urinary β2-microglobulin(U β2-MG). The aim of this study was whether U β2-MG level could predict the response to the initial steroid treatment for the patients with minimal change nephrotic syndrome(MCNS). We analyzed 58 adult patients(33 M, 25 F), aged 33±15 years(range 16-76), with biopsy-proven MCNS treated with 40 to 60mg of oral prednisolone daily up to 16 weeks. The responsiveness(44 cases) inculded complete and partial remission or steroid resistance(14 cases). No difference was found between the steroid responsive and resistant group with regard to age, BUN, serum creatinine, albumin, cholesterol, and urinary protein. The levels of U β2- MG(μg/g creatinine) were 250808±478917 and 1648±2386 in resistan ¡ªKwang-Yul Chang, et al.:Prediction of Steroid Responsiveness in Adult Minimal Change Nephrotic Syndrome Using Urinary β2-Microglobulint group and responsive group, respectively(P<0.05). The cut off value was 400μg/ g creatinine with 78% of sensitivity and 48% of specificity. The likelihood ratio for the resistance was 2.5 to 2.8 with the U β2-MG levels over 400 ug/g creatinine and was 0.2 to 0.3 below that value. Multivariate analysis confirmed that higher U β2- MG level was associated with a lower likelihood of steroid responsiveness, independent of age, sex, creatinine, serum protein, and urinary protein. This study showed that the pretreatment U β2- MG level may be used to identify subgroup of patients with MCNS who are more likely to be responsive to initial steroid treatment.