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Ezuruike U, Blenkinsop A, Pansari A, Abduljalil K. Quantification of Fetal Renal Function Using Fetal Urine Production Rate and Its Reflection on the Amniotic and Fetal Creatinine Levels During Pregnancy. Front Pediatr 2022; 10:841495. [PMID: 35311050 PMCID: PMC8927781 DOI: 10.3389/fped.2022.841495] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Adequate prediction of fetal exposure of drugs excreted by the kidney requires the incorporation of time-varying renal function parameters into a pharmacokinetic model. Published data on measurements of fetal urinary production rate (FUPR) and creatinine at various gestational ages were collected and integrated for prediction of the fetal glomerular filtration rate (GFR). The predicted GFR values were then compared to neonatal values recorded at birth. Collected data for FUPR across different gestational ages using both 3D (N = 517) and 2D (N = 845) ultrasound methods showed that 2D techniques yield significantly lower estimates of FUPR than 3D (p < 0.0001). A power law function was shown to best capture the change in FUPR with fetal age (FA) for both 2D ( F U P R 2 D ( m L min ) = 0 . 000169 FA 2 . 19 ); and 3D ( F U P R 3 D ( m L min ) = 3 . 21 × 1 0 - 7 FA 4 . 21 ) data. The predicted FUPR based on the observed 3D data was shown to be strongly linearly related (R 2 = 0.95) to measured values of amniotic creatinine concentration (N = 664). The FUPR3D data together with creatinine levels in the fetal urine and serum resulted in median predicted fetal GFR values of 0.47, 1.2, 2.5, and 4.9 ml/min at 23, 28, 33, and 38 weeks of fetal age (50% CV), respectively. These values are in good agreement with neonatal values observed immediately at birth. The derived FUPR and creatinine functions can be utilized to assess fetal renal maturation and predict fetal renal clearance.
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Affiliation(s)
| | | | - Amita Pansari
- Certara UK Limited (Simcyp Division), Sheffield, United Kingdom
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Renal injury in neonates: use of "omics" for developing precision medicine in neonatology. Pediatr Res 2017; 81:271-276. [PMID: 27723726 DOI: 10.1038/pr.2016.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/05/2016] [Indexed: 12/18/2022]
Abstract
Preterm birth is associated with increased risks of morbidity and mortality along with increased healthcare costs. Advances in medicine have enhanced survival for preterm infants but the overall incidence of major morbidities has changed very little. Abnormal renal development is an important consequence of premature birth. Acute kidney injury (AKI) in the neonatal period is multifactorial and may increase lifetime risk of chronic kidney disease.Traditional biomarkers in newborns suffer from considerable confounders, limiting their use for early identification of AKI. There is a need to develop novel biomarkers that can identify, in real time, the evolution of renal dysfunction in an early diagnostic, monitoring and prognostic fashion. Use of "omics", particularly metabolomics, may provide valuable information regarding functional pathways underlying AKI and prediction of clinical outcomes.The emerging knowledge generated by the application of "omics" (genomics, proteomics, metabolomics) in neonatology provides new insights that can help to identify markers of early diagnosis, disease progression, and identify new therapeutic targets. Additionally, omics will have major implications in the field of personalized healthcare in the future. Here, we will review the current knowledge of different omics technologies in neonatal-perinatal medicine including biomarker discovery, defining as yet unrecognized biologic therapeutic targets, and linking of omics to relevant standard indices and long-term outcomes.
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Bagci S, Altuntas Ö, Katzer D, Berg C, Willruth A, Reutter H, Bartmann P, Müller A, Zur B. Evaluation of two commercially available ELISA kits for the determination of melatonin concentrations in amniotic fluid throughout pregnancy. Ann Clin Biochem 2016; 54:107-112. [DOI: 10.1177/0004563216645123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of the present study is to evaluate the utility of extraction versus non-extraction-based commercial melatonin ELISA kits for determining the melatonin concentration in amniotic fluid obtained in early and late pregnancy. Methods Pregnancy duration less than 28 weeks was defined as early and from 28 weeks until delivery as late gestation. Nine samples were obtained in early and 18 in late pregnancy. Two commercially available melatonin ELISA kits (melatonin ELISA RE54021, including methanol-based extraction and direct saliva melatonin ELISA RE 54041, not including an extraction step, both from IBL-International, Germany) were used to determine melatonin concentrations in amniotic fluid. Results The mean melatonin concentration in ELISAs assayed by the non-extraction was significantly lower than those assayed after extraction. Subgroup analysis showed that there was no significant difference between melatonin concentration measured by non-extraction versus extraction ELISA in early pregnancy (11.2 ± 7.4 vs. 12.2 ± 7.7, respectively, P = 0.463) but that the mean melatonin concentration in late pregnancy was significantly lower when assayed by non-extraction ELISA than when assayed by extraction ELISA (14.8 ± 9.3 vs. 145.1 ± 179.3, respectively; P < 0.001). Agreement between both measurements in late pregnancy was rather poor (r2 = 0.271, P = 0.022), as opposed to the good correlation found in early pregnancy (r2 = 0.929, P < 0.001). Conclusions The present study revealed that a melatonin assay without an extraction step, such as direct saliva ELISA, does not seem to be a valid method to determine the melatonin concentration of amniotic fluid, especially in late gestation.
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Affiliation(s)
- Soyhan Bagci
- Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Özlem Altuntas
- Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
| | - David Katzer
- Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Arne Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Peter Bartmann
- Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Andreas Müller
- Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Berndt Zur
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
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Jacobo-Estrada T, Cardenas-Gonzalez M, Santoyo-Sánchez M, Parada-Cruz B, Uria-Galicia E, Arreola-Mendoza L, Barbier O. Evaluation of kidney injury biomarkers in rat amniotic fluid after gestational exposure to cadmium. J Appl Toxicol 2016; 36:1183-93. [PMID: 26815315 DOI: 10.1002/jat.3286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 12/24/2022]
Abstract
Cadmium is a well-characterized nephrotoxic agent that is also capable of accumulating and diffusing across the placenta; however, only a few studies have addressed its effects over fetal kidneys and none of them has used a panel of sensitive and specific biomarkers for the detection of kidney injury. The goal of this study was to determine cadmium renal effects in rat fetuses by the quantification of early kidney injury biomarkers. Pregnant Wistar rats were exposed by inhalation to an isotonic saline solution or to CdCl2 solution (DDel =1.48 mg Cd kg(-1) day(-1) ) during gestational days (GD) 8-20. On GD 21, dams were euthanized and samples obtained. Kidney injury biomarkers were quantified in amniotic fluid samples and fetal kidneys were microscopically evaluated to search for histological alterations. Our results showed that cadmium exposure significantly raised albumin, osteopontin, vascular endothelial growth factor and tissue inhibitor of metalloproteinases-1 levels in amniotic fluid, whereas it decreased creatinine. Clusterin, calbindin and IFN-inducible protein 10 did not show any change. Accordingly, histological findings showed tubular damage and precipitations in the renal pelvis. In conclusion, gestational exposure to cadmium induces structural alterations in fetal renal tissue that can be detected by some kidney injury biomarkers in amniotic fluid samples. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tania Jacobo-Estrada
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, CP 07360, México, D.F., México
| | - Mariana Cardenas-Gonzalez
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, CP 07360, México, D.F., México
| | - Mitzi Santoyo-Sánchez
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, CP 07360, México, D.F., México
| | - Benjamín Parada-Cruz
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, CP 07360, México, D.F., México
| | - Esther Uria-Galicia
- Departamento de Morfología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomas, CP 11340, México, D.F., México
| | - Laura Arreola-Mendoza
- Departamento de Biociencias e Ingeniería, Centro Interdisciplinario de Investigaciones y Estudios sobre Medio Ambiente y Desarrollo, Instituto Politécnico Nacional, 30 de Junio de 1520 s/n, Col. Barrio la Laguna Ticomán, CP 07340, México, D.F., México
| | - Olivier Barbier
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, CP 07360, México, D.F., México
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Gubhaju L, Sutherland MR, Black MJ. Preterm birth and the kidney: implications for long-term renal health. Reprod Sci 2011; 18:322-33. [PMID: 21427457 DOI: 10.1177/1933719111401659] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although the majority of preterm neonates now survive infancy, there is emerging epidemiological evidence to demonstrate that individuals born preterm exhibit an elevated risk for the development of hypertension and renal impairment later in life, thus supporting the developmental origins of health and disease hypothesis. The increased risk may potentially be attributed to a negative impact of preterm birth on nephron endowment. Indeed, at the time when most preterm neonates are delivered, nephrogenesis in the kidney is still ongoing with the majority of nephrons normally formed during the third trimester of pregnancy. A number of clinical studies have provided evidence of altered renal function during the neonatal period, but to date there have been limited studies describing the consequences of preterm birth on kidney structure. Importantly, studies in the preterm baboon have shown that nephrogenesis is clearly ongoing following preterm birth; however, the presence of abnormal glomeruli (up to 18% in some cases) is of concern. Similar glomerular abnormalities have been described in autopsied preterm infants. Prenatal and postnatal factors such as exposure to certain medications, hyperoxia and intrauterine and/or extrauterine growth restriction are likely to have a significant influence on nephrogenesis and final nephron endowment. Further studies are required to determine the factors contributing to renal maldevelopment and to identify potential interventional strategies to maximize nephron endowment at the start of life, thereby optimizing long-term renal health for preterm individuals.
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Affiliation(s)
- Lina Gubhaju
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
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Mussap M, Fanos V, Pizzini C, Marcolongo A, Chiaffoni G, Plebani M. Predictive value of amniotic fluid cystatin C levels for the early identification of fetuses with obstructive uropathies. BJOG 2002; 109:778-83. [PMID: 12135214 DOI: 10.1111/j.1471-0528.2002.01430.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of cystatin C with that of creatinine in discriminating renal function in fetuses without ultrasononographic evidence of renal malformations from those with obstructive uropathies. DESIGN Prospective, observational cohort study. SETTING Prenatal morphologic and functional evaluation of fetal obstructive uropathies throughout pregnancy. POPULATION A total of 96 healthy pregnant women at different stages of pregnancy, without any pregnancy-related maternal disease. Eighty-one pregnant women without clinical and ultrasonographic evidence of any fetal anomaly, confirmed at birth, were defined as controls; 15 pregnant women with various fetal obstructive uropathies, evidenced by repeated ultrasound examinations and confirmed at birth, were defined as cases. METHODS Creatinine was measured by a kinetic Jaffe picric acid method and cystatin C by a nephelometric immunoassay. Variables were analysed by applying conventional statistical tests; the non-parametric receiver operating curves (ROC) analysis was used to evaluate the diagnostic efficiencies of the biochemical markers. MAIN OUTCOME MEASURES Incidence of confirmed, diagnosed, neonatal obstructive uropathy by measuring baseline levels of cystatin C and creatinine in amniotic fluid. RESULTS Baseline levels of cystatin C in amniotic fluid were significantly higher (P = 0.0015) among cases than in controls with comparable gestational age; no significant difference was found for creatinine levels (P = n.s.). The maximum diagnostic accuracy of serum cystatin C in discriminating controls from fetal uropathies was 96%, while that of creatinine was 62%. CONCLUSION Cystatin C may be considered a sensitivebiochemical marker for the early identification of fetuses with obstructive uropathies.
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Affiliation(s)
- Michele Mussap
- Department of Laboratory Medicine, University-Hospital of Padova, Padua, Italy
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Nicolini U, Spelzini F. Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn 2001; 21:964-9. [PMID: 11746150 DOI: 10.1002/pd.212] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are a number of potential biochemical markers that may have some role in predicting renal function postnatally. These include urinary sodium, calcium and beta2-microglobulin. The latter may also be measured in fetal serum. However, the accuracy of these parameters at a point in time is far from perfect as urinary tract obstruction is a progressive disease which may be best defined by repeated observations throughout pregnancy.
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Affiliation(s)
- U Nicolini
- Department of Obstetrics and Gynaecology, Ospedale V. Buzzi, University of Milan, Via Castelvetro 32, 20147 Milan, Italy
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Hermans C, Libotte V, Robin M, Clippe A, Wattiez R, Falmagne P, Langhendries JP, Bernard A. Maternal tobacco smoking and lung epithelium-specific proteins in amniotic fluid. Pediatr Res 2001; 50:487-94. [PMID: 11568292 DOI: 10.1203/00006450-200110000-00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The bronchiolar 16 kD Clara cell secretory protein (CC16) and the alveolar surfactant-associated protein A (SP-A) are secreted in the amniotic fluid (AF), where they reflect the growth and the maturity of the fetal lung. To evaluate the possible effects of in utero tobacco smoke exposure upon infant bronchoalveolar epithelium function and maturity, CC16 and SP-A levels were determined in AF obtained at term (36-41 wk) from 28 nonsmoking, 18 smoke-exposed, and 28 smoking mothers with uncomplicated pregnancies. Tobacco smoke exposure was assessed by questionnaire and the assay in AF and maternal urine of cotinine, a stable nicotine metabolite. The specificity of the changes of CC16 and SP-A concentrations in AF was assessed by comparison with nonpulmonary proteins of high- (albumin and transferrin) or low-molecular weight (beta2-microglobulin, retinol binding protein, cystatin-C). Pulmonary and nonpulmonary AF proteins were also compared by two-dimensional gel electrophoresis between smoking and nonsmoking mothers. The levels of CC16 and SP-A as well as low- and high-molecular-weight proteins were not significantly different between the three smoking categories. The protein pattern of AF, established by two-dimensional gel electrophoresis, did not reveal any quantitative or qualitative difference between nonsmoking (n = 10), smoke-exposed (n = 5), and smoking mothers (n = 5). By multiple regression analysis of possible determinants, tobacco smoke did not emerge as a significant predictor of CC16 and SP-A concentrations in AF. SP-A level was dependent only on gestational age at birth (r2 = 0.1, p = 0.001), whereas CC16 correlated only with the levels of low-molecular weight proteins (r2 = 0.2, p = 0.0001). The latter correlation suggests that CC16 enters AF not only as a result of its secretion at the surface of the respiratory tract but also partly following its elimination by the fetal kidney. This study suggests that maternal smoking during pregnancy is not associated with alterations of the secretory functions of the epithelium of the distal airways and the alveoli at term.
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Affiliation(s)
- C Hermans
- Industrial Toxicology and Occupational Medicine Unit, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium.
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Cağdaş A, Aydinli K, Irez T, Temizyürek K, Apak MY. Evaluation of the fetal kidney maturation by assessment of amniotic fluid alpha-1 microglobulin levels. Eur J Obstet Gynecol Reprod Biol 2000; 90:55-61. [PMID: 10767511 DOI: 10.1016/s0301-2115(99)00203-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the fetal renal maturation by assessment of amniotic fluid microproteins and to show these proteins originate from fetal urine. STUDY DESIGN Amniotic fluid proteins (total protein, albumin, high molecular weight protein-HMWP, low molecular weight protein-LMWP, alpha(1)-microglobulin and beta(2)-microglobulin) were determined in 39 pregnant women at delivery and by amniocentesis in 30 pregnant women. These values were compared with first urine values of neonates with the same gestational age. RESULTS Albumin was the largest protein component in the amniotic fluid. LMWP showed an increase in the amniotic fluid until the end of the second trimester; and as pregnancy advanced a progressive decrease occurred in parallel to fetal renal maturation. After 26 weeks' gestation, a strong correlation was identified between LMWP levels and alpha(1)-microglobulin, and between LMWP and beta(2)-microglobulin. No significant difference was detected between LMWP levels in the first urine of the neonates and in amniotic fluids. CONCLUSION Microproteins in the fetal urine are of fetal origin. Fetal renal maturation can be evaluated by measuring microproteins in the amniotic fluid. Fetal renal maturation is best reflected by alpha(1)-microglobulin.
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Affiliation(s)
- A Cağdaş
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Amoresano A, Minchiotti L, Cosulich ME, Campagnoli M, Pucci P, Andolfo A, Gianazza E, Galliano M. Structural characterization of the oligosaccharide chains of human alpha1-microglobulin from urine and amniotic fluid. EUROPEAN JOURNAL OF BIOCHEMISTRY 2000; 267:2105-12. [PMID: 10727951 DOI: 10.1046/j.1432-1327.2000.01217.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Human alpha1-microglobulin (alpha1-m; also called protein HC), a glycoprotein belonging to the lipocalin superfamily, was isolated by sequential anion-exchange chromatography and gel filtration from the urine of hemodialized patients and from amniotic fluid collected in the week 16-18 of pregnancy. The carbohydrate chains of the protein purified from the two sources, which are organized in two Asn-linked and one Thr-linked oligosaccharides, were structurally characterized using matrix-assisted laser desorption ionization and electrospray mass spectrometry. The glycans attached to Thr5 are differently truncated NeuHexHexNAc sequences, and O-glycosylation in the amniotic fluid protein is only partial. Asn96 has both diantennary and triantennary structures attached in the case of urinary alpha1-m and only diantennary glycans in the amniotic fluid protein. The main carbohydrate units attached to Asn17 are in both proteins monosialylated and disialylated diantennary glycans. The position of the oligosaccharide chains in a three-dimensional model of the protein, produced using the automated Swiss-Model service, is also discussed.
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Affiliation(s)
- A Amoresano
- Centro Internazionale di Servizi di Spettrometria di Massa e Dipartimento di Chimica Organica e Biologica, Università di Napoli, Italy
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Cobet G, Gummelt T, Bollmann R, Tennstedt C, Brux B. Assessment of serum levels of alpha-1-microglobulin, beta-2-microglobulin, and retinol binding protein in the fetal blood. A method for prenatal evaluation of renal function. Prenat Diagn 1996; 16:299-305. [PMID: 8734802 DOI: 10.1002/(sici)1097-0223(199604)16:4<299::aid-pd844>3.0.co;2-n] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The concentrations of alpha-1-microglobulin, beta-2-microglobulin, and retinol binding protein were determined in fetal blood sampled by cordocentesis. The blood values of 126 fetuses without ultrasonographic findings of urinary tract abnormalities as controls were found to be independent of the week of gestation. In nine fetuses affected by a severe bilateral renal dysplasia or agenesis, elevated values of alpha-1-microglobulin but normal values of retinol binding protein were obtained. The authors recommend the determination of alpha-1-microglobulin and, with some restriction, also of beta-2-microglobulin in prenatal renal function diagnosis.
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Affiliation(s)
- G Cobet
- Institute of Medical Genetics, Medical School (Charite), Humboldt University, Berlin, Germany
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Mussap M, Fanos V, Piccoli A, Zaninotto M, Padovani EM, Plebani M. Low molecular mass proteins and urinary enzymes in amniotic fluid of healthy pregnant women at progressive stages of gestation. Clin Biochem 1996; 29:51-6. [PMID: 8929824 DOI: 10.1016/0009-9120(95)02006-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Amniotic fluid alpha1-microglobulin (alpha1-m) and beta2-microglobulin (beta2-m) levels, as well as N-acetyl-beta-D-glucosaminidase (NAG) and alanine aminopeptidase (AAP) activities, were measured in the course of uncomplicated pregnancies to assess their variations as gestation progresses. DESIGN AND METHODS Samples were obtained from 141 healthy pregnant women divided into three groups on the basis of gestational stage. Quantitative estimation of proteins was performed immunometrically and enzyme activities were determined spectrophotometrically. RESULTS It was found that, during pregnancy, alpha1-m and beta2-m concentrations as well as AAP activity significantly decrease, although their reduction patterns vary. Controversial results were found for NAG activity: the normalization of values for amniotic fluid creatinine significantly changed the reduction pattern of this enzyme. No statistically significant differences were found between male and female fetuses for amniotic fluid values of the biochemical substances studied. CONCLUSIONS The behavior observed for alpha1-m, beta2-m, and AAP might be linked to the progressive development and maturation of fetal renal tubular function. Amniotic fluid total NAG activity seems not to depend only on fetal urinary excretion.
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Affiliation(s)
- M Mussap
- Department of Laboratory Medicine, School of Medicine, University of Padova, Italy
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Crombach G, Hammerschmidt C, Schmitz-Röckerath B, Herrmann F, Siebolds M, Mies R, Bolte A. Relationship between amniotic fluid insulin and maternal blood glucose concentrations in patients with carbohydrate intolerance during pregnancy. J Perinat Med 1996; 24:77-84. [PMID: 8708935 DOI: 10.1515/jpme.1996.24.1.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In contrast to maternal blood glucose, amniotic fluid insulin (AFI) directly reflects the functional state of the fetal pancreas. In a prospective study we evaluated the correlation of AFI with maternal metabolic control in 70 amniotic fluid specimens from 61 women having carbohydrate intolerance during pregnancy (White A n = 44, B0 n = 17). AFI was measured with the Insulin RIA 100 kit from Pharmacia (Freiburg). The normal range of AFI was established in 304 healthy pregnant women (16th-42nd gestational week). AFI concentrations increased by a factor of 1.5 to 2 during gestation reflecting the maturation of the fetal pancreas. Elevated AFI levels (> 97th centile) were found in 11% of normoglycemic diabetics and in 50% of women with insufficient metabolic control. Despite a high overall concordance (81%) no direct relationship could be found between fetal and maternal parameters. Patients with increased AFI values had a 5-fold higher rate of large-for-gestational age (LGA) infants than women with normal levels. This finding confirms the pathogenetic role of hyperinsulinism in the development of fetal macrosomia.
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Affiliation(s)
- G Crombach
- Department of Obstetrics and Gynecology, University of Cologne, Fed. Rep. of Germany
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14
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Nolte S, Mueller B, Pringsheim W. Serum alpha 1-microglobulin and beta 2-microglobulin for the estimation of fetal glomerular renal function. Pediatr Nephrol 1991; 5:573-7. [PMID: 1716947 DOI: 10.1007/bf00856641] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
As proteins cannot cross the placenta levels of the microproteins alpha 1-microglobulin (alpha 1MG) and beta 2-microglobulin (beta 2 MG) can be used to assess fetal glomerular renal function. alpha 1MG, beta 2MG and creatinine were routinely determined in cord and maternal blood of 133 newborns [gestational age (GA) 25-42 weeks]. Twenty-nine patients with suspected impaired maternal or fetal renal function were studied separately and two fetuses were studied in utero. The mean fetal beta 2MG concentration fell from 3.87 +/- 0.56 mg/l in the 25-31 weeks GA group to 2.60 +/- 0.50 mg/l in the mature newborn group. alpha 1MG concentration fell from 3.10 +/- 0.51 to 2.25 +/- 0.49 mg/dl. In contrast, the mean maternal beta 1MG concentration rose from 1.73 +/- 0.69 mg/l in the 25-31 weeks GA group to a mean of 1.83 +/- 0.48 mg/l in the mature newborn group; alpha 1MG rose from 3.96 +/- 0.58 to 4.33 +/- 1.6 mg/dl. Maternal and fetal creatinine levels were identical. Fetal microprotein levels fall during intra-uterine development as glomerular filtration rate (GFR) rises. There is no correlation between cord blood and maternal alpha 1MG or beta 2MG concentrations. In 13 children with urological anomalies only 1 had elevated microprotein levels and he later developed renal insufficiency. Determination of microprotein levels in fetal serum can be used to detect severe renal function disturbances and to estimate GFR independently of maternal renal function.
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Affiliation(s)
- S Nolte
- Universitäts-Kinderklinik, Freiburg, Federal Republic of Germany
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