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Nephrology Dialysis Transplantation, Vol 12, Issue 6 1161-1166, Copyright © 1997 by Oxford University Press

ORIGINAL ARTICLES

Decreased excretion of urine glycosaminoglycans as marker in renal amyloidosis

J Tencer, O Torffvit, A Grubb, S Bjornsson, H Thysell and B Rippe
Department of Nephrology, Division of Diabetology and Endocrinology, Department of Clinical Chemistry, Division of Clinical Chemistry, Lund University Hospital, S-221 85 Lund, Sweden; Vaxjo Central Hospital, S-351 85 Vaxjo, Sweden; Corresponding author

Background. The diagnosis of renal amyloidosis is normally established by kidney biopsy. In order to advance the determination of the diagnosis and the initiation of the therapy, fast and cheap, non-invasive diagnostic techniques are required. Methods. Urine excretion of glycosaminoglycans (GAG) was measured in 10 patients with AA amyloidosis and 5 patients with AL amyloidosis and compared to 25 controls with primary glomerular diseases and 22 healthy controls. The subjects with primary glomerular disease were matched with regard to their renal function and the degree of albuminuria. Results. The median urine GAG to creatinine ratio and the median fractional GAG excretion were significantly decreased (P<0.05) in both AA amyloidosis (0.21 mg/mmol and 0.053 respectively) and AL amyloidosis (0.33 mg/mmol and 0.077 respectively) compared to control patients with primary glomerular disease (1.73 mg/mmol and 0.336 respectively) and healthy controls (2.67 mg/mmol and 0.226 respectively). The urine GAG to creatinine ratio did not correlate to age, sex, serum creatinine, urine albumin, or to the plasma levels of acute phase proteins. Conclusions. The decreased GAG excretion in renal amyloidosis is probably caused both by diminished number of functioning nephrons, decreased GAG synthesis in functioning glomeruli, and the trapping of GAG by amyloid fibrils. Urinary GAG excretion may serve as an independent marker of renal amyloidosis. It may be used in diagnostic work-up of renal amyloidosis in patients with glomerular diseases and in screening of amyloidosis in patients with chronic inflammatory disorders, with or without signs of renal disease. Keywords: AA amyloidosis; AL amyloidosis, glomerular disease; glycosaminoglycans
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