A study of urinary immunoglobulins excretion after forced lordosis MASAKO MIHATA Department of Pediatrics, Hyogo College of Medicine, Hyogo, Japan (Di
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1 A study of urinary immunoglobulins excretion after forced lordosis MASAKO MIHATA Department of Pediatrics, Hyogo College of Medicine, Hyogo, Japan (Director : Prof. Hiroyoshi Wada) Key word : orthostatic proteinuria, lordosis, urinary immunoglobulins excretion, low/non selective proteinurria Changes in the urinary excretion of immunoglobulins (IgG and IgA) before and after forced lordosis were studied in 26 children with orthostatic proteinuria (group OA, where proteinuria disappeared within 120 min after lordosis was referred to as group OAA and where if disappeared after more than 120 min was group OAB) and 9 children with chronic glomerulonephritis in the clinically stable state (group GN). Urinary immunoglobulins were measured by ELISA (enzymelinked immunosorbent assay). In resting urine, the urinary excretion rates (total protein, IgG, and IgA) and the urinary protein ratio (IgG/protein, IgA/protein, and IgA/IgG) did not significantly differ between groups OA and GN. When forced lordosis was carried out, at maximum protein excretion, the urinary IgA/IgG ratio in groups OAA and OAB were significantly decreased (from % to % and from % to %, respectively). The ratio of IgA/IgG in groups OAA and OAB was significantly lowerr than that in group GN ( %, pc 0.01). The urinary IgA/IgG ratio after lordosis in group OA was similar to the serum IgA/IgG ratio. These findings suggest that transient low or non-selective proteinuria after lordosis is a characteristic of orthostatic proteinuria. Analysis of the urine after forced lordosis, especially using the urinary IgA/IgG ratio at maximum protein excretion, may be an useful examination for differentiating OA from other glomerulonephritides.
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3 Fig, 2a Standard curve and cross reaction of IgG. Fig, 2b Standard curce and cross reaction of IgA. Table 1 %CV of assay.
4 Fig. 3 Change of Protein, IgG, IgA excretion of lordosis. Protein : Total Protein excretion IgG : IgG excretion IgA : IgA excretion * P<0.05 Fig. 4 Changes of IgG/Protein, and IgA/Protein by lordosis.
5 Table 2 Comparison of IgA/IgG ratio between UM and serum. Fig. 5 Change of IgA/IgG by lordosis. Fig, 6 Comparison between group OAA1+OAB1 and group OAA2+OAB2.
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8 13) Frey FJ, Frey BM, Koegel R, Hodler J : Selctivity 1) Springberg PD, Garrett JrLE, Thompson JrAL, Collins NF, London RE, Robinson RR: Fixed and reproducible orthostatic proteinuria results of a 20-yesr follow-up study. Ann Intern Med 92: , ) Bern JS, McDonald B. Gaudo KM, Siegel Nj : Progression of orthostatic proteinuria to focal and segmentalglomeruloscle rosis. Clin Pediatr 25: , ) Robinson RR, Locoq FR, Phillip PJ, Glenn WG : Fixed and reproducible proteinuria. 3. Effect of induced renal hemodyamic alterations upon urinary protein excretion. J Clin Invest 42: , ) Watson A : Orthostatic albuminuria. A time saving method of diagnosis. Lancet 1: , 1951 as a clue to diagnosis of postual proteinuria. Lancet 1 : , ) David R : Statistical Quality Gontrol and Routine Data Processing for Radioimmunoassays and Immunoradiometric Assays. Clin Chem 20: , ) Smart IJ, Koh LY : Competitive inhivition Enzyme Immunoassays for the Measurement of human IgG, IgA and IgM. J Immunol Methods 60: , ) Thomas RT, Michael FL : Measurement of urinary immunoglobulins G, A and M by an enzyme linked immunosorbent assay (ELISA) Clin Chem Acta 139: , ) Galla JH, Spotswood MF, Harrison MF, Mestecky J : Urinary and Henoch Schoenlein Purpura. 5: , 1985 IgA in IgA nephropathy J Clin Immunol 19) Eden CS, Kulhavy R, Marild S, Prince SJ, Mestecky J : Urinary Immunoglobulins in Healthy Individuals and Children with Acute Pyelonephritis, Scand J Immunol 21: , ) Mckay E, Slater RJ : Studies on human pros teinuia. II. Some characteristics of the gamma globurins excreted in normal, exercise, postural, and nephrotic protinuia. J Clin Invest 41: , 1962
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