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New selectivity index calculated using protein fraction as a substitute for the conventional selectivity index

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Abstract

Background

Selectivity index (SI) of proteinuria, calculated using the clearance ratio of immunoglobulin G to transferrin, predicts the response to glucocorticoids in patients with nephrotic syndrome. However, there is disagreement regarding the suitability of SI. Therefore, alternate indices should be considered. This study investigated whether or not selectivity index protein fraction (SIPF) was inferior to SI for the prediction of the response to glucocorticoids.

Methods

Forty-nine patients with nephrotic syndrome were evaluated. On the basis of molecular weight and protein fraction, as an inexpensive substitute for SI, the clearance ratio of the albumin to γ fractions measured in serum and urine protein fractions was defined as SIPF. The quality of SIPF was examined. Moreover, the best cutoff value of SIPF was determined; and SIPF distribution, according to histopathological diagnosis by renal biopsy, was examined.

Results

SIPF was strongly correlated with SI (r = 0.79, P < 0.001). The area under the receiver operating characteristic (ROC) curve of SIPF and SI was not significantly different (P = 0.18). The best cutoff value of SIPF was 0.45. In the group with SIPF > 0.45, only two patients with minimal change disease (MCD) achieved complete remission. In the group with SIPF ≤ 0.45, all patients with MCD achieved complete remission, although eight patients with other histopathological diagnoses did not achieve complete remission.

Conclusions

Analysis of protein fractions as a substitute for SI may be useful for predicting response to glucocorticoids in patients with nephrotic syndrome.

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Author notes

  1. Jun Nakamura

    Present address: Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Authors and Affiliations

  1. Department of Nephrology, Osaka Rosai Hospital, Nagasone-cho, Kita-ku, Sakai, 1179-3, Osaka, Japan

    Jun Nakamura, Katsuyuki Nagatoya, Aki Warada, Atsuyuki Tokuyama, Satoshi Masuyama, Sachio Kajimoto, Ryota Haga & Atsushi Yamauchi

  2. Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Sachio Kajimoto

  3. Department of Nephrology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan

    Naohiko Fujii

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  1. Jun Nakamura
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  2. Katsuyuki Nagatoya
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Corresponding author

Correspondence to Katsuyuki Nagatoya.

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All the authors have declared no competing interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee at which the studies were conducted (IRB Approval Number 30-15) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Nakamura, J., Nagatoya, K., Fujii, N. et al. New selectivity index calculated using protein fraction as a substitute for the conventional selectivity index. Clin Exp Nephrol 23, 1196–1201 (2019). https://doi.org/10.1007/s10157-019-01753-2

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  • DOI: https://doi.org/10.1007/s10157-019-01753-2

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