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Nephron 1990;55:45-48

002X - ’ 766/90/0551 -0045S2.75/0

Fibronectin in Patients with Chronic Renal Failure Undergoing Dialysis Fan-fan Houd, Xun Zhang', Ai-li Wangh, Jian-gou Wuh 'Nanfang Hospital. Guangzhou, and hJinling Hospital. Nanjing. China

Key Words. Fibronectin • Chronic renal failure - Dialysis • Malnutrition Abstract. Fibronectin (FN) levels were determined in 64 cases with chronic renal failure (CRF), some of whom were undergoing dialysis. FN levels were 14.9 ±7.6 mg/dl in CRF (n = 20), 13.4 ±4.3 mg/dl in patients on continuous ambulatory peritoneal dialysis (CAPO) (n = 20) and 16.7± 7.2 mg/dl in patients on hemodialysis (HD) (n = 24). All the levels were significantly lower than in normal subjects (23.1 ±4.6 mg/dl). Serum FN was compared with some nutritional indices. Positive correlations were found between serum FN and nitrogen balance (BN), serum prealbumin (PreA) and transferrin (TO in all the patients. With serum albumin (Alb), however, this correlation was only found in patients undergoing dialysis. Negative correlations were found between serum FN and the ratio of serum urea to serum creatinine (Surca/S cr) in CAPD and HD patients. In 10 CAPD patients, the low serum FN levels went up after increased protein intake. This indicates that it was the result of malnutrition due to decreased protein intake. Serum FN level reflects a negative BN earlier and better than serum PreA, Tf and Alb. It is a sensitive, reliable and simple index for judging the nutritional protein status and the effect of nutritional treatment in patients with CRF undergoing dialysis.

Material and Methods Material 94 cases with chronic kidney diseases were divided into five groups: (1) 20 cases with CRF (mean age 39 years; range 16-88 years); their mean serum creatinine (Scr) was 49l.6±302.6 umol/l); (2) 20 uremic patients on continuous ambulatory peritoneal dialysis (CAPD) (mean age 42 years: range 18-65 years): 18 of them were oliguric or anuric;

(3) 24 uremic patients on periodic hemodialysis (HD) with cuprophane membranes (mean age 39 years: range 25-61 years): 19 of them were oliguric or anuric: (4) 15 cases with pathologically proven chronic glomerulone­ phritis (mean age 35 years; range 20-62 years): 6 were classified as IgA nephropathy, 2 as lgM nephropathy, 7 as mesangial prolifera­ tive glomerulonephritis; all of them with normal creatinine clear­ ances (Ccr). and (5) 15 cases with nephrotic syndrome with normal Cc, (mean age 34 years: range 19 59 years); 5 had pathologically proven IgA neph­ ropathy, 3 membranous proliferative nephritis, 3 membrane nephropathy,2 lgM nephropathyand2minimal change nephropathy. No manifestations of liver diseases, infection or trauma were found in these patients in the period of observation. The normal value of serum FN was determined in 180 healthy volunteers in the same population. Method Fasting blood was sampled in all patients. Serum FN was deter­ mined by a radio-immuno diffusion technique. The normal value is 23.1 ±4.6 mg/dl (m ean±SD , n = 180). Albumin (Alb), prealbumin (PreA), transferrin (Tf). immunoglobulins and C3, C4 were also determined by the same method [I]: 24-hour urinary FN was deter­ mined at the same time in 49 nonanuric cases. Nitrogen balance (BN) was calculated according to the formulae of Maroni and Steinman [2] and Comty and Davis [3], The molar ratio of serum urea to serum creatinine (Su[e,,/Scf) was calculated both in the CAPD and HD groups.

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Fibronectin (FN) is a high-molecular-weight glyco­ protein in plasma and on the surface of various kinds of cells. It plays an important role in many physiological processes, such as coagulation, fibrinolysis and opsoni­ zation. Low plasma FN has been noted in patients with burns, septicemia and cirrhosis since recent years, but rather little or controversial information has been re­ ported about FN in renal diseases. For this reason we studied the plasma FN levels in 94 chronic kidney dis­ eases to evaluate the clinical significance of FN in chronic renal failure (CRF) and in patients undergoing dialysis.

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Hou/Zhang/Wang/Wu

Table I. Serum FN levels (m ean±SD) in various groups versus normal subjects Groups

n

FN. mg/dl

p vs. normal

CRF CAPD HD CGN NS Normal

20 20 24 15 15 180

14.9 ±7.6 13.4 ±4.3 16.7 ±7.2 17.1 ±4.3 11.7 ±2.7 23.1 ±4.6

Fibronectin in patients with chronic renal failure undergoing dialysis.

Fibronectin (FN) levels were determined in 64 cases with chronic renal failure (CRF), some of whom were undergoing dialysis. FN levels were 14.9 +/- 7...
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