Clinical and experimental nephrology · 2026
Novel clinical application of urinary angiotensin-converting enzyme assay in renal sarcoidosis: a retrospective observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Chiba Yuki, Murakami Koji, Miyazaki Mariko, Makino Rui, Yoshida Mai, Nagasawa Tasuku, Sato Hiroshi, Tamada Tsutomu, Tanaka Tetsuhiro, Okamoto Koji
Аннотация
BACKGROUND: Renal involvement, occurring in approximately -1% to 5% of patients with sarcoidosis, is characterized mainly by granulomatous interstitial nephritis. Angiotensin-converting enzyme (ACE) reflects the presence of granuloma; accordingly, serum ACE (sACE) and tubular injury markers are measured in renal sarcoidosis (RS). However, these markers possess low diagnostic accuracy; therefore, we hypothesized that urinary ACE (uACE) could reflect granuloma in the kidneys and be a disease-specific marker for RS.
METHODS: In this single-center retrospective study, the sACE and uACE levels were measured and the creatinine-corrected ratio of uACE and sACE (u/s ACE ratio) was calculated. Additionally, patients with sarcoidosis without renal insufficiency (RI), sarcoidosis with RI, and tubulointerstitial nephritis (TIN) without a sarcoidosis etiology were included as controls.
RESULTS: This study included 18, 18, 14, and 10 patients in the RS, sarcoidosis without RI, sarcoidosis with RI, and TIN without sarcoidosis etiology groups, respectively. uACE and u/s ACE ratio in the RS group were higher than those in the control groups. In the RS group, u/s ACE ratio was positively correlated with the degree of tubulointerstitial injury (r = 0.69, P = 0.0045); the cutoff value of u/s ACE ratio for diffuse tubulointerstitial injury was 0.39%, with a sensitivity and specificity of 100.0% each. Furthermore, obvious positive correlations were observed among u/s ACE ratio, inflammatory cell infiltrates (r = 0.53, P = 0.044), and interstitial fibrosis (r = 0.56, P = 0.029) in the RS group.
CONCLUSION: u/s ACE ratio and sACE could be useful biomarkers for diagnosing RS in sarcoidosis and TIN, respectively. A simple uACE assay could help diagnose and assess disease severity in patients with RS.
METHODS: In this single-center retrospective study, the sACE and uACE levels were measured and the creatinine-corrected ratio of uACE and sACE (u/s ACE ratio) was calculated. Additionally, patients with sarcoidosis without renal insufficiency (RI), sarcoidosis with RI, and tubulointerstitial nephritis (TIN) without a sarcoidosis etiology were included as controls.
RESULTS: This study included 18, 18, 14, and 10 patients in the RS, sarcoidosis without RI, sarcoidosis with RI, and TIN without sarcoidosis etiology groups, respectively. uACE and u/s ACE ratio in the RS group were higher than those in the control groups. In the RS group, u/s ACE ratio was positively correlated with the degree of tubulointerstitial injury (r = 0.69, P = 0.0045); the cutoff value of u/s ACE ratio for diffuse tubulointerstitial injury was 0.39%, with a sensitivity and specificity of 100.0% each. Furthermore, obvious positive correlations were observed among u/s ACE ratio, inflammatory cell infiltrates (r = 0.53, P = 0.044), and interstitial fibrosis (r = 0.56, P = 0.029) in the RS group.
CONCLUSION: u/s ACE ratio and sACE could be useful biomarkers for diagnosing RS in sarcoidosis and TIN, respectively. A simple uACE assay could help diagnose and assess disease severity in patients with RS.