[논문]요비중 또는 크레아티닌 보정에 따른 요중 카드뮴과 신장손상지표와의 관련성 비교

김용대; 엄상용; 임동혁; 권순길; 박충희; 김근배; 유승도; 최병선; 박정덕; 김헌

doi:10.5352/jls.2019.29.2.265

요비중 또는 크레아티닌 보정에 따른 요중 카드뮴과 신장손상지표와의 관련성 비교
Differences in Urine Cadmium Associations with Renal Damage Markers According to the Adjustment with Specific Gravity or Urinary Creatinine 원문보기

생명과학회지 = Journal of life science, v.29 no.2 = no.226, 2019년, pp.265 - 271

김용대 (충북대학교 예방의학교실) , 엄상용 (충북대학교 예방의학교실) , 임동혁 (충북대학교 예방의학교실) , 권순길 (충북대학교 내과학교실) , 박충희 (국립환경과학원 환경건강연구부 환경보건연구과) , 김근배 (국립환경과학원 환경건강연구부 환경보건연구과) , 유승도 (국립환경과학원 환경건강연구부 환경보건연구과) , 최병선 (중앙대학교 예방의학교실) , 박정덕 (중앙대학교 예방의학교실) , 김헌 (충북대학교 예방의학교실)

초록
AI-Helper

일반적으로 요중 카드뮴 농도는 요비중 또는 요중 크레아티닌 농도로 보정한 값을 사용해왔다. 그러나 어떤 보정방법이 더 타당한지에 대한 논란은 계속되고 있다. 본 연구에서는 비교적 큰 규모의 일반인구집단을 대상으로 요중 카드뮴농도와 각종 신장손상지표들과의 관련성을 평가함에 있어 요비중 보정 방법과 요중 크레아티닌 보정 방법 중 어느 방법이 더 타당한지 비교 평가하였다. 1,086명의 자원자 중 신장질환의 질병력이 있는 사람을 제외한 862명이 최종적으로 연구대상에 포함되었다. 대상자들로부터 측정한 요중 카드뮴 농도 및 malondialdehyde (MDA), N-acetyl-${\beta}$-D-glucosaminidase 농도, 혈중 크레아티닌을 이용하여 산출한 사구체여과율 등의 신장손상지표들간의 관련성을 평가하였다. 연구 결과, 요중 크레아티닌 농도보다는 요비중으로 보정한 카드뮴 농도가 각종 신장손상지표와 높은 상관성이 있음을 보여주었다. 특히, 요비중 보정 카드뮴 농도는 요중 MDA 농도와 양의 상관관계를, 사구체여과율과는 음의 상관관계를 보여주었다. 이러한 결과는 일반인구집단에서 카드뮴 노출이 많아질수록 사구체여과율이 감소함을 의미하며 이러한 기전에서 산화적스트레스가 관여하고 있음을 보여준다. 또한, 사구체여과율이 카드뮴 노출에 의한 유용한 신장손상지표 중 하나로 사용될 수 있음을 의미한다.

Abstract ▼ AI-Helper

In general, specific gravity (SG) and urinary creatinine (CR) have been used to adjust urinary cadmium (Cd) concentrations. However, the validity of correction methods has been controversial. We compared the two adjustments to evaluate associations between urinary Cd and various renal damage markers and to evaluate the relationship between urinary Cd concentration and renal disease markers, such as estimated glomerular filtration rate (eGFR), in a relatively large general population sample. Among the 1,086 volunteers who were enrolled in this study, 862 healthy volunteers who did not have kidney disease were included in the final analysis. Urinary Cd, malondialdehyde (MDA), and N-acetyl-${\beta}$-D-glucosaminidase (NAG) concentrations were measured, the creatinine-based eGFR was calculated, and the relationships between these markers were subsequently analyzed. This study showed the use of urinary Cd concentration adjusted with SG rather than with urinary creatinine may be appropriate in studies evaluating renal function based on Cd exposure. Urinary Cd concentration adjusted with SG had a positive correlation with urinary MDA levels and a negative correlation with eGFR. This relationship was relatively stronger in women than in men. This study showed that urinary Cd level was associated with decreased eGFR in the general population, and oxidative stress was likely to act as an intermediator in this process. These results suggest that eGFR can be a very good indicator of kidney damage caused by Cd exposure in the general population.

주제어

표/그림 (4)

표 Table 1. Characteristics of subjects and their biological parameters according to the gender and urinary cadmium level
표 Table 2. Pearson correlation coefficients between logarithmic urinary cadmium (Cd) level and urinary malondialdehyde (MDA), N-acetyl-β-D-glucosaminidase (NAG), and estimated glomerular filtration rate (eGFR)
그림 Fig. 1. Association between logarithmic urinary cadmium level and urinary malondialdehyde (MDA), N-acetyl-β-D-glucosaminidase (NAG), and estimated glomerular filtration rate (eGFR) according to the gender. A, C, E in men; B, D, F in women
표 Table 3. General linear model for changes in logarithmic eGFR

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

제안 방법

Specific gravity (SG) of urine is an alternative method even it is not widely used. In this study, we evaluated the association between urinary Cd exposure and several renal damage markers including eGFR in general population, and compared SG and CR correction method on their relationships.
The subjects were divided into two groups according to the median of urinary Cd concentration (<1.59 μ g/l, low group or >1.59 μ g/l, high group).

대상 데이터

Blood and urine samples were collected and stored at -80℃ until analysis. A total of 1,086 people (456 males and 630 females) were enrolled in the study. Among them, 224 persons with diabetes or other renal diseases were excluded and 862 persons (368 males, 494 females) were finally analyzed.
A total of 1,086 people (456 males and 630 females) were enrolled in the study. Among them, 224 persons with diabetes or other renal diseases were excluded and 862 persons (368 males, 494 females) were finally analyzed.
The subjects of this study were healthy people over 30 years old residing in Seocheon-gun, Chungcheongnam-do. Some of them lived near the Janghang smelter, which was established in 1936 in the town of Janghang and smelted copper (Cu), lead (Pb), and tin (Sn) until 1989.

데이터처리

Statistical comparisons of means were performed using Student’s t-tests, and Pearson correlation coefficients were used to evaluate the relationship between variables.

이론/모형

The serum creatinine level was determined by the Jaffe method to estimate the GFR. The estimated GFR (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula [eGFR = 175× serum creatinine^-1.
The fluorescence intensities of the samples and the NAG standard solution were measured at 580 nm using a spectrophotometer. Urinary NAG activity was corrected using the urinary creatinine concentration, which was determined by the modified Jaffe reaction method.

성능/효과

In conclusion, this study showed that urinary Cd level is associated with decreased GFR in the general population, and oxidative stress is likely to act as an intermediator in this process. These results suggest that eGFR can be a very good indicator of kidney damage caused by Cd exposure in general population.
The eGFR values had a significant correlation with urinary SG adjusted MDA and SG adjusted NAG level of R = -0.775(p<0.001) and R = 0.440 (p<0.001), respectively, suggesting that eGFR can be a good indicator of renal tubular injury and oxidative stress induced by Cd exposure.
The urinary SG adjusted Cd concentration showed a high correlation with urinary SG adjusted MDA level (R=0.678, p<0.001) and urinary SG adjusted NAG activity (R=0.485, p<0.001).

후속연구

These results suggest that eGFR can be a very good indicator of kidney damage caused by Cd exposure in general population. Furthermore, this study suggests that the use of urinary Cd concentrationadjusted with SG rather than the CR adjusted value may be appropriate in studies evaluating renal function based on Cd exposure.

참고문헌 (19)

Agarwal, R. and Chase, S. D. 2002. Rapid, fluorimetric-liquid chromatographic determination of malondialdehyde in biological samples. J. Chromatogr. B Analyt. Technol. Biomed. Life Sci. 775, 121-126.

상세보기
Bernard, A. 2004. Renal dysfunction induced by cadmium: biomarkers of critical effects. Biometals 17, 519-523.

상세보기
Bernard, A. 2008. Cadmium & its adverse effects on human health. Indian J. Med. Res. 128, 557-564.

상세보기
Buser, M. C., Ingber, S. Z., Raines, N. and Fowler, D. A., Scinicariello, F. 2016. Urinary and blood cadmium and lead and kidney function: NHANES 2007-2012. Int. J. Hyg. Environ. Health 219, 261-267.

상세보기
Chung, S., Chung, J. H., Kim, S. J., Koh, E. S., Yoon, H. E., Park, C. W., Chang, Y. S. and Shin, S. J. 2014. Blood lead and cadmium levels and renal function in Korean adults. J. Clin. Exp. Nephrol. 18, 726-734.

상세보기
Eom, S. Y., Seo, M. N., Lee, Y. S., Park, K. S., Hong, Y. S., Sohn, S. J., Kim, Y. D., Choi, B. S., Lim, J. A., Kwon, H. J., Kim, H. and Park, J. D. 2017. Low-level environmental cadmium exposure induces kidney tubule damage in the general population of Korean adults. Arch. Environ. Contam. Toxicol. 73, 401-409.

상세보기
Godt, J., Scheidig, F., Grosse-Siestrup, C., Esche, V., Brandenburg, P., Reich, A. and Groneberg, D. A. 2006. The toxicity of cadmium and resulting hazards for human health. J. Occup. Med. Toxicol. 1, 22.

상세보기
Haddam, N., Samira, S., Dumont, X., Taleb, A., Lison, D., Haufroid, V. and Bernard, A. 2011. Confounders in the assessment of the renal effects associated with low-level urinary cadmium: an analysis in industrial workers. Environ. Health 10, 37.

상세보기
Ikeda, M., Ezaki, T., Tsukahara, T., Moriguchi, J., Furuki, K., Fukui, Y., Okamoto, S., Ukai, H. and Sakurai, H. 2003. Bias induced by the use of creatinine-corrected values in evaluation of beta2-microgloblin levels. Toxicol. Lett. 145, 197-207.

상세보기
Jarup, L. and Akesson, A. 2009. Current status of cadmium as an environmental health problem. Toxicol. Appl. Pharmacol. 238, 201-208.

상세보기
Jarup, L., Berglund, M., Elinder, C. G., Nordberg, G. and Vahter, M. 1998. Health effects of cadmium exposure--a review of the literature and a risk estimate. Scand. J. Work Environ. Health 24, 1-51.

상세보기
Jatlow, P., McKee, S. and O'Malley, S. S. 2003. Correction of urine cotinine concentrations for creatinine excretion: is it useful? Clin. Chem. 49, 1932-1934.

상세보기
Kim, Y. D., Yim, D. H., Eom, S. Y., Moon, S. I., Park, C. H., Kim, G. B., Yu, S. D., Choi, B. S., Park, J. D. and Kim, H. 2015. Temporal changes in urinary levels of cadmium, N-acetyl- ${\beta}$ -d-glucosaminidase and ${\beta}$ 2-microglobulin in individuals in a cadmium-contaminated area. Environ. Toxicol. Pharmacol. 39, 35-41.

상세보기
Klaassen, C. D., Liu, J. and Diwan, B. A. 2009. Metallothionein protection of cadmium toxicity. Toxicol. Appl. Pharmacol. 238, 215-220.

상세보기
Levey, A. S., Coresh, J., Greene, T., Marsh, J., Stevens, L. A., Kusek, J. W. and Van Lente, F. 2007. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin. Chem. 53, 766-772.

상세보기
Nordberg, G., Jin, T., Wu, X., Lu, J., Chen, L., Liang, Y., Lei, L., Hong, F., Bergdahl, I. A. and Nordberg, M. 2012. Kidney dysfunction and cadmium exposure--factors influencing dose-response relationships. J. Trace Elem. Med. Biol. 26, 197-200.

상세보기
Schisterman, E. F., Cole, S. R. and Platt, R. W. 2009. Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology 20, 488-495.

상세보기
Subramanian, K. S., Meranger, J. C. and MacKeen, J. E. 1983. Graphite furnace atomic absorption spectrometry with matrix modification for determination of cadmium and lead in human urine. Anal. Chem. 55, 1064-1067.

상세보기
Weaver, V. M., Vargas, G. G., Silbergeld, E. K., Rothenberg, S. J., Fadrowski, J. J., Rubio-Andrade, M., Parsons, P. J., Steuerwald, A. J., Navas-Acien, A. and Guallar, E. 2014. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents. Environ. Res. 132, 226-232.

상세보기

저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증