Retinol-binding protein and transferrin in urine - New markers of renal function in essential hypertension and white coat hypertension?

We studied the 24 h urinary excretion of albumin, transferrin, immunoglobulin G, and retinol-binding protein in individuals with essential hypertension, white coat hypertension, and normotension. In 56 individuals, we measured the 24 h ambulatory blood pressure (AMBP). The individuals could be divided into three groups: 26 hypertensives, 14 white coat hypertensives, and 16 normotensives. Daytime AMBP values were (median values with range in parentheses, mm Hg): hypertensives 158/105 (198 to 121/95 to 120), white coat hypertensives 141/83 (161 to 129/72 to 90), and normotensives 123/75 (148 to 102/63 to 86). We determined with immunochemical methods the 24 h urinary excretions of albumin, transferrin, and immunoglobulin G, all markers of glomerular dysfunction, and retinol-binding protein, a marker of impaired proximal tubular function. We found a significantly higher excretion of albumin and transferrin in hypertensives (P <.0000/P <.0001) and in white coat hypertensives (P <.003/P <.02) compared to normotensives. Out of 26 hypertensives, seven had microalbuminuria (greater than or equal to 30 to <300 mg albumin/ 24 h). Two cases of microalbuminuria were found among the 14 white coat hypertensives. Immunoglobulin G excretion was not significantly increased in any of the hypertensive groups. Retinol-binding protein excretion was significantly higher in hypertensive patients (P <.007), whereas no elevation was observed in persons with white coat hypertension. In hypertensives, a significant correlation was found between urinary excretion of albumin and transferrin and office blood pressure and systolic AMBP. There was no significant correlation between the urinary excretions of IgG and retinol-binding protein and blood pressures in any of the three groups. Our findings indicate that patients with white coat hypertension, like hypertensives, have a selective type of glomerular dysfunction. However, proximal tubular dysfunction was seen only in hypertensives. Urinary excretions of albumin, transferrin, and retinol-binding protein may be useful as markers of glomerular and tubular dysfunction in essential hypertension.