Original Article| Volume 90, ISSUE 1, P55-61, May 2000

Evaluation of the fetal kidney maturation by assessment of amniotic fluid alpha-1 microglobulin levels


      Objective: To evaluate the fetal renal maturation by assessment of amniotic fluid microproteins and to show these proteins originate from fetal urine. Study design: Amniotic fluid proteins (total protein, albumin, high molecular weight protein-HMWP, low molecular weight protein-LMWP, α1-microglobulin and β2-microglobulin) were determined in 39 pregnant women at delivery and by amniocentesis in 30 pregnant women. These values were compared with first urine values of neonates with the same gestational age. Results: Albumin was the largest protein component in the amniotic fluid. LMWP showed an increase in the amniotic fluid until the end of the second trimester; and as pregnancy advanced a progressive decrease occurred in parallel to fetal renal maturation. After 26 weeks’ gestation, a strong correlation was identified between LMWP levels and α1-microglobulin, and between LMWP and β2-microglobulin. No significant difference was detected between LMWP levels in the first urine of the neonates and in amniotic fluids. Conclusion: Microproteins in the fetal urine are of fetal origin. Fetal renal maturation can be evaluated by measuring microproteins in the amniotic fluid. Fetal renal maturation is best reflected by α1-microglobulin.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      1. Kurjak A. An atlas of ultrasonography in obstetrics and gynecology. The Parthenon Publishing Group, London1992: 57
        • Golbus M.S.
        • Harrison M.R.
        • Filly A.R.
        Prenatal diagnosis and treatment of fetal hydronephrosis.
        Semin Perinatol. 1983; 7: 102
      2. İlter Ö Altinkaya N. Neonatolojide Güncel Sorunlar. Ayhan Matbaasi, Istanbul1991: 95
        • Glick P.L.
        • Harrison R.M.
        • Golbus S.M.
        • Adzick S.N.
        • Filly A.R.
        Management of the fetus with congenital hydronephrosis II: prognostic criteria and selection for treatment.
        J Pediatr Surg. 1985; 210: 376
        • Estes M.J.
        • Harrison R.M.
        Fetal obstructive uropathy.
        Semin Pediatr Surg. 1993; 2: 129
        • Lipitz S.
        • Ryan G.
        • Samuell C.
        • Hausler M.C.H.
        • Robson C.S.
        • Dhillon K.H.
        • Nicolini U.
        • Rodeck C.H.
        Fetal urine analysis for the assessment of renal function in obstructive uropathy.
        Am J Obstet Gynecol. 1993; 168: 174
        • Lenz S.
        • Lund-Hansen T.
        • Bang J.
        • Cristensen E.
        A possible prenatal evaluation of renal function by amino acid analysis on fetal urine.
        Prenat Diagn. 1985; 5: 259
        • Nicolaides K.H.
        • Cheng H.H.
        • Snijders R.J.M.
        • Moniz C.F.
        Fetal urine biochemistry in the assessment of obstructive uropathy.
        Am J Obstet Gynecol. 1992; 166: 932
        • Hill L.M.
        Abnormalities of amniotic fluid volume: oligohydramnios.
        Postgrad Obstet Gynecol. 1991; 11
        • Henneman C.E.
        • Anderson G.V.
        • Tejavej A.
        • Howard G.
        • Heiman M.
        Fetal maturation and amniotic fluid.
        Am J Obstet Gynecol. 1970; 108: 303
        • Zimmerhackl L.B.
        • Postasy K.
        • Wiegele G.
        • Rasenack A.
        • Wilhelm C.
        • Lohner M.
        • Brandis M.
        • Kinne R.K.
        Tamm-Horsfall protein as a marker of tubular maturation.
        Pediatr Nephrol. 1996; 10: 448-452
        • Burghard R.
        • Pallacks R.
        • Gordjani N.
        • Leititis J.U.
        • Hackelöer B.J.
        • Brandis M.
        Microproteins in amniotic fluid as an index of changes in fetal renal function during development.
        Pediatr Nephrol. 1987; 1: 574
      3. Dunn M.J. Gel electrophoresis: proteins; sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Bios Scientific Publishers, Westbury1995
        • Gulbis B.
        • Gervy C.
        • Jauniaux E.
        Amniotic fluid biochemistry in second trimester trisomic pregnancies: relationships to fetal organ maturation and dysfunction.
        Early Hum Dev. 1998; 52: 211-219
        • Muller F.
        • Dommergues M.
        • Bussieres L.
        • Lortat-Jacob S.
        • Loirat C.
        • Oury J.F.
        • Aigrain Y.
        Development of human renal function: reference intervals for 10 biochemical markers in fetal urine.
        Clin Chem. 1996; 142: 1855-1860
        • Mussap M.
        • Fannos V.
        • Piccoli A.
        • Zaninotto M.
        • Padovani E.M.
        • Plebani M.
        Low molecular mass proteins and urinary enzymes in amniotic fluid of healthy pregnant women at progressive stages of gestation.
        Clin Biochem. 1996; 29: 51-56
        • Nolte S.
        • Muellar B.
        • Pringsheim W.
        Serum α1 microglobulin and β2 microglobulin for the estimation of fetal glomerular renal function.
        Pediatr Nephrol. 1991; 5: 573
        • Gulbis B.
        • Jauniaux E.
        • Jurcovic D.
        • Gervy C.
        • Ooms H.A.
        Biochemical investigation of fetal renal maturation in early pregnancy.
        Pediatr Res. 1996; 39: 731-735
        • Takieddin F.
        • Tabbara M.
        • Hall P.
        • Sokol R.J.
        • King K.C.
        Fetal renal maturation.
        Acta Obstet Gynecol Scand. 1983; 2: 311
        • Tack E.D.
        • Pearlman J.M.
        • Robson A.M.
        Renal injury in sick newborn infants: a prospective evaluation using urinary β2 microglobulin concentration.
        Pediatrics. 1988; 81: 432
        • Holzgreve W.
        • Lison A.
        • Bulla M.
        SDS-PAGE as an additional test to determine fetal kidney function prior to intrauterine diversion of urinary tract obstruction.
        Fetal Ther. 1989; 4: 93
        • Muller F.
        • Dommerques M.
        • Mandeldrot L.
        • Aubry M.C.
        • Nihoul-Fekete C.
        • Dumez Y.
        Fetal urinary biochemistry predicts postnatal renal function in children in bilateral obstructive uropathies.
        Obstet Gynecol. 1993; 82: 813
        • Burghard R.
        • Leititis J.U.
        • Brondis M.
        Studies on fetal renal function.
        Contr Nephrol. 1988; 67: 193