101
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[Therapeutics for acute tubular necrosis in 2020]. Nephrol Ther 2021; 17:92-100. [PMID: 33483244 DOI: 10.1016/j.nephro.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
Acute kidney injury is a major cause of in-hospital morbidity and mortality because of the serious nature of the underlying illnesses and the high incidence of complications. The two major causes of acute kidney injury that occur in the hospital are prerenal disease and acute tubular necrosis. Acute tubular necrosis has a histological definition, even if a kidney biopsy is rarely performed. Kidney injuries occurring during acute tubular necrosis are underlined by different pathophysiological mechanisms that emphasize the role of hypoxia on the tubular cells such as apoptosis, cytoskeleton disruption, mitochondrial function and the inflammation mediated by innate immune cells. The microcirculation and the endothelial cells are also the targets of hypoxia-mediated impairment. Repair mechanisms are sometimes inadequate because of pro-fibrotic factors that will lead to chronic kidney disease. Despite all the potential therapeutic targets highlighted by the pathophysiological knowledge, further works remain necessary to find a way to prevent these injuries.
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102
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Srivastava A, Schmidt IM, Palsson R, Weins A, Bonventre JV, Sabbisetti V, Stillman IE, Rennke HG, Waikar SS. The Associations of Plasma Biomarkers of Inflammation With Histopathologic Lesions, Kidney Disease Progression, and Mortality-The Boston Kidney Biopsy Cohort Study. Kidney Int Rep 2021; 6:685-694. [PMID: 33732983 PMCID: PMC7938082 DOI: 10.1016/j.ekir.2020.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/20/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022] Open
Abstract
Background Soluble tumor necrosis factor receptor (sTNFR)-1, sTNFR-2, YKL-40, monocyte chemoattractant protein (MCP)-1, and soluble urokinase plasminogen activator receptor (suPAR) have emerged as promising biomarkers of inflammation but have not been evaluated across diverse types of kidney diseases. Methods We measured these plasma biomarkers in 523 individuals enrolled into a prospective, observational cohort study of patients undergoing clinically indicated native kidney biopsy at 3 tertiary care hospitals. Two kidney pathologists adjudicated biopsy specimens for semiquantitative scores of histopathology. Proportional hazard models tested associations between biomarkers and risks of kidney disease progression (composite of ≥40% estimated glomerular filtration rate [eGFR] decline or end-stage kidney disease [ESKD]) and death. Results Mean eGFR was 56.4±36 ml/min per 1.73 m2 and the median proteinuria (interquartile range) was 1.6 (0.4, 3.9) g/g creatinine. The most common primary clinicopathologic diagnoses were proliferative glomerulonephritis (29.2%), nonproliferative glomerulopathy (18.1%), advanced glomerulosclerosis (11.3%), and diabetic kidney disease (11.1%). sTNFR-1, sTNFR-2, MCP-1, and suPAR were associated with tubulointerstitial and glomerular lesions. YKL-40 was not associated with any histopathologic lesions after multivariable adjustment. During a median follow-up of 65 months, 182 participants suffered kidney disease progression and 85 participants died. After multivariable adjustment, each doubling of sTNFR-1, sTNFR-2, YKL-40, and MCP-1 was associated with increased risks of kidney disease progression, with hazard ratios ranging from 1.21 to 1.47. Each doubling of sTNFR-2, YKL-40, and MCP-1 was associated with increased risks of death, with hazard ratios ranging from 1.33 to 1.45. suPAR was not significantly associated with kidney disease progression or death. Conclusions sTNFR-1, sTNFR-2, YKL-40, MCP-1, and suPAR are associated with underlying histopathologic lesions and adverse clinical outcomes across a diverse set of kidney diseases.
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Affiliation(s)
- Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Insa M. Schmidt
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Renal Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Ragnar Palsson
- Renal Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
- Division of Nephrology, Landspitali–The National University Hospital of Iceland, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Astrid Weins
- Pathology Department, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Isaac E. Stillman
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Helmut G. Rennke
- Pathology Department, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Sushrut S. Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Renal Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
- Correspondence: Sushrut S. Waikar, Evans Biomedical Research Center, 650 Albany St, X504, Boston, Massachusetts 02118, USA.
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103
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Luft FC. Biomarkers and predicting acute kidney injury. Acta Physiol (Oxf) 2021; 231:e13479. [PMID: 32311830 DOI: 10.1111/apha.13479] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/20/2022]
Abstract
AIM How can we convert biomarkers into reliable, validated laboratory tests? Glomerular filtration rate (GFR) estimators exist for more than a century. The first utilitarian biomarkers were endogenously produced urea and creatinine. Clinicians then developed simple tests to determine whether or not renal tubular function was maintained. Are there faster and better tests that reflect decreased renal function and increased acute kidney injury (AKI) risk? METHODS We inspect earlier, and recently propagated biomarkers. Cystatin C reflects GFR and is not confounded by muscle mass. Direct GFR and plasma volume can now be measured acutely within 3 hours. Better yet would be tests that give information before GFR decreases and prior to urea, creatinine, and cystatin C increases. Prospective tests identifying those persons likely to develop AKI would be helpful. Even more utilitarian would be a test that also suggests a therapeutic avenue. RESULTS A number of highly provocative biomarkers have recently been proposed. Moreover the application of big data from huge electronic medical records promise new directions in identifying and dealing with AKI. CONCLUSIONS Pipedreams are in the pipeline; the novel findings require immediate testing, verification, and perhaps application. Future research promises to make such dreams come true.
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Affiliation(s)
- Friedrich C. Luft
- Experimental and Clinical Research Center Max‐Delbrück Center for Molecular Medicine
- Charité Medical Faculty Berlin Germany
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104
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Li L, Liao J, Yuan Q, Hong X, Li J, Peng Y, He M, Zhu H, Zhu M, Hou FF, Fu H, Liu Y. Fibrillin-1-enriched microenvironment drives endothelial injury and vascular rarefaction in chronic kidney disease. SCIENCE ADVANCES 2021; 7:7/5/eabc7170. [PMID: 33571112 PMCID: PMC7840119 DOI: 10.1126/sciadv.abc7170] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/10/2020] [Indexed: 05/05/2023]
Abstract
Endothelial cell injury leading to microvascular rarefaction is a characteristic feature of chronic kidney disease (CKD). However, the mechanism underlying endothelial cell dropout is poorly defined. Here, we show a central role of the extracellular microenvironment in controlling endothelial cell survival and proliferation in CKD. When cultured on a decellularized kidney tissue scaffold (KTS) from fibrotic kidney, endothelial cells increased the expression of proapoptotic proteins. Proteomics profiling identified fibrillin-1 (FBN1) as a key component of the fibrotic KTS, which was up-regulated in animal models and patients with CKD. FBN1 induced apoptosis of endothelial cells and inhibited their proliferation in vitro. RNA sequencing uncovered activated integrin αvβ6/transforming growth factor-β signaling, and blocking this pathway abolished FBN1-triggered endothelial injury. In a mouse model of CKD, depletion of FBN1 ameliorated renal fibrotic lesions and mitigated vascular rarefaction. These studies illustrate that FBN1 plays a role in mediating vascular rarefaction by orchestrating a hostile microenvironment for endothelial cells.
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Affiliation(s)
- Li Li
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinlin Liao
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Yuan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xue Hong
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Li
- Department of Cardiology, The 924th Hospital of Chinese People's Liberation Army Joint Service Support Force, Guilin, China
| | - Yiling Peng
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Meizhi He
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haili Zhu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingsheng Zhu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Haiyan Fu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Youhua Liu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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105
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Latus J, Schwenger V, Schlieper G, Reinecke H, Hoyer J, Persson PB, Remppis BA, Mahfoud F. [Contrast medium-induced acute kidney injury-Consensus paper of the working group "Heart and Kidney" of the German Cardiac Society and the German Society of Nephrology]. Internist (Berl) 2020; 62:111-120. [PMID: 33349899 DOI: 10.1007/s00108-020-00938-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This consensus paper summarizes the expert consensus and recommendations of the working group "Heart and Kidney" of the German Cardiac Society (DGK) and the German Society of Nephrology (DGfN) on contrast medium-induced acute kidney injury. Potentially nephrotoxic contrast agents containing iodine are frequently used in interventional medicine and for computer tomography diagnostics. Acute kidney injury occurs in approximately 8-17% of patients exposed to contrast media. The risk factors and underlying pathophysiology are discussed and recommendations for the prophylaxis and treatment of contrast medium-induced acute nephropathy are presented.
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Affiliation(s)
- J Latus
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Deutschland
| | - V Schwenger
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Deutschland
| | - G Schlieper
- Zentrum für Nieren‑, Hochdruck- und Stoffwechselerkrankungen, Hannover, Deutschland
| | - H Reinecke
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinik Münster, Münster, Deutschland
| | - J Hoyer
- Klinik für Innere Medizin, Nephrologie und Internistische Intensivmedizin, Universitätsklinikum Marburg, Marburg, Deutschland
| | - P B Persson
- Institute of Physiology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B A Remppis
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - F Mahfoud
- Klinik für Innere Medizin III, Kardiologie und Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, IMED, Kirrberger Str. 1, 66421, Homburg/Saar, Deutschland.
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106
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Belliere J, Colombat M, Kounde C, Recher C, Ribes D, Huart A, Chauveau D, Demas V, Luquet I, Beyne-Rauzy O, Tavitian S, Faguer S. Kidney Involvement in Patients With Chronic Myelomonocytic Leukemia or BCR-ABL-Negative Myeloproliferative Neoplasms. Kidney Int Rep 2020; 6:737-745. [PMID: 33732988 PMCID: PMC7938079 DOI: 10.1016/j.ekir.2020.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction The identification of specific molecular signatures and the development of new targeted drugs have changed the paradigm of onco-nephrology, now allowing a multiscale approach of kidney involvement related to hematologic malignancies relying on combined hematologic and molecular assessments. In this study, we aimed to refine the spectrum of kidney disorders associated with chronic myelomonocytic leukemia (CMML) or BCR-ABL–negative myeloproliferative neoplasms (MPNs), 2 very rare conditions scarcely described. Methods Case series. Patients with myeloid neoplasms who were referred to Toulouse University Hospital Nephrology Unit and were diagnosed with acute kidney injury (AKI), chronic kidney disease (CKD), or urine abnormalities were retrospectively included. Results Eighteen patients (males n=13, CMML n=8, essential thrombocytosis [ET] n=7, polycythemia vera [PV] n=1, and myelofibrosis n=2) developed kidney disease 7.7±2 years after the diagnosis of the malignancy. Twelve patients had AKI at presentation. Eight patients had glomerular presentation (high-range proteinuria 33%, microscopic hematuria 56%). Kidney biopsy (n=14) showed various patterns, including pauci-immune glomerulosclerosis (n=5), extramedullary hematopoiesis (n=6), or tubular atrophy and interstitial fibrosis with polymorphic inflammation (n=8). Immunostaining of CD61 confirmed the infiltration of megakaryocytes within glomeruli or interstitium in 5 of 8 patients. Other pictures of glomerulopathy were identified in 3 patients (IgA nephropathy n=2, AA amyloidosis n=1). Massive kidney infiltration by CMML was identified in 1 patient. After a mean follow-up of 24±6 months, malignancy was considered as stable in 11 patients (61%), but 22% of patients had progressed to end-stage renal failure. The remaining had persistently reduced kidney function. No correlation between the malignancy and the renal presentation and outcomes could be identified. Conclusions Kidney complications of CMML/MPN are heterogenous, and kidney biopsy may help to identify new molecular targets to prevent the development of kidney fibrosis.
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Affiliation(s)
- Julie Belliere
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France.,INSERM U1048, Institut des maladies métaboliques et cardio-vasculaires, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - Magali Colombat
- Université Paul Sabatier, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Département d'Anatomopathologie, Toulouse, France
| | - Clément Kounde
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France
| | - Christian Recher
- Université Paul Sabatier, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Service d'Hématologie, Toulouse, France
| | - David Ribes
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France
| | - Antoine Huart
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France
| | - Dominique Chauveau
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France.,INSERM U1048, Institut des maladies métaboliques et cardio-vasculaires, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - Véronique Demas
- Université Paul Sabatier, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire d'Hématologie, Toulouse, France
| | - Isabelle Luquet
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire d'Hématologie, Toulouse, France
| | - Odile Beyne-Rauzy
- Université Paul Sabatier, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Service de Médecine interne, Toulouse, France
| | - Suzanne Tavitian
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Service d'Hématologie, Toulouse, France
| | - Stanislas Faguer
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'Organes, Centre de reference des Maladies rénales rares, Toulouse, France.,INSERM U1048, Institut des maladies métaboliques et cardio-vasculaires, Toulouse, France.,Université Paul Sabatier, Toulouse, France
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107
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Uzawa A, Kojima Y, Ozawa Y, Yasuda M, Onishi Y, Akamine H, Kawaguchi N, Himuro K, Kuwabara S. Serum level of soluble urokinase plasminogen activator receptor (suPAR) as a disease severity marker of myasthenia gravis: a pilot study. Clin Exp Immunol 2020; 202:321-324. [PMID: 32706905 DOI: 10.1111/cei.13499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 02/04/2023] Open
Abstract
Myasthenia gravis (MG) is an autoantibody-mediated inflammatory disease of the neuromuscular junction. Biomarkers indicating disease activity in MG are warranted. Recently, the soluble urokinase plasminogen activator receptor (suPAR) has been reported to be associated with inflammation, tissue damage, disease activity and prognosis in various diseases, including autoimmune diseases. In this study, serum suPAR levels were measured in 40 patients with anti-acetylcholine receptor antibody-positive MG and 30 controls, and their correlations with clinical variables and severity scale scores were investigated. We identified that serum suPAR levels significantly correlated with MG activities of daily living scale (Spearman's ρ = 0·45; P = 0·004) and MG Foundation of America classification (Spearman's ρ = 0·37; P = 0·02) at serum sampling, but not with anti-acetylcholine receptor antibody titers. In conclusion, serum suPAR levels can be a candidate for a novel biomarker of disease activity in anti-acetylcholine receptor antibody-positive MG.
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Affiliation(s)
- A Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Kojima
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Y Ozawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - M Yasuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Onishi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Akamine
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - N Kawaguchi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Neurology, Dowa Institute of Clinical Neuroscience, Neurology Clinic Chiba, Chiba, Japan
| | - K Himuro
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Neurology, Matsudo Neurology Clinic, Chiba, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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108
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Raptis V, Loutradis C, Boutou AK, Faitatzidou D, Sioulis A, Ferro CJ, Papagianni A, Sarafidis PA. Serum Copeptin, NLPR3, and suPAR Levels among Patients with Autosomal-Dominant Polycystic Kidney Disease with and without Impaired Renal Function. Cardiorenal Med 2020; 10:440-451. [PMID: 33202410 DOI: 10.1159/000510834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The pathophysiology of renal disease progression in autosomal-dominant polycystic kidney disease (ADPKD) involves not only cystogenesis but also endothelial dysfunction, leading to the activation of inflammatory and fibrotic pathways. This study evaluated the levels of biomarkers related to osmoregulation, immune system activation, and tubular injury in ADPKD patients with impaired or preserved renal function. METHODS This study included 26 ADPKD patients with modestly impaired renal function (estimated glomerular filtration rate [eGFR] 45-70 mL/min/1.73 m2; Group A), 26 age- and sex-matched ADPKD patients with relatively preserved renal function (eGFR >70 mL/min/1.73 m2; Group B), and 26 age- and sex-matched controls (Group C). Serum levels of copeptin, the inflammasome nucleotide-binding and oligomerization domain-like receptors pyrin domain-containing protein 3 (NLRP3), and soluble urokinase-type plasminogen activator receptor (suPAR) were measured with ELISA techniques. RESULTS Patients in Group A had higher levels of copeptin (median [interquartile range]: 50.44 [334.85] pg/mL), NLRP3 (5.86 [3.89] ng/mL), and suPAR (390.05 [476.53] pg/mL) compared to patients in Group B (32.38 [58.33], p = 0.042; 2.42 [1.96], p < 0.001; and 313.78 [178.85], p = 0.035, respectively) and Group C (6.75 [6.43]; 1.09 [0.56]; and 198.30 [28.53], respectively; p < 0.001 for all comparisons). Levels of all studied markers were also significantly higher in Group B patients compared to controls (p < 0.001), despite having similar eGFR. In patients with ADPKD, all studied biomarkers were correlated positively with asymmetric-dimethylarginine (ADMA) and endocan levels, and negatively with eGFR. ADMA and endocan levels were the only parameters independently associated with increased copeptin levels. CONCLUSIONS This study showed that ADPKD patients with impaired and preserved renal function had higher copeptin, NLRP3, and suPAR levels than controls. Such findings support that cystogenesis and inflammation are associated with endothelial dysfunction, even in the early stages of ADKPD.
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Affiliation(s)
- Vasileios Raptis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Sioulis
- Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,
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109
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Nusshag C, Reuß CJ, Dietrich M, Hecker A, Jungk C, Michalski D, Fiedler MO, Bernhard M, Beynon C, Weigand MA, Brenner T. [Focus nephrology : Intensive medical care studies from 2019/2020]. Anaesthesist 2020; 70:250-256. [PMID: 33103208 DOI: 10.1007/s00101-020-00856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Nusshag
- Klinik für Nephrologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C J Reuß
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Dietrich
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - C Jungk
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - D Michalski
- Neurologische Intensivstation und Stroke Unit, Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - M O Fiedler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - C Beynon
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - T Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
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110
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Affiliation(s)
- Sarah Faubel
- Division of Nephrology, University of Colorado, Denver, and Denver Veterans Administration Medical Center, Denver, CO, USA.
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111
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Terpos E, Ntanasis-Stathopoulos I, Papassotiriou GP, Kastritis E, Margeli A, Kanellias N, Eleutherakis-Papaiakovou E, Migkou M, Fotiou D, Roussou M, Gavriatopoulou M, Malandrakis P, Psimenou E, Papassotiriou I, Dimopoulos MA. Circulating Soluble Urokinase-Type Plasminogen Activator Receptor Levels Reflect Renal Function in Newly Diagnosed Patients with Multiple Myeloma Treated with Bortezomib-Based Induction. J Clin Med 2020; 9:jcm9103201. [PMID: 33022958 PMCID: PMC7600599 DOI: 10.3390/jcm9103201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Soluble urokinase-type plasminogen activator receptor (suPAR) has been implicated in the pathogenesis of kidney disease in different disease settings. The aim of this study was to investigate a possible link between suPAR circulating levels and renal impairment (RI) in newly diagnosed patients with symptomatic multiple myeloma (NDMM) before and after frontline therapy with bortezomib-based regimens. (2) Methods: We studied 47 NDMM patients (57% males, median age 69.5 years) before the administration of anti-myeloma treatment and at best response to bortezomib-based therapy. suPAR was measured in the serum of all patients and of 24 healthy matched controls, using an immuno-enzymatic assay (ViroGates, Denmark). (3) Results: suPAR levels were elevated in NDMM patients at diagnosis compared to healthy individuals (p < 0.001). suPAR levels strongly correlated with disease stage (p-ANOVA < 0.001). suPAR levels both at diagnosis and at best response negatively correlated with estimated glomerular filtration rate (eGFR) values (p < 0.001). Interestingly, no significance changes in suPAR levels were observed at best response compared to baseline values (p = 0.31) among 18 responding patients with baseline eGFR < 50 mL/min/1.73 m2. (4) Conclusions: SuPAR levels reflect renal function in NDMM patients treated with bortezomib-based induction. Responders may have elevated circulating suPAR levels, possibly reflecting persistent kidney damage, despite their renal response.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
- Correspondence: ; Tel.: +30-213-2162846; Fax: +30-213-2162511
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Gerasimos-Petros Papassotiriou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Alexandra Margeli
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.M.); (I.P.)
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Evangelos Eleutherakis-Papaiakovou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Magdalini Migkou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Maria Roussou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Erasmia Psimenou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.M.); (I.P.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (G.-P.P.); (E.K.); (N.K.); (E.E.-P.); (M.M.); (D.F.); (M.R.); (M.G.); (P.M.); (E.P.); (M.A.D.)
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Chalkias A, Mouzarou A, Samara E, Xanthos T, Ischaki E, Pantazopoulos I. Soluble Urokinase Plasminogen Activator Receptor: A Biomarker for Predicting Complications and Critical Care Admission of COVID-19 Patients. Mol Diagn Ther 2020; 24:517-521. [PMID: 32613288 PMCID: PMC7327460 DOI: 10.1007/s40291-020-00481-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The novel coronavirus infection has spread worldwide, causing a wide spectrum of clinical manifestations. Most patients develop moderate clinical illness, but a substantial number will experience severe pneumonia, which may rapidly progress to acute respiratory distress syndrome and multiple organ failure. In this population, soluble urokinase plasminogen activator receptor (suPAR) could serve as a quick triage test and independent marker of clinical severity, hospital and intensive care unit admission, complications, and mortality.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece.
| | - Angeliki Mouzarou
- Department of Cardiology, General Hospital of Paphos, Paphos, Cyprus
| | - Evangelia Samara
- Department of Anesthesiology, Tzaneio General Hospital, Piraeus, Greece
| | | | - Eleni Ischaki
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
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113
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Reisinger AC, Hackl G, Niedrist T, Hoenigl M, Eller P, Prattes J. SuPAR levels in BAL fluid from patients with acute respiratory distress syndrome-a pilot study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:576. [PMID: 32977840 PMCID: PMC7516241 DOI: 10.1186/s13054-020-03299-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/20/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Alexander C Reisinger
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Gerald Hackl
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Hoenigl
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 200 Dickinson Street, San Diego, CA, 92103, USA
| | - Philipp Eller
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Juergen Prattes
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Azam TU, Shadid HR, Blakely P, O'Hayer P, Berlin H, Pan M, Zhao P, Zhao L, Pennathur S, Pop-Busui R, Altintas I, Tingleff J, Stauning MA, Andersen O, Adami ME, Solomonidi N, Tsilika M, Tober-Lau P, Arnaoutoglou E, Keitel V, Tacke F, Chalkias A, Loosen SH, Giamarellos-Bourboulis EJ, Eugen-Olsen J, Reiser J, Hayek SS. Soluble Urokinase Receptor (SuPAR) in COVID-19-Related AKI. J Am Soc Nephrol 2020; 31:2725-2735. [PMID: 32963090 DOI: 10.1681/asn.2020060829] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AKI commonly occurs in patients with coronavirus disease 2019 (COVID-19). Its pathogenesis is poorly understood. The urokinase receptor system is a key regulator of the intersection between inflammation, immunity, and coagulation, and soluble urokinase plasminogen activator receptor (suPAR) has been identified as an immunologic risk factor for AKI. Whether suPAR is associated with COVID-19-related AKI is unknown. METHODS In a multinational observational study of adult patients hospitalized for COVID-19, we measured suPAR levels in plasma samples from 352 adult patients that had been collected within 48 hours of admission. We examined the association between suPAR levels and incident in-hospital AKI. RESULTS Of the 352 patients (57.4% were male, 13.9% were black, and mean age was 61 years), 91 (25.9%) developed AKI during their hospitalization, of whom 25 (27.4%) required dialysis. The median suPAR level was 5.61 ng/ml. AKI incidence rose with increasing suPAR tertiles, from a 6.0% incidence in patients with suPAR <4.60 ng/ml (first tertile) to a 45.8% incidence of AKI in patients with suPAR levels >6.86 ng/ml (third tertile). None of the patients with suPAR <4.60 ng/ml required dialysis during their hospitalization. In multivariable analysis, the highest suPAR tertile was associated with a 9.15-fold increase in the odds of AKI (95% confidence interval [95% CI], 3.64 to 22.93) and a 22.86-fold increase in the odds of requiring dialysis (95% CI, 2.77 to 188.75). The association was independent of inflammatory markers and persisted across subgroups. CONCLUSIONS Admission suPAR levels in patients hospitalized for COVID-19 are predictive of in-hospital AKI and the need for dialysis. SuPAR may be a key component of the pathophysiology of AKI in COVID-19.
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Affiliation(s)
- Tariq U Azam
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Husam R Shadid
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Pennelope Blakely
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Patrick O'Hayer
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hanna Berlin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael Pan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peiyao Zhao
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rodica Pop-Busui
- Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Izzet Altintas
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jens Tingleff
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Marius A Stauning
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Maria-Evangelia Adami
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicky Solomonidi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pinkus Tober-Lau
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, Thessaly, Greece
| | - Verena Keitel
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Athanasios Chalkias
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, Thessaly, Greece
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Salim S Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Research Highlights. Transplantation 2020. [DOI: 10.1097/tp.0000000000003396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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116
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Kidney injury as post-interventional complication of TAVI. Clin Res Cardiol 2020; 110:313-322. [PMID: 32844282 DOI: 10.1007/s00392-020-01732-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an accepted treatment approach of aortic stenosis. In the beginning, this technique was executed in high-risk patients only. Today, intermediate-risk patients are also amenable for TAVI, as long as the transfemoral approach is chosen. Numerous predictors have been identified that could lead to periprocedural complications and are defined by patient co-morbidities as well as being inherent to the technical approach. Although vascular complications and postinterventional paravalvular regurgitation have been minimized over the past years by revised technologies and techniques, there is a prevailing individual risk brought about by the specific pathophysiology of the cardiorenal syndrome.
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117
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Muñoz B, Schobel SA, Lisboa FA, Khatri V, Grey SF, Dente CJ, Kirk AD, Buchman T, Elster EA. Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients. Surgery 2020; 168:662-670. [PMID: 32600883 DOI: 10.1016/j.surg.2020.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-traumatic acute kidney injury has occurred in every major military conflict since its initial description during World War II. To ensure the proper treatment of combat casualties, early detection is critical. This study therefore aimed to investigate combat-related post-traumatic acute kidney injury in recent military conflicts, used machine learning algorithms to identify clinical and biomarker variables associated with the development of post-traumatic acute kidney injury, and evaluated the effects of post-traumatic acute kidney injury on wound healing and nosocomial infection. METHODS We conducted a retrospective clinical cohort review of 73 critically injured US military service members who sustained major combat-related extremity wounds and had collected injury characteristics, assayed serum and tissue biopsy samples for the expression of protein and messenger ribonucleic acid biomarkers. Bivariate analyses and random forest recursive feature elimination classification algorithms were used to identify associated injury characteristics and biomarker variables. RESULTS The incidence of post-traumatic acute kidney injury was 20.5%. Of that, 86% recovered baseline renal function and only 2 (15%) of the acute kidney injury group required renal replacement therapy. Random forest recursive feature elimination algorithms were able to estimate post-traumatic acute kidney injury with the area under the curve of 0.93, sensitivity of 0.91, and specificity of 0.91. Post-traumatic acute kidney injury was associated with injury severity score, serum epidermal growth factor, and tissue activin A type receptor 1, matrix metallopeptidase 10, and X-C motif chemokine ligand 1 expression. Patients with post-traumatic acute kidney injury exhibited poor wound healing and increased incidence of nosocomial infections. CONCLUSION The occurrence of acute kidney injury in combat casualties may be estimated using injury characteristics and serum and tissue biomarkers. External validations of these models are necessary to generalize for all trauma patients.
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Affiliation(s)
- Beau Muñoz
- Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD
| | - Seth A Schobel
- Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Henry Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Felipe A Lisboa
- Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Henry Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Vivek Khatri
- Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Henry Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Scott F Grey
- Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Henry Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Christopher J Dente
- Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Emory University, Atlanta, GA
| | - Allan D Kirk
- Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Duke University, Durham, NC
| | - Timothy Buchman
- Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD; Emory University, Atlanta, GA
| | - Eric A Elster
- Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University Surgical Critical Care Initiative, Bethesda, MD.
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Arnold DT, Hamilton FW, Elvers KT, Frankland SW, Zahan-Evans N, Patole S, Medford A, Bhatnagar R, Maskell NA. Pleural Fluid suPAR Levels Predict the Need for Invasive Management in Parapneumonic Effusions. Am J Respir Crit Care Med 2020; 201:1545-1553. [PMID: 32069085 PMCID: PMC7301729 DOI: 10.1164/rccm.201911-2169oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: Parapneumonic effusions have a wide clinical spectrum. The majority settle with conservative management but some progress to complex collections requiring intervention. For decades, physicians have relied on pleural fluid pH to determine the need for chest tube drainage despite a lack of prospective validation and no ability to predict the requirement for fibrinolytics or thoracic surgery.Objectives: To study the ability of suPAR (soluble urokinase plasminogen activator receptor), a potential biomarker of pleural fluid loculation, to predict the need for invasive management compared with conventional fluid biomarkers (pH, glucose, and lactate dehydrogenase) in parapneumonic effusions.Methods: Patients presenting with pleural effusions were prospectively recruited to an observational study with biological samples stored at presentation. Pleural fluid and serum suPAR levels were measured using the suPARnostic double-monoclonal antibody sandwich ELISA on 93 patients with parapneumonic effusions and 47 control subjects (benign and malignant effusions).Measurements and Main Results: Pleural suPAR levels were significantly higher in effusions that were loculated versus nonloculated parapneumonic effusions (median, 132 ng/ml vs. 22 ng/ml; P < 0.001). Pleural suPAR could more accurately predict the subsequent insertion of a chest tube with an area under the curve (AUC) of 0.93 (95% confidence interval, 0.89-0.98) compared with pleural pH (AUC 0.82; 95% confidence interval, 0.73-0.90). suPAR was superior to the combination of conventional pleural biomarkers (pH, glucose, and lactate dehydrogenase) when predicting the referral for intrapleural fibrinolysis or thoracic surgery (AUC 0.92 vs. 0.76).Conclusions: Raised pleural suPAR was predictive of patients receiving more invasive management of parapneumonic effusions and added value to conventional biomarkers. These results need validation in a prospective multicenter trial.
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Affiliation(s)
- David T. Arnold
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Fergus W. Hamilton
- North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom; and
| | - Karen T. Elvers
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | | | | | - Sonia Patole
- North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom; and
| | - Andrew Medford
- North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom; and
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
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Iversen E, Houlind MB, Kallemose T, Rasmussen LJH, Hornum M, Feldt-Rasmussen B, Hayek SS, Andersen O, Eugen-Olsen J. Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients. Front Cell Dev Biol 2020; 8:339. [PMID: 32596235 PMCID: PMC7303513 DOI: 10.3389/fcell.2020.00339] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/17/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Identifying patients at high risk of developing kidney disease could lead to early clinical interventions that prevent or slow disease progression. Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker thought to be involved in the pathogenesis and development of kidney disease. We aimed to determine whether elevated plasma suPAR measured at hospital admission is associated with incident kidney disease in patients presenting to the emergency department. Materials and Methods This was a retrospective registry-based cohort study performed at the Emergency Department of Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. Patients were included in the study from November 2013 to March 2017 and followed until June 2017. Patients were excluded if they were diagnosed with kidney disease or died prior to index discharge. Plasma suPAR was measured at hospital admission, and the main outcome was time to incident kidney disease, defined by ICD-10 diagnosis codes for both chronic and acute kidney conditions. Association between suPAR and time to incident kidney disease was assessed by Cox proportional hazard regression analysis. Results In total, 25,497 patients (median age 58.1 years; 52.5% female) were admitted to the emergency department and followed for development of kidney disease. In multivariable Cox regression analysis adjusting for age, sex, eGFR, CRP, cardiovascular disease, hypertension, and diabetes, each doubling in suPAR at hospital admission was associated with a hazard ratio of 1.57 (95% CI: 1.38–1.78, P < 0.001) for developing a chronic kidney condition and 2.51 (95% CI: 2.09–3.01, P < 0.001) for developing an acute kidney condition. Discussion In a large cohort of acutely hospitalized medical patients, elevated suPAR was independently associated with incident chronic and acute kidney conditions. This highlights the potential for using suPAR in risk classification models to identify high-risk patients who could benefit from early clinical interventions. The main limitation of this study is its reliance on accurate reporting of ICD-10 codes for kidney disease.
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Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Hospital Pharmacy, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Salim S Hayek
- Department of Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
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Metkus TS, Whitman GJR. Commentary: Acute kidney injury, a multi-billion-dollar issue. J Thorac Cardiovasc Surg 2020; 162:891-892. [PMID: 32682588 DOI: 10.1016/j.jtcvs.2020.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas S Metkus
- Department of Medicine and Department of Surgery, The Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
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Soluble Urokinase Plasminogen Activator Receptor (suPAR) Concentrations Are Elevated in Patients with Neuroendocrine Malignancies. J Clin Med 2020; 9:jcm9061647. [PMID: 32486367 PMCID: PMC7355627 DOI: 10.3390/jcm9061647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine neoplasia (NEN) comprises heterogeneous tumors that are challenging to diagnose and, especially in cases of poorly differentiated (G3) NEN, are associated with very limited survival. Novel biomarkers allowing an early diagnosis as well as an optimal selection of suitable treatment options are urgently needed to improve the outcome of these patients. Recently, alterations of soluble urokinase-type plasminogen activator receptor (suPAR) serum levels were described in various types of cancers. However, the role of circulating suPAR as a biomarker in patients with NEN is unknown. In this study, we measured suPAR serum levels in a large and well-characterized cohort of 187 patients with NEN (neuroendocrine carcinomas (NEC) n = 30; neuroendocrine tumors (NET), n = 157) as well as 44 healthy controls. suPAR concentrations were significantly elevated in patients compared to controls. However, suPAR concentrations were independent of tumor-related factors such as the proliferation activity according to Ki-67, tumor grading, TNM (TNM classification of malignant tumors) stage, somatostatin receptor expression or clinical features such as functional or nonfunctional disease and the presence of tumor relapse. Interestingly, suPAR concentrations in NET patients were similar when compared to those measured in NEC patients. In contrast to previous results from other malignancies, in our analysis suPAR levels were not a significant predictor of overall survival. In conclusion, our data suggests that suPAR serum concentrations are elevated in NEN patients but do not allow prediction of outcome.
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Prognostic Role of Soluble Urokinase Plasminogen Activator Receptor at the Emergency Department: A Position Paper by the Hellenic Sepsis Study Group. Infect Dis Ther 2020; 9:407-416. [PMID: 32399855 PMCID: PMC7217599 DOI: 10.1007/s40121-020-00301-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
In light of the accumulating evidence on the negative predictive value of soluble urokinase plasminogen activator receptor (suPAR), a group of experts from the fields of intensive care medicine, emergency medicine, internal medicine and infectious diseases frame a position statement on the role of suPAR in the screening of patients admitted to the emergency department. The statement is framed taking into consideration existing publications and our own research experience. The main content of this statement is that sUPAR is a non-specific marker associated with a high negative predictive value for unfavourable outcomes; levels < 4 ng/ml indicate that it is safe to discharge the patient, whereas levels > 6 ng/ml are an alarming sign of risk for unfavourable outcomes. However, the suPAR levels should always be interpreted in light of the patient's history.
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Faria LC, Andrade AMF, Trant CGMC, Lima AS, Machado PAB, Porto RD, Andrade MVM. Circulating levels of High‐mobility group box 1 protein and nucleosomes are associated with outcomes after liver transplant. Clin Transplant 2020; 34:e13869. [DOI: 10.1111/ctr.13869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/08/2020] [Accepted: 03/29/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Luciana C. Faria
- Departamento de Clínica Médica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
- Grupo de Transplante de Órgãos Instituto Alfa de Gastroenterologia Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Antônio Márcio F. Andrade
- Grupo de Transplante de Órgãos Instituto Alfa de Gastroenterologia Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Cyntia G. M. C. Trant
- Laboratório de Fisiopatologia Cirúrgica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Agnaldo S. Lima
- Grupo de Transplante de Órgãos Instituto Alfa de Gastroenterologia Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brasil
- Departamento de Cirurgia Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Pedro A. B. Machado
- Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Rodrigo D. Porto
- Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Marcus Vinícius M. Andrade
- Departamento de Clínica Médica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
- Laboratório de Fisiopatologia Cirúrgica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
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Rovina N, Akinosoglou K, Eugen-Olsen J, Hayek S, Reiser J, Giamarellos-Bourboulis EJ. Soluble urokinase plasminogen activator receptor (suPAR) as an early predictor of severe respiratory failure in patients with COVID-19 pneumonia. Crit Care 2020; 24:187. [PMID: 32354367 PMCID: PMC7191969 DOI: 10.1186/s13054-020-02897-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 01/31/2023] Open
Affiliation(s)
- Nikoletta Rovina
- 1st Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, 265 04 Rio, Greece
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Salim Hayek
- Department of Medicine, University of Michigan, Ann Arbor, MI 48103 USA
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612 USA
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
- 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, 12462 Athens, Greece
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Huang DT, Ramirez P. Biomarkers in the ICU: less is more? Yes. Intensive Care Med 2020; 47:94-96. [PMID: 32347324 DOI: 10.1007/s00134-020-06049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/09/2020] [Indexed: 01/11/2023]
Affiliation(s)
- David T Huang
- CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh, Pittsburgh, PA, USA. .,MACRO (Multidisciplinary Acute Care Research Organization) Center, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Critical Care Medicine, University of Pittsburgh, 606B Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA. .,Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Paula Ramirez
- Department of Critical Care Medicine, Hospital Universitario Y Politécnico La Fe, Av Fernando Abril Martorell 106, 46026, Valencia, Spain. .,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Carlos III Research Institute, Madrid, Spain.
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Sandø A, Schultz M, Eugen-Olsen J, Køber L, Engstrøm T, Kelbæk H, Jørgensen E, Saunamäki K, Holmvang L, Pedersen F, Tilsted HH, Høfsten D, Helqvist S, Clemmensen P, Iversen K. Soluble urokinase receptor as a predictor of non-cardiac mortality in patients with percutaneous coronary intervention treated ST-segment elevation myocardial infarction. Clin Biochem 2020; 80:8-13. [PMID: 32213303 DOI: 10.1016/j.clinbiochem.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identification of patients at high risk of non-cardiac mortality following ST-segment elevation myocardial infarction (STEMI) could guide clinicians to identify patients who require attention due to serious non-cardiac conditions after the acute phase of STEMI. The purpose of this study was to evaluate if the non-specific and prognostic biomarker of inflammation and comorbidity, soluble urokinase receptor (suPAR), could predict non-cardiac mortality in a cohort of STEMI patients. METHODS SuPAR was measured in 1,190 STEMI patients who underwent primary percutaneous coronary intervention (pPCI). The primary endpoint was non-cardiac mortality, secondary endpoints were cardiac mortality, all-cause mortality, reinfarction and periprocedural acute kidney injury. Backwards elimination of potential confounders significantly associated with the respective outcome was used to adjust associations. RESULTS Patients were followed for a median of 3.0 years (interquartile range 2.5- 3.6 years). Multivariate cox regression revealed that a plasma suPAR level above 3.70 ng mL-1 was associated with non-cardiac and cardiac mortality at hazard ratios 3.33 (95% confidence interval 1.67-6.63, p = 0.001, adjusted for age) and 0.99 (0.18-5.30, p = 0.98, adjusted for previous myocardial infarction and left ventricular ejection fraction), respectively. CONCLUSION In patients with pPCI treated STEMI, suPAR was an independent prognostic biomarker of non-cardiac but not cardiac mortality and may identify patients with high risk of non-cardiac mortality.
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Affiliation(s)
- Andreas Sandø
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Martin Schultz
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Thomas Engstrøm
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
| | - Erik Jørgensen
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Kari Saunamäki
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Lene Holmvang
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Frants Pedersen
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Hans Henrik Tilsted
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark.
| | - Dan Høfsten
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Steffen Helqvist
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Peter Clemmensen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg-Eppendorf, Hamburg, Germany and Department of Medicine, Division of Cardiology, Nykøbing Falster Hospital, University of Southern Denmark, Fjordvej 15, 4800 Nykøbing Falster, Denmark.
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
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Nadkarni GN. suPAR news for acute kidney injury? Sci Transl Med 2020. [DOI: 10.1126/scitranslmed.abb0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
suPAR might serve as a biomarker for prediction of acute kidney injury with possible therapeutic implications.
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Affiliation(s)
- Girish N. Nadkarni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Affiliation(s)
- Frank Tacke
- From the Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin
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