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Ohno K, Kuno A, Murase H, Muratsubaki S, Miki T, Tanno M, Yano T, Ishikawa S, Yamashita T, Miura T. Diabetes increases the susceptibility to acute kidney injury after myocardial infarction through augmented activation of renal Toll-like receptors in rats. Am J Physiol Heart Circ Physiol 2017; 313:H1130-H1142. [PMID: 28822965 DOI: 10.1152/ajpheart.00205.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) after acute myocardial infarction (MI) worsens the prognosis of MI patients. Although type 2 diabetes mellitus (DM) is a major risk factor of AKI after MI, the underlying mechanism remains unclear. Here, we examined the roles of renal Toll-like receptors (TLRs) in the impact of DM on AKI after MI. MI was induced by coronary artery ligation in Otsuka-Long-Evans-Tokushima fatty (OLETF) rats, a rat DM model, and Long-Evans-Tokushima-Otsuka (LETO) rats, nondiabetic controls. Sham-operated rats served as no-MI controls. Renal mRNA levels of TLR2 and myeloid differentiation factor 88 (MyD88) were significantly higher in sham-operated OLETF rats than in sham-operated LETO rats, although levels of TLR1, TLR3, and TLR4 were similar. At 12 h after MI, protein levels of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in the kidney were elevated by 5.3- and 4.0-fold, respectively, and their mRNA levels were increased in OLETF but not LETO rats. The increased KIM-1 and NGAL expression levels after MI in the OLETF kidney were associated with upregulated expression of TLR1, TLR2, TLR4, MyD88, IL-6, TNF-α, chemokine (C-C motif) ligand 2, and transforming growth factor-β1 and also with activation of p38 MAPK, JNK, and NF-κB. Cu-CPT22, a TLR1/TLR2 antagonist, administered before MI significantly suppressed MI-induced upregulation of KIM-1, TLR2, TLR4, MyD88, and chemokine (C-C motif) ligand 2 levels and activation of NF-κB, whereas NGAL levels and IL-6 and TNF-α expression levels were unchanged. The results suggest that DM increases the susceptibility to AKI after acute MI by augmented activation of renal TLRs and that TLR1/TLR2-mediated signaling mediates KIM-1 upregulation after MI.NEW & NOTEWORTHY This is the first report to demonstrate the involvement of Toll-like recpetors (TLRs) in diabetes-induced susceptibility to acute kidney injury after acute myocardial infarction. We propose that the TLR1/TLR2 heterodimer may be a new therapeutic target for the prevention of acute kidney injury in diabetic patients.
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Affiliation(s)
- Kouhei Ohno
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Atsushi Kuno
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and.,Department of Pharmacology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Murase
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Shingo Muratsubaki
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Takayuki Miki
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Masaya Tanno
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Satoko Ishikawa
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Tomohisa Yamashita
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Tetsuji Miura
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
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Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption. Clin Chem Lab Med 2017; 55:1074-1089. [PMID: 28076311 DOI: 10.1515/cclm-2016-0973] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.
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103
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Janas RM, Rybak A, Wierzbicka-Rucińska A, Socha P, Śnitko R, Szaflarska-Popławska A, Stolarczyk A, Oralewska B, Cytra-Jarocka E, Iwańczak B, Grzybowska-Chlebowczyk U, Cichy W, Czaja-Bulsa G, Socha J. Serum Concentrations of Insulin, Ghrelin, Adiponectin, Leptin, Leptin Receptor and Lipocalin-2 in Children with Celiac Disease Who Do and Do Not Adhere to a Gluten-Free Diet. Gut Liver 2017; 10:587-94. [PMID: 27074817 PMCID: PMC4933420 DOI: 10.5009/gnl15404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/24/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
Background/Aims The roles of the many bioactive peptides in the pathogenesis of celiac disease remain unclear. To evaluate the serum concentrations of insulin, ghrelin, adiponectin, leptin, leptin receptor, and lipocalin-2 in children with celiac disease who do and do not adhere to a gluten-free diet (GFD, intermittent adherence). Methods Prepubertal, pubertal, and adolescent celiac children were included in this study (74 girls and 53 boys on a GFD and 80 girls and 40 boys off of a GFD). Results Insulin levels in prepubertal (9.01±4.43 μIU/mL), pubertal (10.3±3.62 μIU/mL), and adolescent (10.8±4.73 μIU/mL) girls were higher than those in boys (5.88±2.02, 8.81±2.88, and 8.81±2.26 μIU/mL, respectively) and were neither age-dependent nor influenced by a GFD. Prepubertal children off of a GFD exhibited higher ghrelin levels than prepubertal children on a GFD. Adiponectin levels were not age-, sex- nor GFD-dependent. Adherence to a GFD had no effect on the expression of leptin, leptin receptor, and lipocalin-2. Conclusions Adherence to a GFD had no influence on the adiponectin, leptin, leptin receptor, and lipocalin-2 concentrations in celiac children, but a GFD decreased highly elevated ghrelin levels in prepubertal children. Further studies are required to determine whether increased insulin concentrations in girls with celiac disease is suggestive of an increased risk for hyperinsulinemia.
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Affiliation(s)
- Roman M Janas
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Rybak
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Aldona Wierzbicka-Rucińska
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Rafał Śnitko
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Szaflarska-Popławska
- Department of Paediatric Endoscopy and Gastrointestinal Function Testing, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Anna Stolarczyk
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Beata Oralewska
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Cytra-Jarocka
- Department of Pediatrics, Gastroenterology and Allergology, Medical University of Białystok, Białystok, Poland
| | - Barbara Iwańczak
- Second Department of Pediatrics, Gastroenterology and Nutrition, Medical University of Wrocław, Wrocław, Poland
| | - Urszula Grzybowska-Chlebowczyk
- Department of Pediatrics, Division of Gastroenterology, Silesian Center for Child Health, Independent Public Clinical Hospital No. 6, Medical University of Silesia, Katowice, Poland
| | - Wojciech Cichy
- First Department of Paediatric, Department of Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Grażyna Czaja-Bulsa
- Department of Pediatrics, Gastroenterology and Rheumatology, Pomeranian Medical University, Szczecin, Poland
| | - Jerzy Socha
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
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Schutz C, Boulware DR, Huppler-Hullsiek K, von Hohenberg M, Rhein J, Taseera K, Thienemann F, Muzoora C, Meya DB, Meintjes G. Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis. Open Forum Infect Dis 2017; 4:ofx127. [PMID: 28752102 PMCID: PMC5527271 DOI: 10.1093/ofid/ofx127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/15/2017] [Indexed: 01/11/2023] Open
Abstract
Background Cryptococcus is the most common etiology of adult meningitis in Africa. Amphotericin B deoxycholate remains paramount to treatment, despite toxicities, including acute kidney injury (AKI). We assessed the ability of the following urine markers to predict AKI in patients who received amphotericin B: urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), tissue inhibitor of metalloproteinases-2 (TIMP-2), and protein. Methods One hundred and thirty human immunodeficiency virus (HIV)–infected participants with cryptococcal meningitis were enrolled and received amphotericin and fluconazole for 2 weeks. We defined AKI as glomerular filtration rate (GFR) < 60 mL/min/1.73 m2; measured urine NGAL, CysC, TIMP-2, and protein; and explored AKI incidence, risk factors, and associations with mortality using Cox proportional hazards models. Results Participants were 48% female with a median age of 35 years, a median CD4 count of 21 cells/μL, and 44% died within 12 months. Incident AKI occurred in 42% and was associated with mortality (adjusted hazard ratio [aHR] = 2.8; P < .001). Development of AKI was associated with female sex (P = .04) and with higher CD4 count (49 vs 14 cells/μL; P < .01). Urine protein level in the highest quartile independently predicted AKI and mortality (aHR = 1.64, P = .04; aHR = 2.13, P = .02, respectively). Urine NGAL levels in the highest quartile independently predicted AKI (aHR = 1.65; P = .04). Conclusions Acute kidney injury occurred in 42% of patients, and AKI was associated with mortality. Urine biomarkers, specifically urine protein, may be useful for antecedent prediction of amphotericin-associated AKI but need further evaluation.
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Affiliation(s)
- Charlotte Schutz
- Department of Medicine, Faculty of Health Sciences, and.,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - David R Boulware
- Division of Infectious Diseases & International Medicine, Department of Medicine, and
| | | | | | - Joshua Rhein
- Division of Infectious Diseases & International Medicine, Department of Medicine, and.,Infectious Disease Institute, Makerere University, Kampala
| | | | - Friedrich Thienemann
- Department of Medicine, Faculty of Health Sciences, and.,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, and
| | - David B Meya
- Division of Infectious Diseases & International Medicine, Department of Medicine, and.,Infectious Disease Institute, Makerere University, Kampala.,Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Graeme Meintjes
- Department of Medicine, Faculty of Health Sciences, and.,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
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105
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106
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Mesenchymal stem cells correct haemodynamic dysfunction associated with liver injury after extended resection in a pig model. Sci Rep 2017; 7:2617. [PMID: 28572613 PMCID: PMC5454025 DOI: 10.1038/s41598-017-02670-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022] Open
Abstract
In patients, acute kidney injury (AKI) is often due to haemodynamic impairment associated with hepatic decompensation following extended liver surgery. Mesenchymal stem cells (MSCs) supported tissue protection in a variety of acute and chronic diseases, and might hence ameliorate AKI induced by extended liver resection. Here, 70% liver resection was performed in male pigs. MSCs were infused through a central venous catheter and haemodynamic parameters as well as markers of acute kidney damage were monitored under intensive care conditions for 24 h post-surgery. Cytokine profiles were established to anticipate the MSCs’ potential mode of action. After extended liver resection, hyperdynamic circulation, associated with hyponatraemia, hyperkalaemia, an increase in serum aldosterone and low urine production developed. These signs of hepatorenal dysfunction and haemodynamic impairment were corrected by MSC treatment. MSCs elevated PDGF levels in the serum, possibly contributing to circulatory homeostasis. Another 14 cytokines were increased in the kidney, most of which are known to support tissue regeneration. In conclusion, MSCs supported kidney and liver function after extended liver resection. They probably acted through paracrine mechanisms improving haemodynamics and tissue homeostasis. They might thus provide a promising strategy to prevent acute kidney injury in the context of post-surgery acute liver failure.
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107
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Salvador CL, Tøndel C, Rowe AD, Bjerre A, Brun A, Brackman D, Bolstad N, Mørkrid L. Renal Function Influences Diagnostic Markers in Serum and Urine: A Study of Guanidinoacetate, Creatine, Human Epididymis Protein 4, and Neutrophil Gelatinase–Associated Lipocalin in Children. ACTA ACUST UNITED AC 2017; 2:297-308. [DOI: 10.1373/jalm.2016.022145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/17/2017] [Indexed: 11/06/2022]
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108
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Heydari B, Khalili H, Beigmohammadi MT, Abdollahi A, Karimzadeh I. Effects of atorvastatin on biomarkers of acute kidney injury in amikacin recipients: A pilot, randomized, placebo-controlled, clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:39. [PMID: 28465698 PMCID: PMC5393099 DOI: 10.4103/1735-1995.202150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/10/2016] [Accepted: 12/30/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The most common clinical indication of aminoglycosides (AG) is the treatment of serious Gram-negative infections. The aim of this study was to evaluate plausible effects of atorvastatin on the biomarkers of acute kidney injury (AKI) in patients receiving amikacin. MATERIALS AND METHODS In this double-blinded randomized clinical trial, fifty patients (25 in each group) receiving amikacin (15 mg/kg/day) were randomly assigned to either atorvastatin (40 mg/day) or placebo (40 mg/day) groups for 7 days. Blood urea nitrogen (BUN), serum creatinine (SCr), and urinary neutrophil gelatinase-associated lipocalin (NGAL) levels were measured at days 0, 1, and 7 of amikacin treatment. RESULTS During the study period, 4 (8%) patients including two patients in each atorvastatin and placebo group experienced AKI. Urine NGAL/urine Cr did not change significantly between and within placebo and atorvastatin groups during the study period. Similarly, the mean changes in SCr, BUN, and urine NGAL/urine Cr values did not differ significantly between and within patients with and without AKI. CONCLUSION Our data suggested that the changing pattern of urine NGAL/urine Cr ratio did not differ significantly between the atorvastatin and placebo groups during the early phase of amikacin treatment.
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Affiliation(s)
- Behrooz Heydari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taghi Beigmohammadi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Faculty of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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109
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Renal function assessment in heart failure. Rev Clin Esp 2017; 217:267-288. [PMID: 28258719 DOI: 10.1016/j.rce.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/17/2016] [Accepted: 01/14/2017] [Indexed: 11/23/2022]
Abstract
Renal function is one of the most consistent prognostic determinants in heart failure. The prognostic information it provides is independent of the ejection fraction and functional status. This article reviews the various renal function assessment measures, with special emphasis on the fact that the patient's clinical situation and response to the heart failure treatment should be considered for the correct interpretation of the results. Finally, we review the literature on the performance of tubular damage biomarkers.
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110
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Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM. Biomarkers in acute kidney injury - pathophysiological basis and clinical performance. Acta Physiol (Oxf) 2017; 219:554-572. [PMID: 27474473 DOI: 10.1111/apha.12764] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
Various biomarkers of acute kidney injury (AKI) have been discovered and characterized in the recent past. These molecules can be detected in urine or blood and signify structural damage to the kidney. Clinically, they are proposed as adjunct diagnostics to serum creatinine and urinary output to improve the early detection, differential diagnosis and prognostic assessment of AKI. The most obvious requirements for a biomarker include its reflection of the underlying pathophysiology of the disease. Hence, a biomarker of AKI should derive from the injured kidney and reflect a molecular process intimately connected with tissue injury. Here, we provide an overview of the basic pathophysiology, the cellular sources and the clinical performance of the most important currently proposed biomarkers of AKI: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinase 2 (TIMP-2) and calprotectin (S100A8/9). We also acknowledge each biomarker's advantages and disadvantages as well as important knowledge gaps and perspectives for future studies.
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Affiliation(s)
- E. V. Schrezenmeier
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
| | - J. Barasch
- Division of Nephrology; Columbia University College of Physicians and Surgeons; New York NY USA
| | - K. Budde
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Westhoff
- Medical Department I; Universitätsklinikum Marien Hospital Herne; Ruhr University of Bochum; Bochum Germany
| | - K. M. Schmidt-Ott
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
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111
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Zhang Y, Yu Y, Jia J, Yu W, Xu R, Geng L, Wei Y. Administration of HES in elderly patients undergoing hip arthroplasty under spinal anesthesia is not associated with an increase in renal injury. BMC Anesthesiol 2017; 17:29. [PMID: 28222674 PMCID: PMC5320746 DOI: 10.1186/s12871-017-0320-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Background Hydroxyethyl starch (HES) is applied to achieve volume expansion during surgery; however, nephrotoxicity may be induced in patients with sepsis. Simultaneously, neutrophil gelatinase-associated lipocalin (NGAL) and IL-18 have been illustrated as pivotal indicators to diagnose the acute kidney injury (AKI) early. This multi-center, randomized, double-blinded, placebo-controlled study aimed to investigate whether 6% HES 130/0.4 administration caused postoperative AKI, which can be revealed by urinary and plasma NGAL and IL-18 estimations in elderly patients with normal renal function undergoing hip arthroplasty under spinal anesthesia. Methods 120 ASA I–III, patients aged >65 y undergoing hip arthroplasty under spinal anesthesia randomly received 6% HES 130/0.4 or sodium lactate Ringer’s solution 7.5 mL/kg during the first hour of surgery. 118 patients completed the study. Blood pressure, NGAL concentrations, IL18, β2 micro-albumin and albumin in urine and creatinine, NGAL and IL-18 in plasma were repeatedly measured before, during, and after surgery. Results The groups were balanced in mean arterial pressure, urine and plasma NGAL, plasma IL-18 and creatinine, urine β2 microalbumin and albumin (P > 0.05). Urine IL-18 was dramatically elevated in both groups after surgery (P < 0.05), but did not vary significantly between the groups (P > 0.05). Conclusion Elderly patients undergoing surgery under spinal anesthesia are a high-risk population in AKI. These patients with normal renal function receiving a spinal anesthesia for a short duration surgery would not develop AKI when 500 mL (small volume) HES is infused. Trial registration Identifier: NCT02361736. Registration date was 2 February 2015.
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Affiliation(s)
- Yuanyuan Zhang
- Department of Anaesthesiology, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China.,Tianjin Research Institute of Anaesthesiology, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China
| | - Yonghao Yu
- Department of Anaesthesiology, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China. .,Tianjin Research Institute of Anaesthesiology, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China.
| | - Junya Jia
- Department of Nephron, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China
| | - Wenli Yu
- Department of Anaesthesiology, Tianjin First Central Hospital, Fukang Road 24#, Nankai District, Tianjin, CN, 300192, People's Republic of China
| | - Rubin Xu
- Department of Anaesthesiology, Tianjin First Central Hospital, Fukang Road 24#, Nankai District, Tianjin, CN, 300192, People's Republic of China
| | - Licheng Geng
- Department of Anaesthesiology, Tianjin People's Hospital Tianjin Union Medical Center, Jieyuan Road 190#, Hongqiao District, Tianjin, CN, 300121, People's Republic of China
| | - Ying Wei
- Department of Anaesthesiology, Tianjin People's Hospital Tianjin Union Medical Center, Jieyuan Road 190#, Hongqiao District, Tianjin, CN, 300121, People's Republic of China
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113
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Ribitsch W, Schilcher G, Quehenberger F, Pilz S, Portugaller RH, Truschnig-Wilders M, Zweiker R, Brodmann M, Stiegler P, Rosenkranz AR, Pickering JW, Horina JH. Neutrophil gelatinase-associated lipocalin (NGAL) fails as an early predictor of contrast induced nephropathy in chronic kidney disease (ANTI-CI-AKI study). Sci Rep 2017; 7:41300. [PMID: 28128223 PMCID: PMC5269674 DOI: 10.1038/srep41300] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/16/2016] [Indexed: 01/25/2023] Open
Abstract
The aim of the study was to evaluate the diagnostic accuracy of urinary neutrophil gelatinase- associated lipocalin (uNGAL) in patients with chronic kidney disease (CKD) as an early biomarker for contrast induced acute kidney injury (CI-AKI) and to investigate whether patients with an uNGAL increase might benefit from an additional intravenous volume expansion with regard to CI-AKI-incidence. We performed a prospective randomized controlled trial in 617 CKD-patients undergoing intra-arterial angiography. Urinary NGAL was measured the day before and 4-6hrs after angiography. In the event of a significant rise of uNGAL patients were randomized either into Group A, who received intravenous saline post procedure or Group B, who did not receive post-procedural i.v. fluids. Ten patients (1.62%) exhibited a significant rise of uNGAL after angiography and were randomized of whom one developed a CI-AKI. In the entire cohort the incidence of CI-AKI was 9.4% (58 patients) resulting in a specificity of 98.4% (95% CI: 97.0-99.3%) and a sensitivity of 1.72% (95% CI: 0.044-9.2%) of uNGAL for the diagnosis of CI-AKI. In this study uNGAL failed to predict CI-AKI and was an inadequate triage tool to guide an early intervention strategy to prevent CI-AKI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01292317.
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Affiliation(s)
- Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | - Gernot Schilcher
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.,Intensive Care Unit, Department of Internal Medicine, MUG, Austria
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Austria
| | - Rupert H Portugaller
- Department of Vascular and Interventional Radiology, University Clinic of Radiology, Medical University of Graz, Austria
| | - Martini Truschnig-Wilders
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Robert Zweiker
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Philipp Stiegler
- Division of Transplantation Surgery, Medical University of Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | - John W Pickering
- Department of Medicine, University of Otago Christchurch and Emergency Medicine Department, Christchurch Hospital, Christchurch, New Zealand
| | - Joerg H Horina
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
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Krzemień G, Pańczyk-Tomaszewska M, Adamczuk D, Kotuła I, Demkow U, Szmigielska A. Neutrophil Gelatinase-Associated Lipocalin: A Biomarker for Early Diagnosis of Urinary Tract Infections in Infants. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1047:71-80. [PMID: 28980274 DOI: 10.1007/5584_2017_107] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Early diagnosis of urinary tract infection (UTI) is challenging in infants due to unspecific symptoms, difficulty in urine collection and possible contamination. The aim of this study was to assesses the usefulness of serum and urine neutrophil gelatinase-associated lipocalin (sNGAL and uNGAL, respectively) in the diagnosis of febrile and non-febrile UTI in infants. This prospective observational study enrolled 66 infants with the first episode of UTI and 18 healthy controls. At the time of enrollment, sNGAL, uNGAL, urinalysis, urine culture, white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and serum creatinine (sCr) were assessed. We found that, on average, both sNGAL and uNGAL levels were significantly higher in febrile UTI, compared to non-febrile UTI and controls. In turn, the mean sNGAL level, but not uNGAL, was significantly higher in the non-febrile UTI group compared to controls. sNGAL positively correlated with WBC, CRP, ESR and PCT, and uNGAL with CRP and leukocyturia. The receiver operating curves (ROC) demonstrate that the optimum cut-off of 76.2 ng/ml for sNGAL (sensitivity 92.9%, specificity 94.4%, and the area under the curve (AUC) of 0.98) and of 42.2 ng/ml for uNGAL (sensitivity 73.8%, specificity 72.2%, and AUC of 0.76) for diagnosing febrile UTI and 39.0 ng/ml for sNGAL (sensitivity 83.3%, specificity 55.6%, and AUC of 0.70) for diagnosing non-febrile UTI. In conclusion, serum NGAL is an excellent marker for the early diagnosis of febrile UTI, with sensitivity and specificity higher than those of urine NGAL. Diagnostic sensitivity of serum NGAL is smaller in non-febrile infants suffering from UTI, and urine NGAL is not useful for this purpose at all.
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Affiliation(s)
- Grażyna Krzemień
- Department of Pediatrics and Nephrology, Warsaw Medical University, 63A Żwirki and Wigury Street, 02-091, Warsaw, Poland
| | - Małgorzata Pańczyk-Tomaszewska
- Department of Pediatrics and Nephrology, Warsaw Medical University, 63A Żwirki and Wigury Street, 02-091, Warsaw, Poland
| | - Dominika Adamczuk
- Department of Pediatrics and Nephrology, Warsaw Medical University, 63A Żwirki and Wigury Street, 02-091, Warsaw, Poland
| | - Iwona Kotuła
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, Warsaw, Poland
| | - Agnieszka Szmigielska
- Department of Pediatrics and Nephrology, Warsaw Medical University, 63A Żwirki and Wigury Street, 02-091, Warsaw, Poland.
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115
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Parravicini E, Locatelli C, Lorenz JM, Nemerofsky SL, Bateman DA. Is urinary neutrophil gelatinase-associated lipocalin able to predict acute kidney injury episodes in very low birth weight infants in clinical settings? Pediatr Res 2016; 80:663-667. [PMID: 27411038 DOI: 10.1038/pr.2016.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/06/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the potential utility of elevated urinary neutrophil gelatinase-associated lipocalin (UNGAL) concentration as a screening test for early identification of acute kidney injury (AKI) in very low birth weight (VLBW) newborns. METHODS Urine for UNGAL analysis was collected prospectively daily until 32 wk postmenstrual age in 91 VLBW newborns, yielding 2,899 specimens. UNGAL values > 50 ng/ml were considered elevated. AKI was defined as two or more consecutive elevations in s[Cr] above the 95th percentile adjusted for gestational age and chronological age within a 48 h period. We compared UNGAL values taken during the 5 d prior to AKI onset (pre-AKI) to values taken during non-AKI days. RESULTS Overall, 15 episodes of AKI were identified in 13 infants. UNGAL was available in 44 pre-AKI days and 969 non-AKI days. UNGAL > 50 ng/ml occurred more often in pre-AKI days than in non-AKI days (risk ratio 3.48 (1.89, 6.40)). Positive and negative likelihood ratios were 1.92 (1.52, 2.41) and 0.52 (0.34, 0.78), respectively. CONCLUSION Although UNGAL elevation > 50 ng/ml discriminates between pre-AKI and non-AKI days, high false positive and false negative rates limit utility as a screening test in VLBW newborns.
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Affiliation(s)
- Elvira Parravicini
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - John M Lorenz
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Sheri L Nemerofsky
- Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - David A Bateman
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
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116
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Sirisopha A, Vanavanan S, Chittamma A, Phakdeekitcharoen B, Thakkinstian A, Lertrit A, Sathirapongsasuti N, Kitiyakara C. Effects of Therapy on Urine Neutrophil Gelatinase-Associated Lipocalin in Nondiabetic Glomerular Diseases with Proteinuria. Int J Nephrol 2016; 2016:4904502. [PMID: 27525120 PMCID: PMC4976195 DOI: 10.1155/2016/4904502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/30/2016] [Accepted: 06/12/2016] [Indexed: 12/29/2022] Open
Abstract
Urine neutrophil gelatinase-associated lipocalin (NGAL) is widely used as a biomarker for acute kidney injury. Cross-sectional studies have shown that NGAL may be elevated in glomerular diseases, but there is limited information on the value of NGAL in predicting treatment response or on the changes of NGAL levels after therapy. We prospectively evaluated the effects of therapy on NGAL in nondiabetic glomerular diseases. Urine NGAL was collected at biopsy and follow-up at 12 months. At baseline, NGAL in glomerular disease patients (n = 43) correlated with proteinuria, but not with glomerular filtration rate (GFR). After therapy with renin-angiotensin blockers and/or immune modulating agents, change of NGAL correlated with change of proteinuria, but not with change of GFR. NGAL at baseline was not different between patients in complete remission (CR) at follow-up compared to those not in remission (NR). Compared to baseline, NGAL at follow-up decreased in CR (n = 10), but not in NR. Change of NGAL was greater in CR than NR. In conclusion, the change of urine NGAL correlated with the change of proteinuria. Baseline NGAL was not a predictor of complete remission. Future studies will be necessary to determine the role of NGAL as a predictor of long term outcome in proteinuric glomerular diseases.
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Affiliation(s)
- Amnuay Sirisopha
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Somlak Vanavanan
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Anchalee Chittamma
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Bunyong Phakdeekitcharoen
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Amornpan Lertrit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Nuankanya Sathirapongsasuti
- Graduate Program in Translational Medicine, Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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117
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The cardiac surgery–associated neutrophil gelatinase-associated lipocalin (CSA-NGAL) score: A potential tool to monitor acute tubular damage. J Thorac Cardiovasc Surg 2016; 151:1476-81. [DOI: 10.1016/j.jtcvs.2016.01.037] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/19/2015] [Accepted: 01/25/2016] [Indexed: 12/18/2022]
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118
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Risch M, Risch L, Purde MT, Renz H, Ambühl P, Szucs T, Tomonaga Y. Association of the cystatin C/creatinine ratio with the renally cleared hormones parathyroid hormone (PTH) and brain natriuretic peptide (BNP) in primary care patients: a cross-sectional study. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:379-85. [DOI: 10.1080/00365513.2016.1183262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Martin Risch
- Kantonsspital Graubünden, Zentrallabor, Chur, Switzerland
- Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland
- Faculty of Medical Sciences, Private University, Triesen, Liechtenstein
- University Institute of Clinical Chemistry, University Hospital and University of Bern, Bern, Switzerland
| | - Mette-Triin Purde
- Faculty of Science, Tallinn University of Technology, Tallinn, Estonia
| | - Harald Renz
- Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany
| | - Patrice Ambühl
- Division of Nephrology, Stadtspital Waid, Zurich, Switzerland
| | - Thomas Szucs
- European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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119
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Kafkas N, Liakos C, Zoubouloglou F, Dagadaki O, Dragasis S, Makris K. Neutrophil Gelatinase-Associated Lipocalin as an Early Marker of Contrast-Induced Nephropathy After Elective Invasive Cardiac Procedures. Clin Cardiol 2016; 39:464-70. [PMID: 27175937 DOI: 10.1002/clc.22551] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/05/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is an acute kidney injury (AKI) defined as serum creatinine (sCr) increase 48 to 72 hours after contrast administration. Because most subjects undergoing invasive cardiac procedures are discharged within 24 hours, sCr is unsuitable for CIN detection. HYPOTHESIS In the present study we tested the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) is superior compared with sCr and other established nephropathy markers in early CIN diagnosis after elective invasive cardiac procedures. METHODS Serum creatinine, urine creatinine, serum cystatin C, urine albumin, urine NGAL (uNGAL), and plasma NGAL were measured at 0, 6, 24, and 48 hours after contrast administration in 100 elective invasive cardiac procedures. Estimated glomerular filtration rate and albumin-to-creatinine ratio were calculated. Changes from baseline were considered statistically significant at P < 0.05 and clinically significant when > the biomarker's reference change value. Participants were divided into those with and without clinically significant uNGAL changes (uNGAL positive and negative for AKI, respectively). RESULTS Thirty-three individuals were uNGAL positive for AKI. Serum cystatin C changes were statistically and clinically nonsignificant in both groups. Serum creatinine and plasma NGAL were statistically but not clinically elevated 48 hours postcatheterization in the AKI group. Except for contrast volume (higher in AKI group), groups were comparable at baseline (P not significant) regarding cardiovascular risk factors, coronary heart disease, coronary interventions performed, and renal biomarkers. Baseline uNGAL was significantly correlated to estimated glomerular filtration rate and albumin-to-creatinine ratio. CONCLUSIONS Urine NGAL is potentially superior compared with conventional nephropathy markers in early CIN diagnosis after elective invasive cardiac procedures. Definition of clinically significant uNGAL changes with reference change value is probably a valuable supplement to statistically defined significant variations.
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Affiliation(s)
- Nikolaos Kafkas
- Cardiology Department, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Filitsa Zoubouloglou
- Clinical Biochemistry Department, KAT General Hospital of Attica, Kifissia, Greece
| | - Ourania Dagadaki
- Cardiology Department, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Konstantinos Makris
- Clinical Biochemistry Department, KAT General Hospital of Attica, Kifissia, Greece
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120
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Maski MR, Thomas RJ, Karumanchi SA, Parikh SM. Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with Obstructive Sleep Apnea. PLoS One 2016; 11:e0154503. [PMID: 27149121 PMCID: PMC4858300 DOI: 10.1371/journal.pone.0154503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a well-established risk factor for hypertension and cardiovascular morbidity and mortality. More recently, OSA has been implicated as an independent risk factor for chronic kidney disease. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a well-accepted early biomarker of subclinical kidney tubular injury, preceding an increase in serum creatinine. The goal of this study was to determine if an association exists between OSA and increased urinary NGAL levels. Methods We prospectively enrolled adult patients from the sleep clinic of an academic medical center. Each underwent polysomnography and submitted a urine specimen upon enrollment. We measured NGAL and creatinine levels on all urine samples before participants received treatment with continuous positive airway pressure (CPAP), and, in a subset of OSA patients, after CPAP therapy. We compared the urinary NGAL/creatinine ratio between untreated participants with and without OSA, and within a subset of 11 OSA patients also after CPAP therapy. Results A total of 49 subjects were enrolled: 16 controls based on an apnea-hypopnea index (events with at least 4% oxygen desaturation; AHI-4%) <5 events/hour (mean AHI-4% = 0.59 +/- 0.60); 33 OSA patients based on an AHI-4% >5 events/hour (mean AHI-4% = 43.3 +/- 28.1). OSA patients had a higher mean body-mass index than the control group (36.58 +/- 11.02 kg/m2 vs. 26.81 +/- 6.55 kg/m2, respectively; p = 0.0005) and were more likely to be treated for hypertension (54.5% vs. 6.25% of group members, respectively; p = 0.0014). The groups were otherwise similar in demographics, and there was no difference in the number of diabetic subjects or in the mean serum creatinine concentration (control = 0.86 +/- 0.15 mg/dl, OSA = 0.87 +/- 0.19 mg/dl; p = 0.7956). We found no difference between the urinary NGAL-to-creatinine ratios among untreated OSA patients versus control subjects (median NGAL/creatinine = 6.34 ng/mg vs. 6.41 ng/mg, respectively; p = 0.4148). Furthermore, CPAP therapy did not affect the urinary NGAL-to-creatinine ratio (p = 0.7758 for two-tailed, paired t-test). Conclusions In this prospective case-control study comparing patients with severe, hypoxic OSA to control subjects, all with normal serum creatinine, we found no difference between urinary levels of NGAL. Furthermore, CPAP therapy did not change these levels pre- and post-treatment.
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Affiliation(s)
- Manish R. Maski
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care, & Sleep Medicine/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - S. Ananth Karumanchi
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Samir M. Parikh
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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Lertrit A, Worawichawong S, Vanavanan S, Chittamma A, Muntham D, Radinahamed P, Nampoon A, Kitiyakara C. Independent associations of urine neutrophil gelatinase-associated lipocalin and serum uric acid with interstitial fibrosis and tubular atrophy in primary glomerulonephritis. Int J Nephrol Renovasc Dis 2016; 9:111-8. [PMID: 27143950 PMCID: PMC4846074 DOI: 10.2147/ijnrd.s103512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The degree of interstitial fibrosis and tubular atrophy (IFTA) is one of the strongest prognostic factors in glomerulonephritis (GN). In experimental models, high serum uric acid (UA) could contribute to IFTA through direct effects on the renal tubules, but the significance of this process has not been evaluated in patients. Urine neutrophil gelatinase–associated lipocalin (NGAL) is produced by renal tubules following acute or chronic damage. We investigated the relationship between UA and NGAL excretion in primary GN and tested whether these biomarkers are independently associated with IFTA. Urine and blood were collected from patients on the day of kidney biopsy. IFTA was assessed semi-quantitatively. Fifty-one patients with primary GN were enrolled. NGAL/creatinine correlated significantly with proteinuria but not with glomerular filtration rate (GFR). By contrast, UA correlated with GFR but not with proteinuria. NGAL/creatinine did not correlate with UA. Both NGAL/creatinine and UA increased with the severity of IFTA. By multivariate analysis, GFR, NGAL/creatinine, and UA were independently associated with moderate-to-severe IFTA. Combining UA and NGAL/creatinine with classical predictors (proteinuria and GFR) tended to improve discrimination for moderate-to-severe IFTA. Findings that UA was unrelated to urinary NGAL excretion suggest that the two biomarkers reflect different pathways related to the development of IFTA in primary GN. Both NGAL/creatinine and UA were independently associated with moderate-to-severe IFTA.
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Affiliation(s)
- Amornpan Lertrit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somlak Vanavanan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Chittamma
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dittapol Muntham
- Section for Mathematics, Faculty of Science and Technology, Rajamangala University of Technology Suvarnabhumi, Phranakhon Si Ayutthaya, Thailand
| | - Piyanuch Radinahamed
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aumporn Nampoon
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Phillips JA, Holder DJ, Ennulat D, Gautier JC, Sauer JM, Yang Y, McDuffie E, Sonee M, Gu YZ, Troth SP, Lynch K, Hamlin D, Peters DG, Brees D, Walker EG. Rat Urinary Osteopontin and Neutrophil Gelatinase-Associated Lipocalin Improve Certainty of Detecting Drug-Induced Kidney Injury. Toxicol Sci 2016; 151:214-23. [DOI: 10.1093/toxsci/kfw038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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123
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Eilenberg W, Stojkovic S, Piechota-Polanczyk A, Kaun C, Rauscher S, Gröger M, Klinger M, Wojta J, Neumayer C, Huk I, Demyanets S. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is Associated with Symptomatic Carotid Atherosclerosis and Drives Pro-inflammatory State In Vitro. Eur J Vasc Endovasc Surg 2016; 51:623-31. [PMID: 26947538 DOI: 10.1016/j.ejvs.2016.01.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Neutrophil gelatinase-associated lipocalin (NGAL), a protein found in activated neutrophils, is expressed in kidney tubule cells in response to noxious stimuli, and is thus recognized as a marker of acute kidney injury. Recent studies have suggested that NGAL could also have pathophysiological importance in cardiovascular diseases. The aim of the present study was to examine NGAL expression in human carotid endarterectomy tissues ex vivo as well as the effects of NGAL in the main cell types involved in atherogenesis, namely in human macrophages, endothelial cells, and smooth muscle cells in vitro. METHODS NGAL protein was analyzed in human endarterectomy samples from patients with asymptomatic and symptomatic carotid stenosis by immunofluorescence, and NGAL mRNA expression was detected using RealTime-PCR. Human monocyte derived macrophages (MDM), human coronary artery smooth muscle cells (HCASMC), and human umbilical vein endothelial cells (HUVEC) were treated with recombinant human (rh) NGAL at different concentrations. Interleukin (IL)-6, IL-8, and monocyte chemo-attractant protein-1 (MCP-1) were determined by specific enzyme linked immunosorbent assays (ELISAs) in culture supernatants of such treated cells. RESULTS Expression of NGAL protein was demonstrated by macrophages, smooth muscle cells, and endothelial cells in human carotid atherosclerotic tissue. NGAL mRNA expression was detected at a higher rate in atherosclerotic tissue of patients with symptomatic carotid stenosis (in 70%; n = 19) compared with asymptomatic patients (in 37%; n = 20, p < .001). Treatment of MDM, HCASMC, and HUVEC with rhNGAL led to a significant (p < 0.05) and concentration dependent increase of pro-inflammatory cytokines IL-6, IL-8, and MCP-1 in all cell types analyzed. CONCLUSION By induction of pro-inflammatory mediators in human macrophages, smooth muscle cells and endothelial cells, NGAL, which is predominantly expressed in atherosclerotic plaques of symptomatic patients, could be involved in creating the local and systemic pro-inflammatory environment characteristic for atherosclerosis.
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Affiliation(s)
- W Eilenberg
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | - S Stojkovic
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - A Piechota-Polanczyk
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | - C Kaun
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - S Rauscher
- Core Facilities, Medical University of Vienna, Austria
| | - M Gröger
- Core Facilities, Medical University of Vienna, Austria
| | - M Klinger
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | - J Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria; Core Facilities, Medical University of Vienna, Austria
| | - C Neumayer
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | - I Huk
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | - S Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
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Kim S, Kim HJ, Ahn HS, Song JY, Um TH, Cho CR, Jung H, Koo HK, Park JH, Lee SS, Park HK. Is plasma neutrophil gelatinase-associated lipocalin a predictive biomarker for acute kidney injury in sepsis patients? A systematic review and meta-analysis. J Crit Care 2016; 33:213-23. [PMID: 27017333 DOI: 10.1016/j.jcrc.2016.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/12/2016] [Accepted: 02/14/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for early diagnosis of acute kidney injury (AKI). However, the diagnostic value of NGAL for predicting AKI in sepsis patients is unclear. METHODS MEDLINE, EMBASE, and Cochrane Library databases were searched to identify research publications. RESULTS Twelve studies from 9 countries including a total of 1582 patients, of whom 315 (19.9%) developed AKI, were included in the study; plasma NGAL levels were significantly higher in adult sepsis patients with AKI than in those without AKI (mean difference, 274.65; 95% confidence interval [CI], 106.16-443.15; I(2) = 94%). Urine NGAL levels were not significantly different. The diagnostic odds ratio of plasma NGAL for predicting AKI in sepsis patients was 6.64 (95% CI, 3.80-11.58). The diagnostic accuracy of plasma NGAL was 0.881 (95% CI, 0.819-0.923) for sensitivity, 0.474 (95% CI, 0.367-0.582) for specificity, 0.216 (95% CI, 0.177-0.261) for positive predictive value and 0.965 (95% CI, 0.945-0.977) for negative predictive value. CONCLUSION Plasma NGAL has a high sensitivity and a high negative predictive value for detection of AKI in adult sepsis patients. However, its low specificity and low positive predictive value could limit its clinical utility. The usefulness of urine NGAL was not revealed in this study.
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Affiliation(s)
- Sollip Kim
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University Medical College, Seoul, Korea
| | - Hyeong-Sik Ahn
- Department of Preventive Medicine, Korea University Medical College, Seoul, Korea
| | - Ji Yang Song
- Department of Preventive Medicine, Korea University Medical College, Seoul, Korea
| | - Tae-Hyun Um
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Chong-Rae Cho
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Hoon Jung
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Hyeon-Kyoung Koo
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Joo Hyun Park
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Sung-Soon Lee
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea
| | - Hye Kyeong Park
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi, Korea.
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Yang CH, Chang CH, Chen TH, Fan PC, Chang SW, Chen CC, Chu PH, Chen YT, Yang HY, Yang CW, Chen YC. Combination of Urinary Biomarkers Improves Early Detection of Acute Kidney Injury in Patients With Heart Failure. Circ J 2016; 80:1017-23. [PMID: 26888148 DOI: 10.1253/circj.cj-15-0886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with morality and repeated hospitalization, and is frequently encountered in patients with acute decompensated heart failure (ADHF). However, few effective tools exist for early AKI identification and risk stratification. METHODS AND RESULTS This was a prospective observational study conducted in the coronary care unit (CCU) of a tertiary care university hospital. Patients with a diagnosis of ADHF and who were using diuretics were enrolled.Samples collected between December 2013 and February 2015 were tested for serum cystatin C (Cys-C), urinary neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 (KIM-1). Demographic, clinical, and laboratory data were evaluated. A total of 103 adult patients with a mean age of 68 years were investigated. AKI was diagnosed in 49 patients (47.6%). For predicting intrinsic AKI on the first day of CCU admission, a combination of Cys-C and urine KIM-1 yielded an excellent area under the receiver operating characteristic curve of 0.828, a sensitivity of 71.0%, and specificity of 43.0%, for an overall accuracy of 78%. CONCLUSIONS In this study, we found that combinations of the biomarker (Cys-C and KIM-1) were an effective clinical model for predicting AKI in patients with ADHF. The biomarker was also useful for differentiating subclinical AKI in patients with ADHF.
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Affiliation(s)
- Chia-Hung Yang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
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Urine/Plasma Neutrophil Gelatinase Associated Lipocalin Ratio Is a Sensitive and Specific Marker of Subclinical Acute Kidney Injury in Mice. PLoS One 2016; 11:e0148043. [PMID: 26824608 PMCID: PMC4732663 DOI: 10.1371/journal.pone.0148043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 01/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Detection of acute kidney injury (AKI) is still a challenge if conventional markers of kidney function are within reference range. We studied the sensitivity and specificity of NGAL as an AKI marker at different degrees of renal ischemia. METHODS Male C57BL/6J mice were subjected to 10-, 20- or 30-min unilateral renal ischemia, to control operation or no operation, and AKI was evaluated 1 day later by histology, immunohistochemistry, BUN, creatinine, NGAL (plasma and urine) and renal NGAL mRNA expression. RESULTS A short (10-min) ischemia did not alter BUN or kidney histology, but elevated plasma and urinary NGAL level and renal NGAL mRNA expression although to a much smaller extent than longer ischemia. Surprisingly, control operation elevated plasma NGAL and renal NGAL mRNA expression to a similar extent as 10-min ischemia. Further, the ratio of urine to plasma NGAL was the best parameter to differentiate a 10-min ischemic injury from control operation, while it was similar in the non and control-operated groups. CONCLUSIONS These results suggest that urinary NGAL excretion and especially ratio of urine to plasma NGAL are sensitive and specific markers of subclinical acute kidney injury in mice.
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To use or not to use hydroxyethyl starch in intraoperative care: are we ready to answer the 'Gretchen question'? Curr Opin Anaesthesiol 2016; 28:370-7. [PMID: 25887196 DOI: 10.1097/aco.0000000000000194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The decision of the European Medicines Agency (EMA) against the use of hydroxyethyl starch (HES)-based volume replacement solutions in critically ill patients has led to a general uncertainty when dealing with HES-based solutions, even though HES-containing solutions can still be used for the treatment of hypovolaemia caused by acute (sudden) blood loss. This review discusses current evidence of the intraoperative use of HES-based solutions. RECENT FINDINGS HES solutions are often criticized for possible side-effects on the kidney, the coagulation system or tissue storage. Relevant differences exist between modern 6% HES 130/0.4 and older generation of starches. Because of pathophysiological differences between elective surgery and critical illness, the evidence on renal injury and coagulation impairment with HES administration cannot be generalized. Current data suggest that there is no clinically relevant impact of 6% HES 130/0.4 administration on perioperative renal function and coagulation. Over-resuscitation is a frequent problem associated with adverse outcomes. Due to the higher volume effect, fluid overload with HES is probably more harmful than with crystalloids, whereas goal-directed use of HES may be able to reduce intraoperative fluid accumulation and overload. SUMMARY The use of 6% HES 130/0.4 in elective surgery patients is associated with reduced fluid accumulation and no clinically relevant difference in bleeding or the rate of acute kidney injury as compared with crystalloid use alone. Current data do not allow a conclusion on mortality. As they provide no benefit, older starch preparations should not be used.
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De Caridi G, Massara M, Spinelli F, Grande R, Butrico L, Rende P, Amato M, Compagna R, Amato B, de Franciscis S, Serra R. An uncommon case of arterial aneurysms association with high plasma levels of Matrix Metalloproteinase-9 and Neutrophil Gelatinase-Associated Lipocalin. Open Med (Wars) 2015; 10:492-497. [PMID: 28352742 PMCID: PMC5368871 DOI: 10.1515/med-2015-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 01/05/2023] Open
Abstract
The association of an axillary artery aneurysm and an abdominal aortic aneurysm is extremely rare. In this study, we describe this association in a 69 year-old-man. We measured this patient’s metalloproteinases (MMPs) and Neutrophil Gelatinase – Associated Lipocalin (NGAL) levels over a three years period before the abdominal aortic aneurysm rupture. We speculate that high serium levels of MMPs and NGAL may have a prognostic role and may predict aneurysm rupture in patients with an uncommon association of arterial aneurysms.
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Affiliation(s)
- Giovanni De Caridi
- Cardiovascular and Thoracic Department, University of Messina, Messina, Italy
| | - Mafalda Massara
- Cardiovascular and Thoracic Department, University of Messina, Messina, Italy
| | - Francesco Spinelli
- Cardiovascular and Thoracic Department, University of Messina, Messina, Italy
| | - Raffaele Grande
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro. Catanzaro, Italy
| | - Lucia Butrico
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro. Catanzaro, Italy
| | - Pierandrea Rende
- Department of Health Sciences, University Magna Graecia of Catanzaro. Catanzaro, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples. Naples, Italy ; Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology. Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rita Compagna
- Department of Clinical Medicine and Surgery, University Federico II of Naples. Naples, Italy ; Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology. Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples. Naples, Italy ; Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology. Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro. Catanzaro, Italy . Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology. Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro. Catanzaro, Italy ; Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology. Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy
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Significance of Neutrophil Gelatinase-Associated Lipocalin Level-to-Serum Creatinine Ratio for Assessing Severity of Inflammation in Patients with Renal Dysfunction. BIOMED RESEARCH INTERNATIONAL 2015; 2015:791926. [PMID: 26491688 PMCID: PMC4600865 DOI: 10.1155/2015/791926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 01/20/2023]
Abstract
The aim of this study was to assess the significance of the neutrophil gelatinase-associated lipocalin/serum creatinine ratio (NGAL/sCr ratio) in patients with renal dysfunction. The percent difference between plasma NGAL level and the NGAL/sCr ratio was 36.7% (95% CI, 18.4–83.7%) in patients with sCr level ≥ 1.2 mg/dL. In a multivariate analysis, high sensitivity C-reactive protein (hsCRP) was significantly associated with the NGAL/sCr ratio and plasma NGAL level (r = 0.526 and r = 0.453, resp., P < 0.001). In a receiver operating characteristics curve, the diagnostic ability of the NGAL/sCr ratio to identify hsCRP > 4.0 mg/dL was superior to that of NGAL [0.783 (95% CI, 0.674–0.892) versus 0.733 (95% CI, 0.615–0.852), P = 0.032]. The area under the curve of the NGAL/sCr ratio was larger than that of hsCRP to detect corrected erythrocyte sedimentation rate > 25 mm/h and the neutrophil-to-lymphocyte ratio >4.5 in renal dysfunction. In short, the NGAL/sCr ratio may offer useful information when screening patients with both systemic inflammation and renal dysfunction.
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Daggülli M, Utangaç MM, Dede O, Bodakci MN, Hatipoglu NK, Penbegül N, Sancaktutar AA, Bozkurt Y, Söylemez H. Potential biomarkers for the early detection of acute kidney injury after percutaneous nephrolithotripsy. Ren Fail 2015; 38:151-6. [DOI: 10.3109/0886022x.2015.1073494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Cortellini S, Pelligand L, Syme H, Chang YM, Adamantos S. Neutrophil Gelatinase-Associated Lipocalin in Dogs With Sepsis Undergoing Emergency Laparotomy: A Prospective Case-Control Study. J Vet Intern Med 2015; 29:1595-602. [PMID: 26415728 PMCID: PMC4895664 DOI: 10.1111/jvim.13638] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 08/01/2015] [Accepted: 09/03/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neutrophil gelatinase-associated lipocalin (NGAL) is an early indicator of acute kidney injury (AKI) in dogs and its use has not been evaluated in dogs with sepsis. ANIMALS Fifteen dogs with sepsis requiring laparotomy (study dogs) and 10 dogs undergoing surgery for intervertebral disc disease (control dogs). OBJECTIVE To determine whether NGAL increases in dogs with sepsis undergoing emergency laparotomy and whether it is correlated with development of AKI and survival. METHODS Longitudinal study conducted at a referral teaching hospital. Serum neutrophil gelatinase-associated lipocalin (sNGAL), urinary NGAL normalized to urinary creatinine concentration (UNCR), and serum creatinine concentration were measured at 4 time points (admission, after anesthesia, and 24 and 48 hours postsurgery). Development of AKI (increase in serum creatinine concentration of 0.3 mg/dL) and in-hospital mortality were recorded. Linear mixed-model analysis was employed to assess differences between groups over time. Mann-Whitney U-test was performed for comparison of continuous variables between groups and Chi square or Fisher's exact tests were used to assess correlation between discrete data. RESULTS Serum NGAL and UNCR were significantly higher in study dogs across all time points (P = .007 and P < .001, respectively) compared with controls. Urinary NGAL normalized to creatinine in the study group was not significantly different between survivors (n = 12) and nonsurvivors (n = 3). Dogs that received hydroxyethyl starch had significantly higher UNCR across all time points (P = .04) than those that did not. DISCUSSION-CONCLUSION Serum neutrophil gelatinase-associated lipocalin and UNCR are increased in dogs with sepsis requiring emergency laparotomy. Additional studies are needed to evaluate its role as a marker of AKI in this population.
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Affiliation(s)
- S Cortellini
- Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - L Pelligand
- Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.,Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - H Syme
- Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Y M Chang
- Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - S Adamantos
- Langford Veterinary Services, University of Bristol, Langford, UK
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Vaulont S, Schalk I. [Roles of bacterial and mammalian siderophores in host-pathogen interactions]. Med Sci (Paris) 2015; 31:756-63. [PMID: 26340835 DOI: 10.1051/medsci/20153108014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Iron is an essential nutriment for almost all forms of life, from bacteria to humans. Despite its key role in living organisms, iron becomes toxic at high concentrations. In the body, to circumvent this toxicity, almost all the intracellular iron is bound to proteins (especially to ferritin, a protein able to bind up to 4000 atoms of iron) and a small proportion (0.2% to 3%) to low molecular weight ligands (less than 2 kDa) constituting a free iron pool able to ensure the traffic of intracellular iron. A number of small molecules (citrate, phosphate, phospholipid, polypeptide) able to chelate iron, with variable affinities, have been known for a long time. In 2010, two teams have identified new mammal endogen chelators able to bind iron with similar chemical properties as bacterial siderophores. Recently, a few publications emphasized that most of the free iron present in the body cells is indeed linked to these siderophores, which play a key role in infected-host protection mechanisms during bacterial infections, through iron homeostasis and oxidative stress regulation.
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Affiliation(s)
- Sophie Vaulont
- Inserm U1016, institut Cochin, 24, rue du Faubourg Saint-Jacques, 75014 Paris, France - CNRS, UMR8104, Paris, France - Université Paris Descartes, Sorbonne Paris Cité, Paris, France - Laboratory of excellence GR-Ex
| | - Isabelle Schalk
- UMR 7242, université de Strasbourg-CNRS, ESBS, Strasbourg, France - CNRS, UMR 7242, ESBS, Illkirch, France
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Abstract
Acute kidney injury (AKI) is a common and often lethal complication that is also associated with severe morbidity in hospitalized patients. During the last decade, the standardization of AKI diagnostic criteria has helped to facilitate several large-scale investigations of biomarkers of AKI. These studies have led to the international clinical implementation of several biomarkers of renal injury. This review summarizes the results of many of these multicenter investigations and discusses the clinical utility and interpretation of several of these new clinical tests. The merits of combining biomarkers of kidney function is also discussed.
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Neutrophil Gelatinase-Associated Lipocalin: A New Marker of Renal Function in C-Related End Stage Liver Disease. Gastroenterol Res Pract 2015. [PMID: 26221137 PMCID: PMC4499389 DOI: 10.1155/2015/815484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background/Aims. Renal impairment is a common complication of cirrhosis. Serum creatinine is less sensitive in these patients. Measurement of the glomerular filtration rate (GFR) is the gold standard but time consuming. The aim is to validate plasma NGAL (pNGAL) and urinary NGAL (uNGAL) as markers of renal function in patients with HCV related cirrhosis. Patient and Methods. One hundred HCV related end stage liver cirrhosis patients were randomized into two groups: Group I (n = 35), patients with GFR < 60 mL/m measured by isotope scanning of the kidney (Renogram), and Group II (n = 65), patients with GFR ≥ 60 mL/m. The pNGAL and uNGAL were measured within 2 days of the Renogram. Results. Both groups were matched with age, sex, and Child Pugh score. There was statistically significant difference between both groups regarding serum creatinine (1.98 ± 1.04 versus 1.38 ± 0.88 mg/dL; p = 0.003) and pNGAL level (5.79 ± 2.06 versus 7.25 ± 3.30 ng/dL; p = 0.019). Both groups were comparable (p > 0.05) for the uNGAL (6.00 ± 0.78 versus 6.03 ± 0.96 ng/mL). Unlike uNGAL, the pNGAL positively correlated with total GFR by Renogram (r = 0.3; p = 0.001). With a cutoff ≥4 ng/mL, pNGAL had 94.3% sensitivity and 1.5% specificity and PPV = 34, NPV = 33.3, LR+ = −175.1, and LR− = −60.6. Conclusion. The pNGAL is a promising marker of the renal function in patients with cirrhosis.
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136
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Huen SC, Parikh CR. Molecular phenotyping of clinical AKI with novel urinary biomarkers. Am J Physiol Renal Physiol 2015; 309:F406-13. [PMID: 26084933 DOI: 10.1152/ajprenal.00682.2014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 06/10/2015] [Indexed: 01/09/2023] Open
Abstract
Acute kidney injury (AKI) is a common hospital complication. There are no effective treatments to minimize kidney injury or limit associated morbidity and mortality. Currently, serum creatinine and urine output remain the gold standard used clinically in the diagnosis of AKI. Several novel biomarkers can diagnose AKI earlier than elevations of serum creatinine and changes in urine output. Recent long-term observational studies have elucidated a subgroup of patients who have positive biomarkers of AKI but do not meet criteria for AKI by serum creatinine or urine output, termed subclinical AKI. These patients with subclinical AKI have increased risk of both short- and long-term mortality. In this review, we will highlight the implications of what these patients may represent and the need for better phenotyping of AKI by etiology, severity of injury, and ability to recover. We will discuss two AKI biomarkers, neutrophil gelatinase-associated lipocalin (NGAL) and breast regression protein-39 (BRP-39)/YKL-40, that exemplify the need to characterize the complexity of the biological meaning behind the biomarker, beyond elevated levels reporting on tissue injury. Ultimately, careful phenotyping of AKI will lead to identification of therapeutic targets and appropriate patient populations for clinical trials.
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Affiliation(s)
- Sarah C Huen
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
| | - Chirag R Parikh
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut
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M. Sancho-Martínez S, Prieto L, Blanco-Gozalo V, Fontecha-Barriuso M, Vicente-Vicente L, G. Casanova A, Prieto M, Pescador M, I. Morales A, M. López-Novoa J, Martínez-Salgado C, J. López-Hernández F. Acute tubular necrosis: An old term in search for a new meaning within the evolving concept of acute kidney injury. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.nhtm.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rafiei A, Mohammadjafari H, Bazi S, Mirabi AM. Urinary neutrophil gelatinase-associated lipocalin (NGAL) might be an independent marker for anticipating scar formation in children with acute pyelonephritis. J Renal Inj Prev 2015; 4:39-44. [PMID: 26060836 PMCID: PMC4459727 DOI: 10.12861/jrip.2015.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/04/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Urinary tract infections (UTIs) are the most serious common bacterial infections among young children. It may affect kidneys that classified as acute pyelonephritis (APN) and may lead to renal parenchymal involvement and scarring with high prevalence rate (15%-60%) among children. This study aimed to assess the urinary concentration of neutrophil gelatinase-associated lipocalin (NGAL) in patients with APN to diagnose those with potency to scar formation. PATIENTS AND METHODS Children who were admitted with a diagnosis of APN were enrolled and divided into two groups; APN with scar and APN without scar. Urinary levels of NGAL and its ratio to creatinine (Cr) levels were measured in the acute phase of infection. A receiver operating characteristic (ROC) curve was generated to allow calculation of cut-off values. RESULTS Fifty-four children were enrolled across the 2 groups: group 1 consisted of 16 patients (all female); group 2 consisted of 38 children (36 female and 2 male). Urinary levels of NGAL were significantly higher in APN with scar than in APN without scar (P = 0.037). For comparison of groups 1 and 2, the cut-off values were measured as 7.32 ng/ml, sensitivity; 81.3% and specificity; 66%. CONCLUSION Evaluation of urinary NGAL levels may help us to identify children with APN who are at risk of developing renal scarring.
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Affiliation(s)
- Alireza Rafiei
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Mohammadjafari
- Antimicrobial Resistant Nosocomial Infection Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sara Bazi
- Department of Pediatrics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Araz Mohammad Mirabi
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Persson PB. Waterworks. Acta Physiol (Oxf) 2015; 214:147-8. [PMID: 25882508 DOI: 10.1111/apha.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P. B. Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
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Ramirez-Sandoval JC, Herrington W, Morales-Buenrostro LE. Neutrophil gelatinase-associated lipocalin in kidney transplantation: A review. Transplant Rev (Orlando) 2015; 29:139-44. [PMID: 26071983 DOI: 10.1016/j.trre.2015.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 12/13/2022]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a protein expressed by kidney tubular cells in response to ischemia, but may also be an early indicator of immunological rejection, calcineurin inhibitor toxicity, obstructive nephropathy, subclinical tubulitis or infection. Although there is currently no evidence to support the routine serial measurement of blood or urinary NGAL to detect subclinical acute tubular injury, NGAL has the potential to provide useful information to those that care for kidney transplant recipients (KTRs). First, high urinary or serum NGAL concentrations shortly after transplantation are a predictor of delayed graft function and are associated with reduced graft function at one year. Secondly, among KTRs with previously stable graft function who then suffer acute graft dysfunction, a high urinary NGAL predicts graft loss at one year. If further refined, diagnostic tests based on NGAL levels may provide future useful clinical tools.
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Affiliation(s)
- Juan C Ramirez-Sandoval
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador, Zubirán, ZP 14000, Mexico City, Mexico
| | - William Herrington
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Churchill Hospital, Headington, Oxford, OX3 7LJ, UK
| | - Luis E Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador, Zubirán, ZP 14000, Mexico City, Mexico.
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Delfino Duarte PA, Fumagalli AC, Wandeur V, Becker D. Urinary neutrophil gelatinase-associated lipocalin in critically ill surgical cancer patients. Indian J Crit Care Med 2015; 19:251-6. [PMID: 25983430 PMCID: PMC4430742 DOI: 10.4103/0972-5229.156459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS Neutrophil gelatinase-associated lipocalin (N-GAL) is an early biomarker of acute kidney injury (AKI) due to various etiologies. On the other hand, N-GAL is also elevated in patients with acute inflammatory conditions and in several solid neoplasms. The goal of this study was to assess the efficacy of N-GAL as a predictor of AKI and mortality in oncological surgical patients postoperatively in the intensive care unit (ICU). METHODS This was a prospective cohort observation study on adult cancer patients submitted to elective or emergency surgeries and admitted in the ICU. Urinary N-GAL was measured at the first 2 h after admission. AKI incidence and other complications were assessed, including hospital mortality. RESULTS A total of 22 patients were assessed (77% male, age 52.8 years, Acute Physiology and Chronic Health Evaluation II [APACHE II] 17.3) in whom the most frequent site of cancer was the gastrointestinal tract. AKI incidence was 13.6%. Urinary N-GAL was a predictor of AKI (22.0 ng/ml in patients without AKI vs. 239.1 ng/ml in patients with AKI, P < 0.001). Multivariate analysis showed that the main predictors of AKI were age, APACHE II, and N-GAL. N-GAL was also higher, although not statistically significant in patients who died in the hospital. CONCLUSIONS In oncological postoperative patients admitted to the ICU, urinary N-GAL was an independent predictor of AKI; moreover, its level was higher in the deceased patients.
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Affiliation(s)
- Pericles Almeida Delfino Duarte
- From: General Intensive Care Unit, Cancer Hospital/Western Paraná State League for Cancer Treatment and Research (UOPECCAN), Cascavel, PR, Brazil
| | - Andreia Cristina Fumagalli
- From: General Intensive Care Unit, Cancer Hospital/Western Paraná State League for Cancer Treatment and Research (UOPECCAN), Cascavel, PR, Brazil
| | | | - Delmiro Becker
- From: General Intensive Care Unit, Cancer Hospital/Western Paraná State League for Cancer Treatment and Research (UOPECCAN), Cascavel, PR, Brazil
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Kancir ASP, Johansen JK, Ekeloef NP, Pedersen EB. The effect of 6% hydroxyethyl starch 130/0.4 on renal function, arterial blood pressure, and vasoactive hormones during radical prostatectomy: a randomized controlled trial. Anesth Analg 2015; 120:608-618. [PMID: 25627076 DOI: 10.1213/ane.0000000000000596] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although hydroxyethyl starch (HES) is commonly used as an intravascular volume expander in surgical patients, recent studies suggest that it may increase the risk of renal failure in critically ill patients. We hypothesized that patients undergoing radical prostatectomy and receiving HES would be more likely to develop markers of renal failure, such as increasing urinary neutrophil gelatinase-associated lipocalin (u-NGAL), creatinine clearance (C(crea)), and decreasing urine output (UO). METHODS In a randomized, double-blinded, placebo-controlled study, 40 patients referred for radical prostatectomy received either 6% HES 130/0.4 or saline 0.9%; 7.5 mL/kg during the first hour of surgery and 5 mL/kg in the following hours; u-NGAL, urine albumin, C(crea), UO, arterial blood pressure, and plasma concentrations of creatinine, renin, angiotensin II, aldosterone, and vasopressin were measured before, during, and after surgery. RESULTS Thirty-six patients completed the study. u-NGAL, C(crea), UO, plasma neutrophil gelatinase-associated lipocalin, p-creatinine, urine albumin, and arterial blood pressure were the same in both groups. Blood loss was higher in the HES group (HES 1250 vs saline 750 mL), while p-albumin was reduced to a significantly lower level. P-renin and p-angiotensin-II increased in both groups, whereas p-aldosterone and p-vasopressin increased significantly in the saline group. CONCLUSIONS We found no evidence of nephrotoxicity after infusion of 6% HES 130/0.4 in patients undergoing prostatectomy with normal preoperative renal function. Hemodynamic stability and infused fluid volume were the same in both groups. We observed an increased blood loss in the group given 6% HES 130/0.4.
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Affiliation(s)
- Anne Sophie Pinholt Kancir
- From the *University Clinic for Nephrology and Hypertension, Department of Medical Research and Medicine, and Department of Anesthesiology, Holstebro Hospital and University of Aarhus, Holstebro, Denmark; †Department of Urology, Holstebro Hospital, Holstebro, Denmark; ‡Department of Anesthesiology, Holstebro Hospital, Holstebro, Denmark; and §University Clinic for Nephrology and Hypertension, Department of Medical Research and Department of Medicine, Holstebro Hospital and University of Aarhus, Holstebro, Denmark
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143
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Imamura T, Kinugawa K, Doi K, Hatano M, Fujino T, Kinoshita O, Nawata K, Noiri E, Kyo S, Ono M. Plasma neutrophil gelatinase-associated lipocalin and worsening renal function during everolimus therapy after heart transplantation. Int Heart J 2015; 56:73-9. [PMID: 25742944 DOI: 10.1536/ihj.14-179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recently, the mammalian target of rapamycin inhibitor everolimus (EVL) has been introduced as a novel immunosuppressant for heart transplant (HTx) recipients, and is expected to preserve renal function compared to conventional calcineurin inhibitors (CNIs). However, a considerable number of recipients treated with EVL were not free from worsening renal function regardless of CNI reduction. Data were collected retrospectively from 27 HTx recipients who had received EVL (trough concentration, 3.1-9.2 ng/mL) along with reduced CNIs (%decreases in trough concentration, 27.3 ± 13.0%) because of switching from mycophenolate mophetil due to digestive symptoms or neutropenia, progressive coronary artery vasculopathy, or persistent renal dysfunction, and had been followed over 1 year between August 2008 and January 2013. Estimated glomerular filtration rate (eGFR) decreased in 5 recipients (18.5%) during the study period. Univariate logistic regression analysis demonstrated that a higher plasma neutrophil gelatinase-associated lipocalin (P-NGAL) level was the only significant predictor for a decrease in eGFR over a 1-year EVL treatment period among all baseline parameters (P = 0.008). eGFR and proteinuria worsened almost exclusively in patients with baseline P-NGAL ≥ 85 ng/mL, which was the cutoff value calculated by an ROC analysis (area under the curve, 0.955; sensitivity, 1.000; specificity, 0.955). In conclusion, higher P-NGAL may be a novel predictor for the worsening of renal function after EVL treatment that is resistant to CNI reduction in HTx recipients.
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Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
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144
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Lafferty EI, Wiltshire SA, Angers I, Vidal SM, Qureshi ST. Unc93b1 -Dependent Endosomal Toll-Like Receptor Signaling Regulates Inflammation and Mortality during Coxsackievirus B3 Infection. J Innate Immun 2015; 7:315-30. [PMID: 25675947 DOI: 10.1159/000369342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/26/2014] [Indexed: 12/24/2022] Open
Abstract
Coxsackievirus strain B serotype 3 (CVB3)-induced myocarditis is an important human disease that causes permanent tissue damage and can lead to death from acute infection or long-term morbidity caused by chronic inflammation. The timing and magnitude of immune activation following CVB3 infection can mediate a positive host outcome or increase tissue pathology. To better elucidate the role of endosomal Toll-like receptor (TLR) signaling in acute CVB3 infection, we studied mice with a loss-of-function mutation, known as Letr for 'loss of endosomal TLR response', in Unc93b1, which is a chaperone protein for TLR3, TLR7 and TLR9. Using Unc93b1(Letr/)(Letr) mice, we determined that Unc93b1-dependent TLR activation was essential for the survival of acute CVB3-induced myocarditis. We also determined that a lack of endosomal TLR signaling was associated with a higher viral load in target organs and that it increased inflammation, necrosis and fibrosis in cardiac tissue. Loss of Unc93b1 function was also associated with increased cardiac expression of Ifn-b and markers of tissue injury and fibrosis including Lcn2 and Serpina3n early after CVB3 infection. These observations establish a significant role for Unc93b1 in the regulation of the host inflammatory response to CVB3 infection and also reveal potential mediators of host tissue damage that merit further investigation in acute viral myocarditis.
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Affiliation(s)
- Erin I Lafferty
- Meakins-Christie Laboratories, McGill University, Montréal, Qué., Canada
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145
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Diverse functional roles of lipocalin-2 in the central nervous system. Neurosci Biobehav Rev 2015; 49:135-56. [DOI: 10.1016/j.neubiorev.2014.12.006] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 11/28/2014] [Accepted: 12/04/2014] [Indexed: 12/16/2022]
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146
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Persson PB. Acta Physiologica strives to make the research world a bit fairer. Acta Physiol (Oxf) 2015. [DOI: 10.1111/apha.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P. B. Persson
- Institute of Vegetative Physiology; Charité Universitaetsmedizin Berlin; Berlin Germany
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147
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Neutrophil gelatinase-associated lipocalin (NGAL) in heart transplant recipients after conversion to everolimus therapy. J Cardiol 2015; 66:347-52. [PMID: 25583090 DOI: 10.1016/j.jjcc.2014.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/07/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Due to the lack of nephrotoxic activity, proliferation signal inhibitors (PSI) such as everolimus are recommended for immunosuppression after heart transplantation, but the assessment of renal function in patients receiving PSI has led to conflicting results. We examined renal integrity and function using neutrophil gelatinase-associated lipocalin (NGAL) and conventional markers [plasma creatinine, cystatin C, urine albumin, α1-microglobulin (α1M)] in heart transplant patients, who underwent conversion to everolimus due to allograft vasculopathy, graft rejection episodes, or renal function deterioration, and in patients maintained on calcineurin inhibitors (CNI). METHODS This cross-sectional study included 121 consecutive heart transplant recipients: 44 patients received CNI-free immunosuppressive therapy with everolimus and 77 patients received CNI. Renal parameters were determined in plasma and urine samples using standard enzymatic or immunochemical methods. RESULTS Heart transplant recipients receiving everolimus therapy had significantly lower NGAL concentrations in plasma [median (95% CI): 128 (97-176)ng/mL vs. 252 (224-283)ng/mL, p<0.001] and urine [median (95% CI): 6.4 (4.5-7.6)ng/g vs. 15.7 (10.2-25.9)ng/g creatinine, p<0.001]. In contrast, no significant differences were observed between everolimus- and CNI-treated groups with regard to creatinine and cystatin C, as well as urine albumin and α1M levels. Significant correlations were noted between plasma NGAL and creatinine (r=0.42, p<0.001), cystatin C (r=0.44, p<0.001), N-terminal brain natriuretic propeptide (r=0.31, p<0.01) and indicators of chronic inflammation [lipoprotein-associated phospholipase A2 (Lp-PLA2), r=0.31, p<0.01] and soluble CD40 ligand (sCD40L, r=0.22, p<0.05), and between urinary NGAL and α1M (r=0.21, p<0.05). Multiple regression analysis indicated that cystatin C and Lp-PLA2 were the best predictors of plasma NGAL. CONCLUSION The present study documents reduced plasma and urinary NGAL levels in the absence of differences in conventional renal parameters in patients on CNI-free immunosuppressive therapy with everolimus. These results support favorable effects of everolimus on renal integrity in heart transplant recipients.
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148
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Alhaddad OM, Alsebaey A, Amer MO, El-Said HH, Salman TAH. Neutrophil Gelatinase-Associated Lipocalin: A New Marker of Renal Function in C-Related End Stage Liver Disease. Gastroenterol Res Pract 2015. [DOI: https://doi.org/10.1155/2015/815484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background/Aims. Renal impairment is a common complication of cirrhosis. Serum creatinine is less sensitive in these patients. Measurement of the glomerular filtration rate (GFR) is the gold standard but time consuming. The aim is to validate plasma NGAL (pNGAL) and urinary NGAL (uNGAL) as markers of renal function in patients with HCV related cirrhosis.Patient and Methods. One hundred HCV related end stage liver cirrhosis patients were randomized into two groups: Group I (n=35), patients with GFR < 60 mL/m measured by isotope scanning of the kidney (Renogram), and Group II (n=65), patients with GFR ≥ 60 mL/m. The pNGAL and uNGAL were measured within 2 days of the Renogram.Results. Both groups were matched with age, sex, and Child Pugh score. There was statistically significant difference between both groups regarding serum creatinine (1.98 ± 1.04 versus 1.38 ± 0.88 mg/dL;p=0.003) and pNGAL level (5.79 ± 2.06 versus 7.25 ± 3.30 ng/dL;p=0.019). Both groups were comparable (p>0.05) for the uNGAL (6.00 ± 0.78 versus 6.03 ± 0.96 ng/mL). Unlike uNGAL, the pNGAL positively correlated with total GFR by Renogram (r=0.3;p=0.001). With a cutoff ≥4 ng/mL, pNGAL had 94.3% sensitivity and 1.5% specificity and PPV = 34, NPV = 33.3, LR+ = −175.1, and LR− = −60.6.Conclusion. The pNGAL is a promising marker of the renal function in patients with cirrhosis.
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Affiliation(s)
| | - Ayman Alsebaey
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Mohamed Omar Amer
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Hala Hany El-Said
- Department of Clinical Biochemistry, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Tary Abdel Hamid Salman
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
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149
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Alhaddad OM, Alsebaey A, Amer MO, El-Said HH, Salman TAH. Neutrophil Gelatinase-Associated Lipocalin: A New Marker of Renal Function in C-Related End Stage Liver Disease. Gastroenterol Res Pract 2015. [DOI: https:/doi.org/10.1155/2015/815484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background/Aims. Renal impairment is a common complication of cirrhosis. Serum creatinine is less sensitive in these patients. Measurement of the glomerular filtration rate (GFR) is the gold standard but time consuming. The aim is to validate plasma NGAL (pNGAL) and urinary NGAL (uNGAL) as markers of renal function in patients with HCV related cirrhosis.Patient and Methods. One hundred HCV related end stage liver cirrhosis patients were randomized into two groups: Group I (n=35), patients with GFR < 60 mL/m measured by isotope scanning of the kidney (Renogram), and Group II (n=65), patients with GFR ≥ 60 mL/m. The pNGAL and uNGAL were measured within 2 days of the Renogram.Results. Both groups were matched with age, sex, and Child Pugh score. There was statistically significant difference between both groups regarding serum creatinine (1.98 ± 1.04 versus 1.38 ± 0.88 mg/dL;p=0.003) and pNGAL level (5.79 ± 2.06 versus 7.25 ± 3.30 ng/dL;p=0.019). Both groups were comparable (p>0.05) for the uNGAL (6.00 ± 0.78 versus 6.03 ± 0.96 ng/mL). Unlike uNGAL, the pNGAL positively correlated with total GFR by Renogram (r=0.3;p=0.001). With a cutoff ≥4 ng/mL, pNGAL had 94.3% sensitivity and 1.5% specificity and PPV = 34, NPV = 33.3, LR+ = −175.1, and LR− = −60.6.Conclusion. The pNGAL is a promising marker of the renal function in patients with cirrhosis.
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Affiliation(s)
| | - Ayman Alsebaey
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Mohamed Omar Amer
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Hala Hany El-Said
- Department of Clinical Biochemistry, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Tary Abdel Hamid Salman
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
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150
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Lack of nephrotoxicity by 6% hydroxyethyl starch 130/0.4 during hip arthroplasty: a randomized controlled trial. Anesthesiology 2014; 121:948-58. [PMID: 25127210 DOI: 10.1097/aln.0000000000000413] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hydroxyethyl starch (HES) is commonly used as plasma expander during surgery but may be nephrotoxic as seen in studies in patients with sepsis. The authors hypothesized that the possible nephrotoxicity of 6% HES 130/0.4 could be revealed by measurements of urinary excretion of neutrophil gelatinase-associated lipocalin (u-NGAL) in patients with normal renal function during hip arthroplasty. METHODS In this randomized, double-blinded, placebo-controlled study, 40 patients referred for hip arthroplasty received either 6% HES 130/0.4 or isotonic saline 0.9%; 7.5 ml/kg during the first hour of surgery and 5 ml/kg during the following hours; 38 patients completed the study. U-NGAL, urine albumin, blood pressure, and plasma concentrations of creatinine, renin, NGAL, albumin, angiotensin-II, and aldosterone were measured before, during, and after surgery. U-NGAL was defined as primary outcome. RESULTS There were no significant differences in U-NGAL (mean difference and 95% CI), plasma creatinine, and urine albumin during the study. U-NGAL and urine albumin increased significantly in both groups the morning after surgery but was normalized at follow-up after 10 to 12 days. Mean arterial pressure was significantly higher during the recovery period in the HES group compared with that in the control group (91 [13] and 83 [6] mmHg, mean [SD], P < 0.03). Plasma renin and angiotensin-II were nonsignificantly different in both groups, whereas plasma aldosterone was significantly lower in the HES group. Plasma albumin was reduced in both groups, but to a significantly lower level in the HES group. CONCLUSION The study showed no evidence of a harmful effect of intraoperative infusion of 6% HES 130/0.4 on renal function in patients during hip arthroplasty.
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