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Alzu'bi A, Abu-El-Rub E, Al-Trad B, Alzoubi H, Abu-El-Rub H, Albals D, Abdelhady GT, Bader NS, Almazari R, Al-Zoubi RM. In vivo assessment of the nephrotoxic effects of the synthetic cannabinoid AB-FUBINACA. Forensic Toxicol 2024:10.1007/s11419-024-00699-9. [PMID: 39120650 DOI: 10.1007/s11419-024-00699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/28/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The widespread misuse of synthetic cannabinoids (SCs) has led to a notable increase in reported adverse effects, raising significant health concerns. SCs use has been particularly associated with acute kidney injury (AKI). However, the pathogenesis of SCs-induced AKI is not well-understood. METHODS We investigated the nephrotoxic effect of acute administration of N-[(1S)- 1-(aminocarbonyl)-2-methylpropyl]-1-[(4-fluorophenyl)methyl]-1H-indazole-3-carboxamide (AB-FUBINKA) (3 mg/kg for 5 days) in mice. Various parameters of oxidative stress, inflammation, and apoptosis have been quantified. The expressions of mitochondrial complexes (I-V) in renal tissues were also assessed. RESULTS Our findings showed that AB-FUBINACA induced substantial impairment in the renal function that is accompanied by elevated expression of renal tubular damage markers; KIM-1 and NGAL. Administration of AB-FUBINACA was found to be associated with a significant increase in the expression of oxidative stress markers (iNOS, NOX4, NOX2, NOS3) and the level of lipid peroxidation in the kidney. The expression of pro-inflammatory markers (IL-6, TNF-alpha, NF-kB) was also enhanced following exposure to AB-FUBINACA. These findings were also correlated with increased expression of major apoptosis regulatory markers (Bax, caspase-9, caspase-3) and reduced expression of mitochondrial complexes I, III, and IV. CONCLUSION These results indicate that AB-FUBINACA can trigger oxidative stress and inflammation, and activate caspase-dependent apoptosis in the kidney, with these processes being possibly linked to disruption of mitochondrial complexes and could be an underlying mechanism of SCs-induced nephrotoxicity.
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Affiliation(s)
- Ayman Alzu'bi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan.
| | - Ejlal Abu-El-Rub
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Bahaa Al-Trad
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, 211-63, Jordan
| | - Hiba Alzoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Hadeel Abu-El-Rub
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Dima Albals
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Yarmouk University, Irbid, 211-63, Jordan
| | - Gamal T Abdelhady
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Noor S Bader
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Rawan Almazari
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, 3050, Doha, Qatar.
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, 2713, Doha, Qatar.
- Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
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Özatman E, Aksu B, Zemheri IE, Erman H, Durakbaşa ÇU. Investigation of reno-protective efficacy of thymoquinone in a unilateral hydronephrosis model. Biotech Histochem 2024:1-8. [PMID: 38780092 DOI: 10.1080/10520295.2024.2358034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
We aimed to evaluate the effects of the antioxidant thymoquinone on treated and untreated kidneys on histological and oxidative parameters as well as Kidney Injury Molecule (KIM-1) levels in an experimental unilateral ureteropelvic junction obstruction (UPJO) with resultant hydronephrosis (HN) model. In adherence to the Animal research: reporting of in vivo exepriments guidelines, 34 male Wistar rats were randomly divided into four groups which were named accordingly: "CO" (corn oil), "TQ" (thymoquinone and corn oil), "HNCO" (UPJO-HN and corn oil), "HNTQ" (UPJO-HN, thymoquinone and corn oil). Histologically, pelvic epithelial damage, glomerular shrinkage and sclerosis, tubular damage, interstitial edema-inflammation-fibrosis (IEIF), and vascular congestion were assessed. Biochemically, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione reductase (GR) and KIM-1 levels were assessed. Macroscopic HN developed in all obstructed kidneys. Ipsilateral obstructed kidneys deteriorated in all histological parameters. Thymoquinone attenuated glomerular shrinkage and sclerosis alterations but increased vascular congestion. Contralateral non-obstructed kidneys also showed histological deterioration. Thymoquinone had beneficial effects in terms of IEIF presence in contralateral kidneys but it increased vascular congestion. MDA and SOD results were inconclusive. UPJO caused decreased GR levels in the ipsilateral kidneys but not in the contralateral ones. This effect was not ameliorated by thymoquinone treatment. KIM-1 levels were increased in ipsilateral obstructed kidneys with a lower level in HNTQ group than in HNCO. KIM-1 level of the ipsilateral HNTQ group was higher than in both non-obstructed ipsilateral kidney groups. The effect of thymoquinone in ameliorating bilaterally observed histological alterations was limited and controversial. Oxidative damage detected by GR measurements was not prevented by thymoquinone. Thymoquinone partially decreased the damage as evidenced by reduced KIM-1 levels in thymoquinone-treated obstructed kidneys.
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Affiliation(s)
- Erdem Özatman
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Hospital, Prof. Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
| | - Burhan Aksu
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Hospital, Prof. Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
| | - Itir Ebru Zemheri
- Department of Pathology, Saglik Bilimleri University Hamidiye Faculty of Medicine, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Hayriye Erman
- Department of Biochemistry, Istanbul Medeniyet University Faculty of Medicine, Prof. Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
| | - Çiğdem Ulukaya Durakbaşa
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Hospital, Prof. Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
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3
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Lv W, Xue L, Liang L, Liu D, Li C, Liao J, Jin Y. Endotoxin induced acute kidney injury modulates expression of AQP1, P53 and P21 in rat kidney, heart, lung and small intestine. PLoS One 2023; 18:e0288507. [PMID: 37490500 PMCID: PMC10368293 DOI: 10.1371/journal.pone.0288507] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023] Open
Abstract
This study was designed to explore whether aquaporin 1(AQP1), P53 and P21 can be used as diagnostic biomarkers of lipopolysaccharide (LPS)-induced acute kidney injury (AKI) and potential indicators of sepsis-induced multiple organ injury. Bioinformatics results demonstrated that AQP1, P53, P21 was dramatically elevated 6h after Cecal ligation and puncture (CLP)-AKI in rat renal tissue. The expression of AQP1, P53, P21, NGAL and KIM-1 in kidney were increased significantly at first and then decreased gradually in LPS-induced AKI rats. Histopathological sections showed swelling of tubular epithelial cells and destruction of basic structures as well as infiltration of numerous inflammatory cells in LPS-induced AKI. Moreover, the expressions of AQP1, P53 and P21 in heart were significantly increased in LPS treatment rats, while the AQP1 expressions in lung and small intestine were significantly decreased. The level of NGAL mRNA in heart, lung and small intestine was firstly increased and then decreased during LPS treatment rats, but the expression of KIM-1 mRNA was not affected. Therefore, our results suggest that AQP1, P53 and P21 is remarkably upregulated in LPS-induced AKI, which may be considered as a potential novel diagnostic biomarker of Septic AKI. NGAL may serve as a biomarker of sepsis-induced multiple organ damage during the process of LPS-induced AKI.
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Affiliation(s)
- Wuyang Lv
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Longge Xue
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Liang
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Dongyang Liu
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Cuicui Li
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia Liao
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yingyu Jin
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Gupta A, Bajpai M, Anand S, Ali A. Preoperative and postoperative urinary NGAL levels in children with bladder exstrophy. J Nephrol 2023; 36:1409-1414. [PMID: 36562911 DOI: 10.1007/s40620-022-01548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Urinary NGAL (neutrophil gelatinase-associated lipocalin) levels have been shown to predict renal damage in various medical conditions. The present study was conducted to study the role of urinary NGAL levels in children with bladder exstrophy-epispadias complex post single-stage total reconstruction (SSTR) as markers of early renal function reduction. METHODS Urine samples were collected from children with bladder exstrophy before SSTR (Group A, n = 11), 5 years post SSTR (Group B, n = 40) and controls (Group C, n = 41) and stored at - 20 °C. NGAL levels were estimated using double antibody sandwich ELISA. RESULTS Mean NGAL levels in Groups A, B and C were 1.39, 34.24 and 2.58 ng/ml, respectively. Mean NGAL levels among Group B subjects with glomerular filtration rate (GFR) ≥ 80 ml/min/1.73 m2 body surface area (BSA) was 29.8 ng/ml, while it was 31.74 ng/ml in those with GFR < 80 ml/min. Urine samples were also evaluated 6 months post SSTR. Mean NGAL at 6 months was 6.76 ng/ml, while at 12 months it was 30.3 ng/ml, remaining > 30 ng/ml at 18 and 24 months. Dimercaptosuccinic acid (DMSA) scans did not show any scarring, and GFR on diethylenetriamine pentaacetate (DTPA) scans remained stable. CONCLUSIONS Increasing levels of urinary NGAL following bladder-exstrophy and epispadias complex repair suggest that NGAL detects the earliest signs of renal damage even before any deterioration is observed in DMSA and/or DTPA-GFR scans. Further studies with an adequate sample size and periodic measurement of NGAL need to be performed before any definitive conclusion can be drawn.
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Affiliation(s)
- Alisha Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Abid Ali
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Meng Q, Tian X, Li J, Pruekprasert N, Dhawan R, Holz GG, Cooney RN. GTS-21, a selective alpha7 nicotinic acetylcholine receptor agonist, ameliorates diabetic nephropathy in Lepr db/db mice. Sci Rep 2022; 12:22360. [PMID: 36572735 PMCID: PMC9792461 DOI: 10.1038/s41598-022-27015-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Diabetic nephropathy (DN) is a serious complicating factor in human type 2 diabetes mellitus (T2DM), and it commonly results in end-stage renal disease (ESRD) that requires kidney dialysis. Here, we report that the α7 nicotinic acetylcholine receptor (α7nAChR) agonist GTS-21 exerts a novel anti-inflammatory action to ameliorate DN, as studied using an inbred strain of Leprdb/db mice in which hyperglycemia and obesity co-exist owing to defective leptin receptor (Lepr) signaling. For this analysis, GTS-21 was administered to 10-12 week-old male and female mice as a 4 mg/kg intraperitoneal injection, twice-a-day, for 8 weeks. Kidney function and injury owing to DN were monitored by determination of plasma levels of BUN, creatinine, KIM-1 and NGAL. Histologic analysis of glomerular hypertrophy and mesangial matrix expansion were also used to assess DN in these mice. Concurrently, renal inflammation was assessed by measuring IL-6 and HMGB1, while also quantifying renal cell apoptosis, and apoptotic signaling pathways. We found that Leprdb/db mice exhibited increased markers of BUN, creatinine, NGAL, KIM-1, IL-6, cytochrome C, and HMGB-1. These abnormalities were also accompanied by histologic kidney injury (mesangial matrix expansion and apoptosis). Remarkably, all such pathologies were significantly reduced by GTS-21. Collectively, our results provide new evidence that the α7nAChR agonist GTS-21 has the ability to attenuate diabetes-induced kidney injury. Additional studies are warranted to further investigate the involvement of the vagal cholinergic anti-inflammatory reflex pathway (CAP) in ameliorating diabetic nephropathy.
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Affiliation(s)
- Qinghe Meng
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St., Suite 8141, Syracuse, NY, 13210, USA
| | - Xinghan Tian
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St., Suite 8141, Syracuse, NY, 13210, USA
- Yantai Yuhuangding Hospital, No 20 Yuhuangding East Road, Yantai, 264000, Shandong Province, China
| | - Junwei Li
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St., Suite 8141, Syracuse, NY, 13210, USA
| | - Napat Pruekprasert
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St., Suite 8141, Syracuse, NY, 13210, USA
| | - Ravi Dhawan
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St., Suite 8141, Syracuse, NY, 13210, USA
| | - George G Holz
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Robert N Cooney
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St., Suite 8141, Syracuse, NY, 13210, USA.
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6
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Biomarker bei ureteropelviner Stenose. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Role of urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL), Monocyte Chemoattractant Protein-1(MCP-1), and Interleukin-6(IL-6) as biomarkers in pediatric patients with hydronephrosis. Pediatr Surg Int 2022; 38:1635-1641. [PMID: 36057907 DOI: 10.1007/s00383-022-05207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The decision to surgically intervene in a hydronephrotic kidney in children is based on many debatable guidelines, some requiring repeated ultrasounds or renal scans. Urinary proteins have the potential to reflect renal disorders and hence can be the alternatives to such scans. Here, we aim to assess the role of urinary Neutrophil Gelatinase-Associated Lipocalin, Monocyte Chemoattractant Protein-1, and Interleukin-6 (IL-6) in such patients. METHODS Seventeen children had obstructive hydronephrosis requiring pyeloplasty (UPJO), while seven were kept on conservative management in view of non-obstructive dilation (NOD). Urine samples were measured for the three urinary proteins at the time of presentation and following pyeloplasty using commercially available ELISA kits. RESULTS The levels of all three urinary proteins were significantly higher in patients with UPJO children compared to the NOD group. Cut-off values to differentiate obstructive from non-obstructive hydronephrosis were obtained. A significant fall in the post-operative value of urinary IL-6 was also observed. CONCLUSION This study highlights the potentiality of urinary proteins as biomarkers in identifying children with hydronephrosis and picking out the ones with obstructive hydronephrosis who will require pyeloplasty. The drop in levels after pyeloplasty can be employed to evaluate the effectiveness of pyeloplasty when sent serially.
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8
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Sangeetha G, Babu R. Comparing accuracy of urinary biomarkers in differentiation of ureteropelvic junction obstruction from nonobstructive dilatation in children. Pediatr Nephrol 2022; 37:2277-2287. [PMID: 35237864 DOI: 10.1007/s00467-022-05488-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 12/20/2022]
Abstract
Multiple urinary biomarkers have been reported in differentiation of nonobstructive dilatation (NOD) from ureteropelvic junction obstruction (UPJO). In this meta-analysis, we compared the accuracy of common urinary biomarkers applicable to UPJO. A systematic literature review of electronic databases was conducted for: (UPJO) OR (NOD) AND (urinary biomarkers) AND (children) for articles published in the last decade. PRISMA guidelines were used to exclude duplicate and erroneous articles. Meta-analysis involved risk of bias analysis, heterogeneity assessment, and comparison of sensitivity/specificity by forest plot analysis using MetaXL 5.3. Among the 264 articles analyzed, 19 articles met the inclusion criteria and reported the following: neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemotactic protein-1 (MCP1), carbohydrate antigen 19-9 (CA 19-9), kidney injury molecule (KIM1), epidermal growth factor (EGF), and interferon gamma induced protein-10 (IP10). There was substantial heterogeneity among articles. There was wide variation in applied cut-offs among studies. Overall sensitivity was highest at 87% for CA 19-9 while overall specificity was highest at 76% for NGAL. Overall accuracy was highest at 78% for CA 19-9 followed by 77% for NGAL and 75% for KIM1. In this meta-analysis, the overall accuracy was highest for CA 19-9 followed by NGAL and KIM1. The small number of studies for CA 19-9 and considerable heterogeneity for all should be considered while interpreting these findings. Based on the current meta-analysis, we support a panel of biomarkers combining NGAL, KIM, and CA 19-9 for the best diagnostic accuracy of UPJO in children.
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Affiliation(s)
- Geminiganesan Sangeetha
- Pediatric Nephrology Unit, Sri Ramachandra Institute of Higher Education & Research, Chennai, 600116, India.
| | - Ramesh Babu
- Pediatric Urology Unit, Sri Ramachandra Institute of Higher Education & Research, 600116, Chennai, India
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Aithal S, Saxena R, Pathak M, Sinha A. Commentary to "The use of urinary osmolality to evaluate postoperative renal function in children with ureteropelvic junction obstruction". J Pediatr Urol 2022; 18:714-715. [PMID: 35945146 DOI: 10.1016/j.jpurol.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Shrilakshmi Aithal
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342005, India.
| | - Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342005, India
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Seifriedova Z, Flogelova H, Sarapatka J, Smakal O, Student V. The use of biomarkers in the diagnosis and treatment of obstruction of the upper urinary tract in children. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:243-250. [PMID: 35147136 DOI: 10.5507/bp.2022.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Antenatal hydronephrosis, dilatation of the upper urinary tract (UUTD), is a common finding on prenatal ultrasound. One of the most common causes is ureteropelvic junction (UPJ) obstruction. Although such prenatally diagnosed UUTD resolves spontaneously in most newborns, further examination of these children is advocated to prevent possible irreversible kidney damage, and ultrasound is mainly used for this. If the dilatation persists or becomes symptomatic, it is necessary to proceed to other relatively demanding and invasive diagnostic examinations for these small patients, where the question of the right timing of indications for possible surgical solutions is still unclear. For this reason, various biomarkers have been investigated in a number of clinical trials as potential mini-invasive diagnostic tools for determining when upper urinary tract dilatation in such children poses a threat to the developing kidneys and they should be operated on, and vice versa, when to proceed conservatively. The aim of this article is to review the findings on and current issues with the use of biomarkers in the diagnosis and treatment of UPJ obstruction in children.
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Affiliation(s)
- Zuzana Seifriedova
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Hana Flogelova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jan Sarapatka
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Oldrich Smakal
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Vladimir Student
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Yücel ÖB, Dönmez Mİ, Küçükgergin C, Ziylan O, Seçkin Ş, Oktar T. Urinary biomarkers can identify the need for pyeloplasty in presence of supranormal differential renal function in antenatally diagnosed unilateral hydronephrosis. J Pediatr Urol 2022; 18:6-12. [PMID: 34535387 DOI: 10.1016/j.jpurol.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Decision for surgery can be challenging in children with AH (Antenatal Hydronephrosis) especially in the setting of supranormal differential renal function (SnDRF). OBJECTIVE Aim of this study is to investigate whether IP-10 (interferon gamma-induced protein 10), MCP-1 (monocyte chemotactic protein-1), NGAL (neutrophil gelatinase-associated lipocalin), CA 19-9 (carbohydrate antigen 19-9), and KIM-1 (kidney injury molecule-1) can identify the need for pyeloplasty in presence of SnDRF in antenatally diagnosed unilateral hydronephrosis. STUDY DESIGN A prospectively collected urinary biomarker database was used for the study. There was a total of 53 patients in the AH group. Nineteen children with no history of AH and a normal urinary ultrasonography were taken as controls. Patients with initial ipsilateral DRF (Differential Renal Function) over 50% were included in the SnDRF group while the remaining were named as non-SnDRF. Patients that didn't undergo surgery were classified as non-obstructive dilation (NOD) in both groups. RESULTS Pyeloplasty was performed in 6/20 patients in SnDRF group, and in 19/33 patients in non-SnDRF group. Biomarker levels in the pyeloplasty and NOD groups were not affected by the presence or absence of SnDRF (p = 1.00, for both). Urinary NGAL, and CA 19-9 could determine the need for surgery in SnDRF group with 83% and 100% sensitivity, 86% and 79% specificity, respectively whereas urinary IP-10 and KIM-1 could with 84% and 83% sensitivity, 57% and 71% specificity, respectively. Urinary MCP-1 could differentiate patients who underwent surgery with 83% sensitivity and 50% specificity in SnDRF groups. CONCLUSION Our results showed that biomarker levels were not affected whether the kidney has SnDRF. Furthermore, in patients with SnDRF, NGAL and CA 19-9 appear to better estimate requirement for surgical correction before deterioration of renal function.
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Affiliation(s)
- Ömer Barış Yücel
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Turkey.
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - Canan Küçükgergin
- İstanbul University, İstanbul Faculty of Medicine, Department of Biochemistry, Turkey.
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - Şule Seçkin
- İstanbul University, İstanbul Faculty of Medicine, Department of Biochemistry, Turkey.
| | - Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey; Koç University, School of Medicine, Department of Urology, Turkey.
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Is the urinary kidney injury molecule an optimum biomarker for early detection of obstructive nephropathy? Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Williams V, Jayashree M, Nallasamy K, Dayal D, Rawat A, Attri SV. Serial urinary neutrophil gelatinase associated lipocalin in pediatric diabetic ketoacidosis with acute kidney injury. Clin Diabetes Endocrinol 2021; 7:20. [PMID: 34719396 PMCID: PMC8559408 DOI: 10.1186/s40842-021-00133-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) due to Diabetic Ketoacidosis (DKA) is rather common. Novel biomarkers to diagnose AKI are being increasingly used in different settings. The use of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) in predicting persistent AKI in pediatric DKA cases is still not thoroughly investigated. METHODS This was a secondary analysis of Saline versus Plasma-Lyte in Ketoacidosis (SPinK) trial data; 66 children (> 1 month-12 years) with DKA, defined by the International Society for Pediatric and Adolescent Diabetes (ISPAD), were analyzed. Children with cerebral edema, chronic kidney disease and those who received pre-referral fluids and/or insulin were excluded. uNGAL and urine NGAL-creatinine ratio (uNCR) at 0 and 24 h were measured in all. Persistent AKI was defined as a composite outcome of continuance of AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3 beyond 48 h from AKI onset, progression of AKI from either KDIGO stage 0 or 1 to a worse stage, need of renal replacement therapy or death. MAIN OUTCOMES Thirty-five (53%) children had AKI at admission; 32 (91.4%) resolved within 48 h. uNGAL was significantly higher in the AKI group at admission [79.8 ± 27.2 vs 54.6 ± 22.0, p = 0.0002] and at 24 h [61.4 ± 28.3 vs 20.2 ± 14.5, p = 0.0003]. Similar trend was observed with uNCR at admission [6.7 ± 3.7 vs 4.1 ± 2.6, p = 0.002] and at 24 h [6.3 ± 2.5 vs 1.2 ± 1.0, p = 0.01]. Furthermore, uNGAL at admission showed a moderate positive linear correlation with serum creatinine. Additionally, elevated uNGAL at 0 and 24 h correlated with corresponding KDIGO stages. Admission uNGAL >88 ng/ml and uNCR of >11.3 ng/mg had a sensitivity of 66% and 67%, specificity of 76% and 95%, and Area under the receiver operating characteristic curve (AUC) of 0.78 and 0.89 respectively for predicting persistent AKI at 48 h. CONCLUSIONS Majority of AKI resolved with fluid therapy. While uNGAL and uNCR both correlated with serum creatinine and AKI stages, serial uNCR was a better predictor of persistent AKI than uNGAL alone. However, feasibility of routine uNGAL measurement to predict persistent AKI in DKA needs further elucidation. TRIAL REGISTRATION This was a secondary analysis of the data of SPinK trial [CTRI/2018/05/014042 ( ctri.nic.in )].
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Intensive Care, Department of Critical Care, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Devi Dayal
- Division of Pediatric Endocrinology, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Rawat
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Division of Pediatric Biochemistry, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yang Q, Li L, Liu Z, Li C, Yu L, Chang Y. Penehyclidine hydrochloride ameliorates renal ischemia reperfusion-stimulated lung injury in mice by activating Nrf2 signaling. BIOIMPACTS : BI 2021; 12:211-218. [PMID: 35677666 PMCID: PMC9124878 DOI: 10.34172/bi.2021.23401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 06/15/2023]
Abstract
Introduction: Penehyclidine hydrochloride (PHC) is an anticholinergic with anti-inflammatory and anti-oxidation activities. PHC displayed protectivity against renal ischemia reperfusion (RIR) injury. Nevertheless, the precise protectivity of PHC on RIR-induced lung injury remains unknown. Methods: We examined the effects of PHC on RIR-induced lung injury and investigated the underlying mechanism. We induced RIR in mice and administrated PHC to RIR mice. Kidney function was monitored by measuring the blood urea nitrogen (BUN) and creatinine level in serum. We evaluated the lung injury, myeloperoxidase (MPO) activity in lung, pro-inflammatory cytokine level, and oxidative markers in serum and lung tissues. We tested the expression level of nuclear factor erythroid 2-related factor 2 (Nrf-2) and heme oxygenase 1 (HO-1) in lung of RIR mice after PHC treatment. Finally, we evaluated the effects of PHC in RIR Nrf2-/- mice. Results: PHC greatly downregulated the serum levels of BUN, creatinine, IL-6, NO, malondialdehyde (MDA), and matrix metalloproteinase-2. PHC also ameliorated the lung injury, decreased the MPO activity, and suppressed production of IL-6, TNF-α, IFN-γ, MDA, and O2-, while it promoted production of superoxide dismutase (SOD) and catalase (CAT) in lung. PHC improved the production of Nrf2 and HO-1. Conclusion: The protectivity of PHC was absent in Nrf2-/- mice. PHC ameliorated RIR-induced lung injury through Nrf2 pathway.
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Affiliation(s)
- Qiang Yang
- Department of Anesthesiology, Cangzhou Central Hospital, Teaching Hospital of Tianjin Medical University, Cangzhou 061000, Hebei, China
| | - Lei Li
- Physical Examination Center, Cangzhou Central Hospital, Teaching Hospital of Tianjin Medical University, Cangzhou 061000, Hebei, China
| | - Zhaohui Liu
- Department of Anesthesiology, Cangzhou Central Hospital, Teaching Hospital of Tianjin Medical University, Cangzhou 061000, Hebei, China
| | - Chunlei Li
- Department of Anesthesiology, Cangzhou Central Hospital, Teaching Hospital of Tianjin Medical University, Cangzhou 061000, Hebei, China
| | - Lili Yu
- Department of Anesthesiology, Cangzhou Central Hospital, Teaching Hospital of Tianjin Medical University, Cangzhou 061000, Hebei, China
| | - Yulin Chang
- Department of Anesthesiology, Cangzhou Central Hospital, Teaching Hospital of Tianjin Medical University, Cangzhou 061000, Hebei, China
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Göger YE, Özkent MS, Topçu C, Atıcı A, Sönmez MG, Balasar M, Gürbilek M. Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study. Urol Int 2021; 106:446-454. [PMID: 34333489 DOI: 10.1159/000517883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery. MATERIALS AND METHODS We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement. RESULTS The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0-1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively). CONCLUSION KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.
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Affiliation(s)
- Yunus Emre Göger
- Department of Urology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Cemile Topçu
- Department of Biochemistry, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Atıcı
- Department of Urology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Giray Sönmez
- Department of Urology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Gürbilek
- Department of Biochemistry, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
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Kocatürk H, Bedir F, Turangezli Ö, Şebin E, Altay MS, Bedir B, Sarıca K. Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones. ACTA ACUST UNITED AC 2021; 93:178-183. [PMID: 34286552 DOI: 10.4081/aiua.2021.2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the course of functional and morphological recovery of the kidney following the relief of obstruction with ureteral JJ stent in cases with unilateral impacted stones. MATERIALS AND METHODS A total of 42 adult patients who were admitted to our clinic with unilateral obstructing impacted ureteral stones requiring JJ stent placement were included in the study. The course of functional recovery was assessed by evaluating the serum creatinine levels, renal resistive index (RRI) values and urinary levels of kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin as well as microalbumin before at 1 day, 1 week and 4 weeks after JJ stent placement. Course of morphologic recovery was evaluated by evaluating the degree of hydronephrosis, kidney size, perirenal straining and ureteral diameter. RESULTS Our results showed that all relevant parameters began to decrease after 24 hours and continue to normalize during 1 week evaluation; majority of these variables indicating the functional and morphological recovery were in normal range after 4 weeks. Decompression of the obstructed kidneys with JJ stent placement in patients with impacted ureteral stones was found to be effective enough with recovery of normal renal functional and morphological status after a minimum time period of 4 weeks. Morphological recovery of affected kidneys following JJ stenting was obtained with a significant difference between baseline and 1-month evaluation findings (p = 0.001, p < 001, p < 001, respectively). KIM-1 excretion began to decline to normal levels after 4 weeks (3.52 ± 0.99 ng/ml versus 2.84 ± 0.66 ng/ml, p < 0.001). The same findings were observed for the urinary excretion levels of NGAL, which normalized at the 1-month evaluation (604.55 ± 140.28 ng/ml versus 596.87 ± 80.17 ng/ml p = 0.895). Urinary microalbumin excretion levels however remained high even until 1-month follow-up with a statistically significant difference when compared with the normal excretion values (p < 0.001). There was a statistically significant difference in RRI values between baseline and 1-month follow-up findings in obstructed kidney (p < 0.001). CONCLUSIONS Elective management of the obstructing impacted ureteral stone(s) will be safer with limited risk of infective complications after functional and morphological normalization in such kidneys following 4 weeks of JJ stent placement.
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Affiliation(s)
- Hüseyin Kocatürk
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Fevzi Bedir
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Ömer Turangezli
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Engin Şebin
- Department of Biochemistry Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Mehmet Sefa Altay
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Banu Bedir
- Aziziye District Health Directorate, Erzurum.
| | - Kemal Sarıca
- Biruni University, Faculty of Medicine, Department of Urology, Istanbul.
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Urinary biomarkers as point-of-care tests for predicting progressive deterioration of kidney function in congenital anomalies of kidney and urinary tract: trefoil family factors (TFFs) as the emerging biomarkers. Pediatr Nephrol 2021; 36:1465-1472. [PMID: 33420628 DOI: 10.1007/s00467-020-04841-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/02/2020] [Accepted: 10/22/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Children with congenital anomalies of kidney and urinary tract (CAKUT) are at high risk of progressive deterioration of kidney function and further developing stage 5 chronic kidney disease (CKD 5), even after a successful surgery. This prospective study was designed to determine whether urinary biomarkers can predict progressive deterioration of kidney function in children with CAKUT. METHODS The study included 50 consecutive children, aged < 14 years, who were diagnosed with congenital uropathies (PUV, VUR, and PUJO) and 20 age-matched controls. Examination of four urinary biomarkers, i.e., trefoil family factors (TFF) 1 and 3, neutrophil gelatinase-associated lipocalin (NGAL) and microalbuminuria (MALB) was done at the beginning of follow-up. Kidney function was assessed, at the beginning and after 12-months of follow-up, by technetium-99m diethylene triamine pentaacetic acid (DTPA) and technetium-99m dimercaptosuccinic acid (DMSA) scans. Progressive deterioration in the kidney function was defined as a fall in the GFR from ≥ 60 to < 60 ml/min/1.73 m2 on comparing the baseline and latest DTPA scans; and/or new-onset cortical scar/scars or increase in the size of previous scar/scars on serial DMSA scans. Group 1 and group 2 included children without and with progressive functional deterioration respectively. RESULTS The median (IQR) age of children with CAKUT and controls was 3 (1.5-5) and 2.3 (1.2-3.6) years, respectively, and showed no significant difference (p = 0.29). Median concentrations of TFF1, TFF3, NGAL, and microalbumin in patients were 44.5, 176.5, 281.2, and 15.5 mcg/gCr, respectively, and were significantly elevated as compared to controls (p < 0.05). Children belonging to group 2 had significantly higher concentration of biomarkers as compared to those in group 1. TFF3 was found have the highest AUC (0.9198) on ROC curve for predicting progressive functional deterioration. CONCLUSION Urinary TFFs, NGAL, and microalbumin significantly correlate with progressive deterioration of kidney function in children harboring CAKUT. TFF3, with the strongest prediction of functional deterioration, is an emerging peptide showing sufficient potential to be included in the biomarker panel. Graphical abstract.
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Bratina P, Ključevšek D, Paro-Panjan D, Kersnik Levart T. Urinary Neutrophil Gelatinase-Associated Lipocalin as a Marker of Urinary Tract Obstruction in Newborns with Congenital Unilateral Urinary Tract Dilatation. Indian J Pediatr 2021; 88:510-511. [PMID: 33594618 DOI: 10.1007/s12098-021-03669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Petra Bratina
- Department of Neonatology, Hospital for Women Diseases and Obstetrics Postojna, Postojna, Slovenia
| | - Damjana Ključevšek
- Department of Radiology, Division of Pediatrics, University Medical Centre, Ljubljana, Slovenia
| | - Darja Paro-Panjan
- Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, Slovenia
| | - Tanja Kersnik Levart
- Department of Nephrology, Division of Pediatrics, University Medical Centre, Bohoričeva 20, 1000, Ljubljana, Slovenia.
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Fendereski K, Nabighadim A, Seyedtabib M, Daryabari SS, Haghi-Ashtiani MT, Kajbafzadeh AM. Comparing predictive values of carbohydrate antigen 19-9, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 in 161 patients with ureteropelvic junction obstruction. Pediatr Nephrol 2021; 36:631-638. [PMID: 32936324 DOI: 10.1007/s00467-020-04750-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To evaluate and compare the efficacy of urinary carbohydrate antigen 19-9 (CA19-9), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) biomarkers as predictive factors to determine the surgery requirement in patients with ureteropelvic junction obstruction. METHODS We obtained urine samples from 161 patients at diagnosis and evaluated their levels of the three biomarkers. The patients were under observation for 2 years; subsequently, they were divided into two groups based on their requirement of pyeloplasty. We determined the correlation between the urinary concentration of the biomarkers and surgical interventions, as well as the kidney function deterioration and sonography outcomes. RESULTS The non-surgery group included 60 male and 22 female patients with mean age of 21 months. The surgery group comprised 58 boys and 21 girls with mean age of 26.9 months with no significant difference of age and gender between the two groups. The outcomes were indicative of higher efficacy of CA19-9 level with a sensitivity and specificity of 84.2% and 73.2% at the cutoff point of 59.09 U/ml. Also, a significant negative correlation was detected between the kidney function and the concentrations of CA19-9 and NGAL. CONCLUSIONS Our evaluations demonstrate the higher efficacy of CA19-9 to predict the requirement of surgical intervention in comparison with the other biomarkers, as well as a significant correlation between kidney function deterioration and urinary CA19-9 and NGAL. The outcomes of this investigation could pave the way for more extensive clinical application of these urinary biomarkers, besides future research determining the association between markers and kidney fibrosis.
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Affiliation(s)
- Kiarad Fendereski
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr.Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Amirreza Nabighadim
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr.Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh Sima Daryabari
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr.Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | | | - Abdol-Mohammad Kajbafzadeh
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr.Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran.
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20
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Amiri R, Hosseini H, Sanaei Z, Shamahmoudi S, Solgi G. Urinary neutrophil glatinase-associated lipocalin level (uNGAL) may predict the severity of congenital hydronephrosis in infants. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2021; 10:1-7. [PMID: 33815957 PMCID: PMC8012300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
Clinical findings suggest that the urinary neutrophil gelatinase-associated lipocalin (uNGAL) level may be a highly sensitive biomarker and predictor of progressive tubular and glomerular injury. This cross-sectional study aimed to determine the predictive power of uNGAL in infants with congenital hydronephrosis. Forty-five children (30 males and 15 females) under the age of two with congenital obstructive uropathy were evaluated for urinary levels of creatinine, uNGAL and uNGAL/uCreatinine (Cr) ratio. Totally, 62.2% of patients had mild, 15.6% had moderate and 22.2% had severe hydronephrosis. We observed a higher significantly uNGAL level in cases with severe form than cases with mild to moderate forms (P=0.002). Also, infants with severe hydronephrosis showed a higher ratio of uNGAL/uCr compared with mild to moderate cases (P=0.006). Correlation analysis showed a significant inverse correlation between uCr levels and pelvic diameter (P=0.002) and direct correlations between uNGAL and uNGAL/uCr ratio and pelvic diameter (P<0.001). By defining a cut-off point of 73.7 ng/ml for uNGAL in ROC analysis, we observed a sensitivity of 70.0% and a specificity of 91.4% forthe prediction of severe hydronephrosis. Our results indicate the potential predictive valueof uNGAL and uNGAL/uCr ratio for hydronephrosis and, more importantly, for discrimination of the severe hydronephrosis from mild to moderate forms.
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Affiliation(s)
- Rahimpour Amiri
- Pediatric Department, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
| | - Hiwa Hosseini
- Pediatric Department, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
| | - Zahra Sanaei
- Department of Community Medicine, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
| | - Saba Shamahmoudi
- Pediatric Department, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
| | - Ghasem Solgi
- Department of Immunology, School of Medicine, Hamadan University of Medical SciencesHamadan, Iran
- Psoriasis Research Center, Hamadan University of Medical SciencesHamadan, Iran
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Can serum Neutrophil Gelatinase Associated Lipocalin and Kidney Injury Molecule-1 help in decision making for surgery in antenatally dedected hydronephrosis. J Pediatr Urol 2021; 17:71.e1-71.e7. [PMID: 33139211 DOI: 10.1016/j.jpurol.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Congenital obstructive uropathies are among leading reasons for renal failure in children. Answers to questions such as what the critical threshold of obstruction is or which degree of obstruction disrupts the development of the kidney still remain unclear. Several biomarkers such as Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Associated Lipocalin (NGAL) may help clinicians in the clinical evaluation and appropriate planning of the disease. OBJECTIVE This study aimed to investigate whether serum and urinary KIM-1 and NGAL levels contribute to conventional methods in decision-making for surgery in the postnatal period of infants with antenatal hydronephrosis. STUDY DESIGN 34 patients with the diagnosis of antenatal hydronephrosis were evaluated prospectively. Renal pelvis diameters of all patients were above 10 mm in the ultrasonography (USG). Patients underwent diuretic renal scintigraphy after neonatal period. Patients were divided into two groups as surgery or follow-up based on USG and scintigraphy findings. Blood and urine samples were collected at first visits in both groups and again at the 3. Postoperative month in the surgery group. Serum and urinary NGAL and KIM-1 levels were measured by ELISA method. Study data were compared through the Mann-Whitney U and Wilcoxon Signed-Ranks test. RESULTS There were 10 patients in the surgery group and 24 patients in the follow-up group. The age and gender did not differ between the groups. The surgery group had significantly higher median serum NGAL values (259.2 ng/mL) than that in the follow-up group (46.8 ng/mL, p = 0.028). The postoperative reduction of the median serum NGAL to 68.1 ng/mL compared to preoperative level was also found to be significant (p = 0.037) in the surgery group. Between the groups and within the surgery group no statistically significant difference was detected in terms of median urinary NGAL, and serum and urine KIM-1 levels. DISCUSSION USG and renal scintigraphy are frequently used in determining whether patients with antenatal hydronephrosis need surgical intervention in the postnatal period. Several new biomarkers might help clinicians in decision making for surgery. KIM-1 and NGAL levels can be measured both in urine and serum. To our knowledge, this is the only study where serum NGAL and KIM-1 levels were measured in patients with antenatal diagnosis. Small sample size, lack of long term findings and control group are limitations of our study. CONCLUSION Serum NGAL levels of patients with antenatal hydronephrosis may help in decision making on the surgical intervention.
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Latoch E, Konończuk K, Muszyńska-Rosłan K, Taranta-Janusz K, Wasilewska A, Szymczak E, Trochim J, Krawczuk-Rybak M. Urine NGAL and KIM-1-Tubular Injury Biomarkers in Long-Term Survivors of Childhood Solid Tumors: A Cross-Sectional Study. J Clin Med 2021; 10:399. [PMID: 33494327 PMCID: PMC7866176 DOI: 10.3390/jcm10030399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
The deterioration of renal function after childhood solid tumors treatment is the result of using the intensive multimodal therapy. In recent years, urinary kidney injury molecule-1 (KIM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) have been introduced as potential promising biomarkers of early kidney damage. The aim of the present study was to determine whether anticancer treatment has any effect on the concentration of KIM-1 and NGAL and its association with renal impairment in survivors of childhood solid tumors. Sixty patients previously treated for solid tumors were involved in this study. The median time after end of treatment was 8.35 years. Urine KIM-1 and NGAL levels were measured using immunoenzymatic ELISA commercial kits. Higher levels of urine NGAL, KIM-1/cr. (creatinine), and NGAL/cr. ratios were found in comparison with healthy controls (p < 0.0001). Among all subjects, 23% were found to have decreased estimated glomerular filtration rate (eGFR). A strong correlation between KIM-1/cr. and a cumulative dose of ifosfamide was observed (r = 0.865, p < 0.05). In addition, a moderate correlation between NGAL/cr. and a cumulative dose of cisplatin was identified (r = 0.534, p < 0.05). The AUC for KIM-1/cr. was 0.52, whereas NGAL/cr. showed a diagnostic profile describing the AUC of 0.67. Univariable regression showed significant associations between NGAL/cr. ratio and subjects after unilateral nephrectomy (coeff. 63.8, p = 0.007), cumulative dose of cisplatin (coeff. 0.111, p = 0.033), and age at diagnosis (coeff. 3.75, p = 0.023). The multivariable model demonstrated only cumulative dose of cisplatin as an independent factor influence on NGAL/cr. ratio. The results of our study showed increased levels of urine KIM-1 and NGAL many years after completion of the childhood solid tumors treatment, which correlated positively with a cumulative dose of ifosfamide and cisplatin. This study also suggests that unilateral nephrectomy could affect the concentration of the studied biomarkers.
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Affiliation(s)
- Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.K.); (K.M.-R.); (M.K.-R.)
| | - Katarzyna Konończuk
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.K.); (K.M.-R.); (M.K.-R.)
| | - Katarzyna Muszyńska-Rosłan
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.K.); (K.M.-R.); (M.K.-R.)
| | - Katarzyna Taranta-Janusz
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.T.-J.); (A.W.); (E.S.)
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.T.-J.); (A.W.); (E.S.)
| | - Edyta Szymczak
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.T.-J.); (A.W.); (E.S.)
| | - Justyna Trochim
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, 15-274 Białystok, Poland;
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Białystok, Poland; (K.K.); (K.M.-R.); (M.K.-R.)
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Olawale OO, Adekanmbi AF, Sonuga AA, Sonuga OO, Akodu SO, Ogundeyi MM. Assessment of Renal Function Status in Steady-State Sickle Cell Anaemic Children Using Urine Human Neutrophil Gelatinase-Associated Lipocalin and Albumin:Creatinine Ratio. Med Princ Pract 2021; 30:557-562. [PMID: 34348300 PMCID: PMC8740162 DOI: 10.1159/000518458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sickle cell anaemia is characterized by defective haemoglobin synthesis and is associated with both endocrine and metabolic alterations. The effects of this clinical condition on kidney function are multifactorial and often begin early in childhood. This study aims to assess renal function in children with sickle cell anaemia using urine albumin:creatinine ratio (ACR) and urine human neutrophil gelatinase-associated lipocalin (NGAL). METHODS This case-control study was conducted on 200 children aged 5-15 years in 2 tertiary hospitals in South West Nigeria: 150 were of haemoglobin S genotype and 50 were of haemoglobin A genotype. Serum urea, creatinine, urine albumin, and NGAL were assayed by known standard methods. eGFR, urine ACR, and urine NGAL/creatinine ratio (urine NCR) were calculated. RESULTS The weight, height, BMI, systolic blood pressure, plasma urea, plasma creatinine, and spot urine creatinine of the HbS genotype children were significantly lower compared to that of the HbA genotype children. The eGFR, spot urine albumin, and urine ACR were significantly higher in the HbS group compared to the HbA group. There was no significant difference in the spot urine NGAL and urine NCR between the 2 groups, though both were higher in the HbS group compared to the HbA group. CONCLUSIONS Kidney injury probably starts early in childhood in sickle cell individuals as indicated by the higher urine ACR detected in them. We infer that urine NGAL and uNCR are not sensitive markers of kidney disease especially in young sickle cell individuals possibly because of the hyperfiltration present at this age.
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Affiliation(s)
| | | | | | | | - Samuel Olufemi Akodu
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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24
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Özkuvancı Ü, Dönmez Mİ, Ziylan O, Oktar T, Küçükgergin C, Çetin B, Erdem S, Seçkin Ş. Can urinary biomarkers detect obstruction defined by renal functional loss in antenatal hydronephrosis? J Pediatr Urol 2020; 16:844.e1-844.e7. [PMID: 32988771 DOI: 10.1016/j.jpurol.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Diagnosing obstruction and thus, assessment of need for surgery in the management of antenatal hydronephrosis may be challenging. Current diagnostic tests are not capable of indicating which patients are at risk for obstructive nephropathy. Biomarkers may play an important role in distinguishing these patients. OBJECTIVE The aim of this study is to evaluate if urinary biomarkers could differentiate obstruction (OBS) from non-obstructive dilation (NOD) in patients with antenatal hydronephrosis (AH) that underwent pyeloplasty due to loss of differential renal function (DRF). STUDY DESIGN Children with a history of AH and postnatal anteroposterior (AP) diameter ≥15 mm were included in this study of prospectively collected data between 2010 and 2018. The OBS group included patients who underwent pyeloplasty due to solely ≥10% subsequent decrease in DRF on a MAG-3 scan during follow-up. Patients with stable or improving hydronephrosis with no significant reduction in ipsilateral DRF (<10%) during follow-up formed the NOD group. Healthy children with no history of AH and a normal urinary ultrasound were taken as the control group. Urinary IP-10, MCP-1, KIM-1, NGAL, and Ca19-9 levels using ELISA were measured. In the OBS group, urine samples were obtained preoperatively and at 3rd post operative-month whereas in the NOD and control groups, samples were collected at the time of enrollment. RESULTS There were 24 children in the OBS and 27 children in the NOD groups. The control group consisted of 27 healthy children. The pre-operative bladder urine levels of biomarkers of the OBS group were significantly higher than in the NOD and control group (p < 0.05, for all). In terms of differentiating OBS from NOD, results of ROC analyses for the given cut-off values were as follows: 135.06 ng/mgCr (sensitivity 75%; specificity 66%, AUC = 0.735) for IP-10, 0.89 ng/mgCr (sensitivity 79.2%; specificity 88%, AUC = 0.802) for KIM-1, 367.65 pg/mgCr (sensitivity 62.5%; specificity 52%, AUC = 0.660) for MCP-1, 16.15 ng/mgCr (sensitivity 70.8%; specificity 70.4%, AUC = 0.669) for NGAL, and 55.5 U/mgCr (sensitivity 75%; specificity 66%, AUC = 0.676) for Ca 19-9. Moreover, when KIM-1 was combined with IP-10 and Ca19-9, sensitivity and specificity levels were 83% and 85% (AUC = 0.919), respectively. CONCLUSION In this novel study, which focused on scintigraphic DRF loss, KIM-1 was the most successful among all the biomarkers evaluated. Combination of IP-10, Ca19-9 and KIM-1 resulted increased diagnostic ability.
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Affiliation(s)
- Ünsal Özkuvancı
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - Canan Küçükgergin
- İstanbul University, İstanbul Faculty of Medicine, Department of Biochemistry, Turkey.
| | - Bilal Çetin
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Turkey.
| | - Selçuk Erdem
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Turkey.
| | - Şule Seçkin
- İstanbul University, İstanbul Faculty of Medicine, Department of Biochemistry, Turkey.
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Turgut D, Pişkinpaşa SV, Çoşkun Yenigün E, Aydemir N, Dede F. Urinay neutrophil gelatinase-associated lipocalin as a biomarker in different renal problems. Turk J Med Sci 2020; 50:1566-1572. [PMID: 32927927 PMCID: PMC7605094 DOI: 10.3906/sag-2002-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Neutrophil gelatinase-associated lipocalin (NGAL) is used previously to estimate the etiology, severity, and clinical outcomes of acute kidney injury (AKI). However, the role of urinary NGAL (uNGAL) in the postrenal setting is not clear. In our study, we aimed to discover the cut-off value of uNGAL that can be used in the differential diagnosis of underlying AKI etiologies. Materials and methods In this prospective cross-sectional study, we examined 82 subjects in four groups: patients that had (1) postrenal AKI; (2) AKI other than postrenal etiologies; (3) stable chronic kidney disease; and (4) healthy subjects. A renal function assessment was carried out by measuring serum creatinine (sCr) and uNGAL at the time of diagnosis [0th min (T0)]. We followed the study group for three months. Results At the time of diagnosis, sCr (T0) was highest in the postrenal AKI and AKI groups in contrast to stable chronic kidney disease patients and healthy subjects (P < 0.001), as expected. T0 median uNGAL was highest in the postrenal group (P < 0.001). Area under curve (AUC) of uNGAL to estimate postrenal AKI presence was 0.957 (95% CI, 0.897–1.000; P < 0.001). The cut-off point of uNGAL was 42.625 ng/mL for this estimation. Conclusion Patients with AKI must be classified according to the underlying etiologies as soon as possible. uNGAL may be useful to estimate the etiologies, and whether the problem is acute or chronic in the course. In postrenal kidney problems, to plan the urgency of the urologic procedures, it is crucial.
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Affiliation(s)
- Didem Turgut
- Division of Nephrology, Department of Internal Medicine, Başkent University Ankara Hospital, Ankara, Turkey
| | | | - Ezgİ Çoşkun Yenigün
- Department of Nephrology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nihal Aydemir
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Fatih Dede
- Department of Nephrology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Urine NGAL and KIM-1: tubular injury markers in acute lymphoblastic leukemia survivors. Cancer Chemother Pharmacol 2020; 86:741-749. [PMID: 33052454 PMCID: PMC7603460 DOI: 10.1007/s00280-020-04164-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/03/2020] [Indexed: 12/27/2022]
Abstract
Introduction Nephrotoxicity is a potential adverse effect of anticancer treatment in childhood. Cytostatics, abdominal radiotherapy, total body irradiation (TBI) and some agents used in supportive care may induce acute kidney injury (AKI) or lead to chronic kidney disease (CKD). The aim of this study was to test the hypothesis whether urinary kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are increased in acute lymphoblastic leukemia (ALL) survivors. Method The study cohort consisted of 86 patients (42 females) previously treated for ALL. The median time after cessation of treatment was 6.55 (IQR: 1.96–9.93) years and median age at the time of study: 12 (IQR: 6.76–16.00). The control group included 53 healthy peers. Immunoenzymatic ELISA commercial kits were used to measure urine KIM-1 and NGAL levels. Results The median levels of urine uNGAL (p < 0.05), uNGAL/creatinine (cr.) ratio (p < 0.0001) and uKIM-1/creatinine ratio (p < 0.0001) were significantly higher in ALL survivors in comparison with healthy controls. Female patients had significantly higher levels of NGAL and NGAL/cr. than males (mean 8.42 ± 7.1 vs. 4.59 ± 4.5 ng/mL and 86.57 ± 77 vs. 37.7 ± 37 ng/mg, respectively; p < 0.01). Of all the study participants, 11 (13%) presented eGFR below 90 mL/min/1.73 m2. The NGAL/cr. ratio seemed to be the best predictor of decreased eGFR (AUC = 0.65). The cumulative dose of methotrexate and cyclophosphamide did not predict the values of the urine NGAL, NGAL/cr., KIM-1/cr. and eGFR. Five years after the end of treatment, the patients had higher levels of uKIM-1 (1.02 ± 0.8 vs. 0.62 ± 0.6 ng/mL, p < 0.01), uNGAL (7.9 ± 6.7 vs. 4.6 ± 5 ng/mL, p < 0.01) and lower eGFR (114 ± 29 vs. 134 ± 35 mL/min/1.73 m2, p < 0.01) in comparison with ALL survivors with the observation period of less than 5 years. Conclusion We demonstrated that ALL survivors have higher levels of urine NGAL, NGAL/cr. and uKIM-1/cr. ratio as compared to the control group. Further long-term follow-up studies are necessary to assess the significance of the NGAL and KIM-1 and their relationship to kidney damage after anticancer treatment in childhood.
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Campagno RV, Nosetto EC, Brandoni A, Torres AM. Utility of urinary organic anion transporter 5 as an early biomarker of obstructive nephropathy. Clin Exp Pharmacol Physiol 2020; 47:1674-1681. [PMID: 32497308 DOI: 10.1111/1440-1681.13360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
Ureteral obstruction is a relevant cause of kidney damage. The traditional parameters used in clinical practice for the detection of renal injury are insensitive and non-specific for the diagnosis of obstructive renal disease. The organic anion transporter 5 (Oat5) is a carrier expressed exclusively in the kidney. In this study, the Oat5 urinary excretion (Oat5u ) was evaluated as a potential biomarker of obstructive nephropathy, comparing it with traditional markers of renal function and with neutrophil gelatinase-associated lipocalin in urine (NGALu ), a more recent biomarker of renal pathology. Bilateral ureteral obstruction (BUO) was induced in male Wistar rats, by complete ligation of ureters for 1 hour (BUO1), 2 hours (BUO2), 5 hours (BUO5), or 24 hours (BUO24). After 24 hours of ureteral releasing, urea and creatinine plasma concentrations, creatinine clearance, urinary total proteins, urinary glucose, and alkaline phosphatase activities in urine were evaluated. Oat5 and NGAL levels were assessed in urine samples by immunoblotting. All parameters of renal function were altered in the BUO24 and some also in BUO5, while the Oat5u increased in all of the experimental groups analyzed. After a long time of ureteral obstruction (BUO24), the urinary excretion of Oat5 markedly increased, in parallel with the alteration in the other parameters evaluated. Nevertheless, in BUO1 and BUO2, Oat5u appeared as the only parameter modified. Therefore, Oat5u could be proposed as a novel early biomarker of ureteral obstruction, with the additional potential to inform about the severity of the obstructive injury suffered by the kidney.
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Affiliation(s)
- Romina V Campagno
- Pharmacology Area, Faculty of Biochemistry and Pharmaceutical Sciences, National University of Rosario, CONICET, Rosario, Argentina
| | - Evangelina C Nosetto
- Pharmacology Area, Faculty of Biochemistry and Pharmaceutical Sciences, National University of Rosario, CONICET, Rosario, Argentina
| | - Anabel Brandoni
- Pharmacology Area, Faculty of Biochemistry and Pharmaceutical Sciences, National University of Rosario, CONICET, Rosario, Argentina
| | - Adriana M Torres
- Pharmacology Area, Faculty of Biochemistry and Pharmaceutical Sciences, National University of Rosario, CONICET, Rosario, Argentina
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Gupta S, Nicassio L, Junquera GY, Jackson AR, Fuchs M, McLeod D, Alpert S, Jayanthi VR, DaJusta D, McHugh KM, Becknell B, Ching CB. Impact of successful pediatric ureteropelvic junction obstruction surgery on urinary HIP/PAP and BD-1 levels. J Pediatr Urol 2020; 16:592.e1-592.e7. [PMID: 32278658 PMCID: PMC7529730 DOI: 10.1016/j.jpurol.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In the pediatric patient whose ureteropelvic junction obstruction (UPJO) is not always symptomatic, imaging is the most common means of detecting surgical success. There is interest, however, in other means of post-operative monitoring. A panel of antimicrobial peptides (AMPs) has been previously found to be elevated in UPJO, but the impact of surgical correction on these AMPs is unknown. OBJECTIVE To determine if elevated levels of candidate urinary AMP biomarkers of urinary tract obstruction decrease following UPJO repair. STUDY DESIGN Pediatric patients undergoing surgical correction of an UPJO were recruited for participation. Bladder urine from uninfected consenting/assenting patients was collected immediately prior to surgery and then at least 6 months afterward. Based on prior studies demonstrating significant elevation of beta defensin 1 (BD-1), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), cathelicidin (LL-37), and neutrophil gelatinase-associated lipocalin (NGAL) in patients with UPJO versus control patients, we performed enzyme-linked immunosorbent assays on these four AMPs to compare their expression before and after surgical intervention. If found to significantly decrease, AMP levels were compared to healthy controls. AMP levels were normalized to urine creatinine. Results were analyzed with paired t test or Wilcoxon test using Graphpad software. Correlation was calculated using Pearson or Spearman correlation. A p-value of <0.05 was considered significant. RESULTS 13 UPJO patients were included in this study; 9 were male (69%). Age at surgery was a median of 4.3 years (average 6.1, range 0.4-18.4 years). Follow-up urine samples were collected a median of 27.4 months after surgery (average 27.4; range 7.8-45.3 months). All 13 patients had clinical improvement and/or signs of improved hydronephrosis on post-operative imaging. HIP/PAP and BD-1 significantly decreased in post-surgical samples compared to pre-surgical samples (p = 0.02 and 0.01, respectively); NGAL and LL-37 did not significantly change. Overall, HIP/PAP decreased in 12 patients (92%) and BD-1 decreased in 11 patients (85%). BD-1 levels after successful repair were not different from healthy controls (p = 0.06). DISCUSSION Urinary biomarkers of obstruction should detect significant obstructive pathology as well as reflect its resolution. This would enable their use in post-operative monitoring and augment current methods of determining successful surgical outcome through imaging. CONCLUSIONS The AMPs HIP/PAP and BD-1 are significantly elevated in UPJO but then significantly decrease after pyeloplasty, with BD-1 returning to healthy control levels. As a result, these AMPs could serve as markers of successful surgical intervention.
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Affiliation(s)
- Sudipti Gupta
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lauren Nicassio
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guillermo Yepes Junquera
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ashley R Jackson
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Biomedical Education & Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly Fuchs
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daryl McLeod
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Seth Alpert
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Venkata R Jayanthi
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel DaJusta
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kirk M McHugh
- Department of Biomedical Education & Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian Becknell
- Division of Pediatric Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina B Ching
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Ren H, Zuo S, Hou Y, Shang W, Liu N, Yin Z. Inhibition of α1-adrenoceptor reduces TGF-β1-induced epithelial-to-mesenchymal transition and attenuates UUO-induced renal fibrosis in mice. FASEB J 2020; 34:14892-14904. [PMID: 32939891 DOI: 10.1096/fj.202000737rrr] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Renal fibrosis is a common pathological hallmark of chronic kidney disease (CKD). Renal sympathetic nerve activity is elevated in patients and experimental animals with CKD and contributes to renal interstitial fibrosis in obstructive nephropathy. However, the mechanisms underlying sympathetic overactivation in renal fibrosis remain unknown. Norepinephrine (NE), the main sympathetic neurotransmitter, was found to promote TGF-β1-induced epithelial-mesenchymal transition (EMT) and fibrotic gene expression in the human renal proximal epithelial cell line HK-2. Using both genetic and pharmacological approaches, we identified that NE binds Gαq-coupled α1-adrenoceptor (α1-AR) to enhance EMT of HK-2 cells by activating p38/Smad3 signaling. Inhibition of p38 diminished the NE-exaggerated EMT process and increased the fibrotic gene expression in TGF-β1-treated HK-2 cells. Moreover, the pharmacological blockade of α1-AR reduced the kidney injury and renal fibrosis in a unilateral ureteral obstruction mouse model by suppressing EMT in the kidneys. Thus, sympathetic overactivation facilitates EMT of renal epithelial cells and fibrosis via the α1-AR/p38/Smad3 signaling pathway, and α1-AR inhibition may be a promising approach toward treating renal fibrosis.
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Affiliation(s)
- Huiwen Ren
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Shengkai Zuo
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yayan Hou
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Wenlong Shang
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Na Liu
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Zhuming Yin
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Kajbafzadeh AM, Ladi Seyedian SS, Kameli SM, Nabavizadeh B, Boroomand M, Moghtaderi M. Urinary carbohydrate antigen 19-9 level as a biomarker in children with acute pyelonephritis. Eur J Pediatr 2020; 179:1389-1394. [PMID: 32146571 DOI: 10.1007/s00431-020-03626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/21/2019] [Accepted: 02/27/2020] [Indexed: 01/25/2023]
Abstract
Early and prompt diagnosis of pyelonephritis is of great importance in children. The aim of this study is to evaluate the diagnostic accuracy of urinary carbohydrate antigen 19-9 (CA19-9) levels for predicting acute pyelonephritis (APN) in children with urinary tract infection (UTI). Patients were allocated into two groups of APN and acute cystitis according to their diagnosis. Urine samples of all patients were collected. Also, complete history was taken, and physical examination, kidney and bladder ultrasonography, 99mTc-dimercaptosuccinic acid renal cortical scintigraphy, and urine analysis and culture were performed. Urinary CA19-9 was measured by an electrochemiluminescence enzyme immunometric kit. In addition, CA19-9 levels were measured in the APN group 2 weeks and 3 months later. A total of 100 children were included in this study (mean age 46 ± 31 months, 16 males and 84 females). CA19-9 levels were significantly greater in the APN group than acute cystitis group (510 ± 328 vs. 18.7 ± 18.6 U/ml, P < 0.001). During follow-up periods of the APN group, CA19-9 levels decreased to 180 ± 124 U/ml after 2 weeks (P < 0.001) and 30 ± 23 U/ml after 3 months (P < 0.001). Urinary CA-19-9 had 95.3% sensitivity and 80% specificity for the diagnosis of APN. The area under the curve value of CA19-9 was 0.904 (95% CI 0.831-0.977).Conclusion: Urinary CA19-9 level can be used as a reliable biomarker for early detection of APN prior to urine culture confirmation in children with UTI. What is known: • Early and prompt diagnosis of pyelonephritis is necessary in children to prevent renal damage. • Acute pyelonephritis can present with vague and nonspecific symptoms in infants and children. What is new: • Urinary carbohydrate antigen 19-9 is a reliable biomarker for early detection of acute pyelonephritis prior to urine culture confirmation. • Urinary carbohydrate antigen 19-9 has 95.3% sensitivity and 80% specificity for diagnosis of acute pyelonephritis.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran.
| | - Seyedeh Sanam Ladi Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Seyedeh Maryam Kameli
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Maryam Boroomand
- Pediatric Nephrology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mastaneh Moghtaderi
- Pediatric Nephrology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Bolgeri M, Whiting D, Reche A, Manghat P, Sriprasad S. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker of renal injury in patients with ureteric stones: a pilot study. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820947561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The role of neutrophil gelatinase-associated lipocalin in renal obstruction remains unclear. The aim of this study is to assess neutrophil gelatinase-associated lipocalin kinetics and its potential role as a biomarker of renal damage in acute ureteric colic. Methods: Thirty-six patients with acute ureteric colic were prospectively recruited and compared with two control groups. Blood and urine samples for plasma neutrophil gelatinase-associated lipocalin and urinary neutrophil gelatinase-associated lipocalin levels were obtained at various time points. Results: There were significantly higher levels of urinary neutrophil gelatinase-associated lipocalin and the urinary neutrophil gelatinase-associated lipocalin/creatinine ratio at presentation when comparing patients with acute ureteric colic to healthy controls ( P=0.002 and P=0.004, respectively). In patients with acute ureteric colic managed with surgical intervention ( n=27) there was a significant reduction in plasma neutrophil gelatinase-associated lipocalin ( P=0.001) and an increase in the urinary neutrophil gelatinase-associated lipocalin/creatinine ratio 6 hours postoperatively ( P=0.03). Eight of nine patients managed conservatively for acute ureteric obstruction had spontaneous stone passage at follow-up (median 26 days) with a significant reduction in the urinary neutrophil gelatinase-associated lipocalin/creatinine ratio ( P=0.03). Conclusion: The observation of a reduction in plasma neutrophil gelatinase-associated lipocalin and urinary neutrophil gelatinase-associated lipocalin levels following relief of renal obstruction due to ureteric stones suggests the potential role of neutrophil gelatinase-associated lipocalin as a biomarker in this scenario and in the follow-up setting as a potential marker of relief of obstruction. Level of evidence: 3b
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Devarakonda CKV, Shearier ER, Hu C, Grady J, Balsbaugh JL, Makari JH, Ferrer FA, Shapiro LH. A novel urinary biomarker protein panel to identify children with ureteropelvic junction obstruction - A pilot study. J Pediatr Urol 2020; 16:466.e1-466.e9. [PMID: 32620509 PMCID: PMC7529974 DOI: 10.1016/j.jpurol.2020.05.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE Reliable urinary biomarker proteins would be invaluable in identifying children with ureteropelvic junction obstruction (UPJO) as the existing biomarker proteins are inconsistent in their predictive ability. Therefore, the aim of this study was to identify consistent and reliable urinary biomarker proteins in children with UPJO. METHODS To identify candidate biomarker proteins, total protein from age-restricted (<2 years) and sex-matched (males) control (n = 22) and UPJO (n = 21) urine samples was analyzed by mass spectrometry. Proteins that were preferentially identified in UPJO samples were selected (2-step process) and ranked according to their diagnostic odds ratio value. The top ten proteins with highest odds ratio values were selected and tested individually by ELISA. The total amount of each protein was normalized to urine creatinine and the median with interquartile ranges for control and UPJO samples was determined. Additionally, fold change (UPJO/Control) of medians of the final panel of 5 proteins was also determined. Finally, we calculated the average + 3(SD) and average + 4(SD) values of each of the 5 proteins in the control samples and used it as an arbitrary cutoff to classify individual control and UPJO samples. RESULTS In the first step of our selection process, we identified 171 proteins in UPJO samples that were not detected in the majority of the control samples (16/22 samples, or 72.7%). Of the 171 proteins, only 50 proteins were detected in at least 11/21 (52.4%) of the UPJO samples and hence were selected in the second step. Subsequently, these 50 proteins were ranked according to the odds ratio value and the top 10 ranked proteins were validated by ELISA. Five of the 10 proteins - prostaglandin-reductase-1, ficolin-2, nicotinate-nucleotide pyrophosphorylase [carboxylating], immunoglobulin superfamily-containing leucine-rich-repeat-protein and vascular cell adhesion molecule-1 were present at higher levels in the UPJO samples (fold-change of the median protein concentrations ranging from 2.9 to 9.4) and emerged as a panel of biomarkers to identify obstructive uropathy. Finally, the order of prevalence of the 5 proteins in UPJO samples is PTGR1>FCN2>QPRT>ISLR>VCAM1. CONCLUSION In summary, this unique screening strategy led to the identification of previously unknown biomarker proteins that when screened collectively, may reliably distinguish between obstructed vs. non-obstructed infants and may prove useful in identifying informative biomarker panels for biological samples from many diseases.
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Affiliation(s)
- Charan Kumar V Devarakonda
- Center for Vascular Biology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Emily R Shearier
- Center for Vascular Biology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Chaoran Hu
- Biostatistics Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - James Grady
- Biostatistics Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Jeremy L Balsbaugh
- Proteomics and Metabolomics Facility, Center for Open Research Resources and Equipment, University of Connecticut, Storrs, CT, 06269, USA.
| | - John H Makari
- Department of Surgery, Division of Urology, University of Nebraska, Omaha, NE, 68918, USA.
| | - Fernando A Ferrer
- Center for Vascular Biology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Linda H Shapiro
- Center for Vascular Biology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
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Roles Played by Biomarkers of Kidney Injury in Patients with Upper Urinary Tract Obstruction. Int J Mol Sci 2020; 21:ijms21155490. [PMID: 32752030 PMCID: PMC7432915 DOI: 10.3390/ijms21155490] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Partial or complete obstruction of the urinary tract is a common and challenging urological condition caused by a variety of conditions, including ureteral calculi, ureteral pelvic junction obstruction, ureteral stricture, and malignant ureteral obstruction. The condition, which may develop in patients of any age, induces tubular and interstitial injury followed by inflammatory cell infiltration and interstitial fibrosis, eventually impairing renal function. The serum creatinine level is commonly used to evaluate global renal function but is not sensitive to early changes in the glomerular filtration rate and unilateral renal damage. Biomarkers of acute kidney injury are useful for the early detection and monitoring of kidney injury induced by upper urinary tract obstruction. These markers include levels of neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemotactic protein-1, kidney injury molecule 1, N-acetyl-b-D-glucosaminidase, and vanin-1 in the urine and serum NGAL and cystatin C concentrations. This review summarizes the pathophysiology of kidney injury caused by upper urinary tract obstruction, the roles played by emerging biomarkers of obstructive nephropathy, the mechanisms involved, and the clinical utility and limitations of the biomarkers.
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Qian S, Xia W, Wu Y, Cao Q, Ding Y, Huang Y, Shen H. Urinary kidney injury molecule-1: a novel biomarker to monitor renal function in patients with unilateral ureteral obstruction. Int Urol Nephrol 2020; 52:2065-2072. [PMID: 32507943 DOI: 10.1007/s11255-020-02528-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to investigate the clinical significance of urinary kidney injury molecule-1 (KIM-1) to monitor renal function in patients with obstructive unilateral ureteral calculi. METHODS Kidneys of 12 male C57BL/6J mice, as well as their urine and plasma specimens, were extracted to detect KIM-1 expressions 24 h after unilateral ureteral obstruction (UUO) construction or sham surgery. Meanwhile, a cohort of 89 patients with unilateral ureteral calculi was retrospectively reviewed. 46 of which received double-J ureteral stent indwelling (group 1) and the remaining 43 were treated conservatively (group 2). Urinary KIM-1 levels in the baseline, 2 h and 1 day after treatments were analyzed. RESULTS KIM-1 expressions were dramatically higher in mice underwent UUO surgery when compared with the sham group. Clinical data showed urinary KIM-1 levels decreased as time went by for patients in group 1 (1.787 ± 1.081 ng/mL for baseline, 1.668 ± 1.162 ng/mL for 2 h and 0.935 ± 0.526 ng/mL for 1 day after operation; p = 0.0001). Nevertheless, for those in group 2, a mild increase (1.659 ± 0.997 ng/mL, 1.691 ± 0.872 ng/mL and 1.675 ± 0.911 ng/mL, correspondingly; p = 0.9869) was observed. Additionally, a urinary KIM-1 value of 1.04 ng/mL had a sensitivity of 83.1% and specificity of 62.5% to predict the presence of hydronephrosis (95% CI: 0.641-0.873, AUC: 0.757, p < 0.001). CONCLUSIONS Urinary KIM-1 is a sensitive biomarker of post-renal acute kidney injury (AKI) and might predict the presence of hydronephrosis. It can be used as an effective surrogate to monitor renal function.
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Affiliation(s)
- Subo Qian
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Weimin Xia
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Yu Wu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Qifeng Cao
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Yu Ding
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Yunteng Huang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Haibo Shen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China.
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Paraboschi I, Mantica G, Dalton NR, Turner C, Garriboli M. Urinary biomarkers in pelvic-ureteric junction obstruction: a systematic review. Transl Androl Urol 2020; 9:722-742. [PMID: 32420179 PMCID: PMC7215034 DOI: 10.21037/tau.2020.01.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Antenatal hydronephrosis is a common finding detected on prenatal ultrasound. Although hydronephrosis will spontaneously resolve in the majority of newborns, there is a significant amount of cases that will worsen with the risk of a progressive and permanent loss of renal function. There is an increasing concern among experts that the current criteria for evaluation of clinically significant obstructions are limited. Our aim is to provide a systematic review of the available literature on biomarkers of renal injury, potential targets for diagnosis and prognosis of children with hydronephrosis. The main search was conducted in the electronic databases from inception through March 2019 using various combinations of the keywords: pelvic-ureteric [All Fields] AND junction [All Fields] AND obstruction [All Fields] AND “biomarkers” [MeSH Terms] OR “biomarkers” [All Fields] OR “biomarker” [All Fields]. To broaden the research, additional articles were identified through hand-searching review of the references reported in each study previously selected. Histopathological studies, studies with no control group or with participants suffering from concomitant urological diseases and articles published in language other than English were excluded. Data on study design, sample size, average patient age, hydronephrosis definition used, surgical indication, duration and pattern of follow-up, details on biomarker studied, diagnostic test characteristics, area under the curve (AUC) on receiver operating characteristic (ROC) analysis with the best cut-off (BCO) values, sensitivity, specificity and outcomes were all collected. 38 articles analysing 41 biomarkers were selected. The most frequent proteins investigated were neutrophil gelatinase-associated lipocalin (NGAL) (n=9; 23.7%), monocyte chemotactic peptide-1 (MCP1) (n=8; 21.1%), transforming growth factor β1 (TGFβ1) (n=7; 18.4%), epidermal growth factor (EGF) (n=6; 15.8%) and kidney injury molecule 1 (KIM 1) (n=6; 15.8%). Twenty-seven (71.1%) studies evaluated the effect of pyeloplasty on voided urine biomarker concentrations, comparing their values before and after surgery. Twelve (31.6%) studies investigated the correlation between preoperative biomarker concentration and the anterior posterior renal pelvis diameter (DAP) while 20 (52.6%) studies investigated the correlation between preoperative biomarker concentration with the split renal function (SRF) measured on nuclear medicine assessments. ROC curves were used to investigate the performance of urinary biomarkers in the total patient data set in 27 (71.1%) studies. Some biomarkers offer promising results. However, a critic analysis of the published studies demonstrates bias and lack of consistency suggesting that larger multicentre and carefully designed prospective studies are still needed to evaluate the clinical usefulness of urinary biomarkers in the diagnosis and follow-up of children with congenital obstructive hydronephrosis.
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Affiliation(s)
- Irene Paraboschi
- Paediatric Surgery Unit, Istituto Giannina Gaslini, DiNOGMI, University of Genova, Genoa, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Neil R Dalton
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Charles Turner
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
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Assadi F, Mazaheri M. Urinary polyomavirus: novel biomarker of congenital ureteropelvic junction obstruction. J Pediatr Urol 2020; 16:107.e1-107.e5. [PMID: 31818677 DOI: 10.1016/j.jpurol.2019.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pregnancy is associated with reactivation and transmission of latent polyomavirus to fetus. Polyomavirus is also known to cause ureteral stenosis and hydronephrosis. OBJECTIVE The aim of this study was to investigate whether the urinary polyomavirus could be used as a potential biomarker in newborns with ureteropelvic junction obstruction (UPJO). STUDY DESIGN Urinary polyomavirus virus was measured by PCR in 42 newborn infants with fetal hydronephrosis history. Random urine samples were obtained from newborns immediately after birth and from their mothers at the time of delivery. Results were compared with 25 healthy infants matched for gestational and postnatal ages. The diagnosis of UPJO was established by diuretic renal scintigraphy. UPJO was graded according to the Society for Fetal Urology (SFU) classification. RESULTS The urine samples of healthy infants showed no detectable polyomavirus. No statistically significant difference was found in the median urinary polyomavirus level between grade 1 (1000 copies/mL) and grade 2 (1500 copies/mL) UPJO infants. When the median urinary BKV values were compared for each grade of UPJO, patients with grade 3 and 4 had significantly higher urinary polyomavirus levels than those with grades 1 or 2 (P < 0.001). There was a strong correlation between the median polyomavirus in the urine of pregnant women and the urine of newborns with UPJO (P < 0.001). DISCUSSION Data suggest that routine screening of urinary polyomavirus may help to identify infants with severe obstruction in whom early surgical intervention could reduce the risk of developing progressive kidney disease. To the best of our knowledge this is the first prospective study to present the role of urinary polyomavirus in newborn infants with UPJO to distinguish between patients who would benefit from early surgical intervention. CONCLUSION Urinary polyomavirus is a potential biomarker of UPJO in newborns with fetal hydronephrosis.
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Affiliation(s)
- Farahnak Assadi
- Department of Pediatric Nephrology, Rush University Medical Center, Chicago, IL, USA.
| | - Mojgan Mazaheri
- Department of Pediatrics, Section of Nephrology, Semnan University of Medical Sciences, Semnan, Iran
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Pavlaki A, Printza N, Farmaki E, Stabouli S, Taparkou A, Sterpi M, Dotis J, Papachristou F. The role of urinary NGAL and serum cystatin C in assessing the severity of ureteropelvic junction obstruction in infants. Pediatr Nephrol 2020; 35:163-170. [PMID: 31606750 DOI: 10.1007/s00467-019-04349-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ideal management of ureteropelvic junction obstruction (UPJO) remains debatable. This prospective case-control study aimed to investigate if urinary levels of Neutrophil Gelatinase-Associated Lipocalin (NGAL) and serum levels of cystatin C could distinguish surgical from non-surgical cases of UPJO and if they could detect earlier impairment of renal function. METHODS Biomarkers were measured in the following age-matched groups: (a) 22 infants with surgical UPJO, at initial diagnosis and 12 months postoperatively (groups A1 and A2, respectively); (b) 19 infants with non-surgical UPJO (group B); and (c) 17 controls (group C). Based on serum cystatin C levels, estimated glomerular filtration rate (eGFR) was calculated. RESULTS Urinary NGAL (uNGAL) was significantly higher in group A1 vs. group A2 (p = 0.02) and in group A1 vs. group C (p = 0.03), whereas there was no statistically significant difference between groups A2 and C (p = 0.77). Likewise, cystatin C levels were significantly higher in group A1 vs. group A2 and in group A1 vs. group C (p = 0.004 and p = 0.02, respectively), but no statistically significant difference between groups A2 and C (p = 0.82). uNGAL and serum cystatin C did not differ between groups B and A, nor did they differ between groups B and C. Cystatin C levels and eGFR of group A1 were significantly higher than those of group A2 and group C (p = 0.0001 and p = 0.02, respectively). CONCLUSION It seems that NGAL and cystatin C are able to distinguish patients who were treated surgically from healthy controls, and their levels appear to improve significantly following surgery.
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Affiliation(s)
- Antigoni Pavlaki
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, 49th Konstantinoupoleos Street, 546 42, Thessaloniki, Greece.
| | - Nikoleta Printza
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, 49th Konstantinoupoleos Street, 546 42, Thessaloniki, Greece
| | - Evangelia Farmaki
- Paediatric Immunology and Rheumatology Referral Center, First Department of Paediatrics, Hippokratio Hospital, Thessaloniki, Greece
| | - Stella Stabouli
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, 49th Konstantinoupoleos Street, 546 42, Thessaloniki, Greece
| | - Anna Taparkou
- Paediatric Immunology and Rheumatology Referral Center, First Department of Paediatrics, Hippokratio Hospital, Thessaloniki, Greece
| | - Magdalini Sterpi
- Department of Neonatology and Neonatal Intensive Care Unit, Hippokratio Hospital, Thessaloniki, Greece
| | - John Dotis
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, 49th Konstantinoupoleos Street, 546 42, Thessaloniki, Greece
| | - Fotios Papachristou
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, 49th Konstantinoupoleos Street, 546 42, Thessaloniki, Greece
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A study of the utility of novel non-invasive urinary and serum biomarkers of blunt kidney injury in a rat model: NGAL, KIM-1, and IL-18. Cent Eur J Immunol 2019; 44:219-225. [PMID: 31871414 PMCID: PMC6925560 DOI: 10.5114/ceji.2019.89592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/08/2017] [Indexed: 12/05/2022] Open
Abstract
This study investigated changes in the concentrations of serum and urine neutrophil gelatinase lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (IL-18), and cystatin-C (Cys-C) induced by parenchymal and tubular damage following blunt kidney trauma, as well as their potential utility as biomarkers in the detection and follow-up of patients with suspected blunt renal trauma. Three-month-old male Sprague-Dawley rats (n = 18) were divided into three groups (n = 6 in each): group 1: control group (no intervention); group 2: sham group (explorative surgery and exposure of the left kidneys); and group 3: trauma group (explorative surgery and induction of blunt renal trauma of the left kidneys). Serum and urine samples were collected before and 12-24, 36-48, and 60-72 hours later for NGAL, KIM-1, IL-18, and Cys-C measurements. In the trauma group, there was a statistically significant increase in post-operative NGAL, KIM-1, and IL-18 values after 12-24 h and 36-48 h, as compared with pre-operative values. There was also a statistically significant increase in post-operative serum and urine Cys-C values after 60-72 h, as compared with pre-operative values. NGAL, KIM-1, and IL-18 may represent novel non-invasive descriptive candidate biomarkers of early-stage tubular damage in children with renal trauma.
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Screening of Early Diagnostic Markers of Gentamicin-induced Acute Kidney Injury in Canines. J Vet Res 2019; 63:405-411. [PMID: 31572822 PMCID: PMC6749733 DOI: 10.2478/jvetres-2019-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction The value of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (Kim-1), and liver-type fatty acid binding protein (L-FABP) was assessed in early diagnosis of gentamicin-induced acute kidney injury (AKI) in dogs. Material and Methods Subcutaneous gentamicin injection in 16 healthy adult beagles made the AKI model. Blood was sampled every 6 h to detect NGAL, Kim-1, L-FABP, and serum creatinine (SCr) concentrations. Kidney tissue of two dogs was taken before the injection, as soon as SCr was elevated (78 μmol/L), and when it had risen to 1.5 times the baseline, and haematoxylin-eosin staining and transmission electron microscopy (TEM) were used to observe changes. Results NGAL, Kim-1, and SCr levels were significantly increased (P < 0.05) at 18, 30, and 78 h post injection, but L-FABP concentration was not associated with renal injury. At the earliest SCr elevation stage, findings were mild oedema, degeneration, and vacuolisation in renal tubular epithelial cells in pathology, and mild cytoplasmic and mitochondrial oedema in TEM. At this time point, NGAL and Kim-1 concentrations were significantly increased (P < 0.05), indicating that these two molecules biomark early kidney injury in dogs. Using receiver operating characteristic curve analysis, their warning levels were > 25.31 ng/mL and > 48.52 pg/mL. Conclusion Plasma NGAL and Kim-1 above warning levels are early indicators of gentamicin-induced AKI in dogs.
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Kostic D, Dos Santos Beozzo GPN, do Couto SB, Kato AHT, Lima L, Palmeira P, Krebs VLJ, Bunduki V, Francisco RPV, Zugaib M, de Carvalho WB, Koch VHK. First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction. Pediatr Nephrol 2019; 34:1117-1128. [PMID: 30694385 DOI: 10.1007/s00467-019-4195-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. METHODS This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-β1), retinol-binding protein (RBP), cystatin C (uCyC), and microalbuminuria (μALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. RESULTS All urine biomarkers showed significantly higher values at the first month of life (p ≤ 0.009), while NGAL (p = 0.005), TGF-ß1 (p < 0.001), and μALB (p < 0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-ß1 or KIM-1 and NGAL with CyC ([AUC] ≤ 0.934; sensitivity ≤ 92.4%; specificity ≤ 92.8%). CONCLUSIONS RBP, NGAL, KIM-1, TGF-ß1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
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Affiliation(s)
- Dusan Kostic
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil.
| | | | - Saulo Brasil do Couto
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil
| | - André Henrique Teruaki Kato
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil
| | - Laila Lima
- Laboratory of Clinical Investigations (LIM-36)-Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Palmeira
- Laboratory of Clinical Investigations (LIM-36)-Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Lúcia Jornada Krebs
- Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Bunduki
- Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Werther Brunow de Carvalho
- Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Hermina Kalika Koch
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil
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The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants. J Pediatr Urol 2019; 15:242.e1-242.e9. [PMID: 30979613 DOI: 10.1016/j.jpurol.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. OBJECTIVE The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. STUDY DESIGN The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-β1), retinol-binding protein (RBP), and microalbuminuria (μALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro(uretero)nephrosis, 13 cases with grade III bilateral hydro(uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 °C and thereafter analyzed by quantitative enzymatic immunoassay. RESULTS Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P ≤ 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P ≤ 0.043), NGAL (P ≤ 0.043), KIM-1 (P ≤ 0.03), and TGF-β1 (P ≤ 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. DISCUSSION To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-β1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. CONCLUSIONS Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention.
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A Novel Biomarker for Acute Kidney Injury, Vanin-1, for Obstructive Nephropathy: A Prospective Cohort Pilot Study. Int J Mol Sci 2019; 20:ijms20040899. [PMID: 30791405 PMCID: PMC6412925 DOI: 10.3390/ijms20040899] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/03/2019] [Accepted: 02/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Vanin-1 is a novel acute kidney injury (AKI) biomarker that has not been clinically investigated as a biomarker for obstructive nephropathy. This study investigated the diagnostic value of vanin-1 as a biomarker for adult obstructive nephropathy by comparing it to existing AKI biomarkers. Methods: A total of 49 patients, 21 controls, and 28 hydronephrosis (HN) cases were assessed. AKI biomarkers in bladder (BL) urine and renal pelvic (RP) urine in the HN group were compared to each BL marker in the control group. In a subgroup of cases receiving interventions for obstructive nephropathy, the BL values of each biomarker were assessed after the intervention. Results: RP vanin-1 levels were significantly higher while BL vanin-1 levels were marginally higher in the HN group than in the control group. The area under the receiver operating characteristics curve values for RP and BL vanin-1 were 0.9778 and 0.6386, respectively. In multivariate analyses, BL vanin-1 and N-acetyl-β-D-glucosaminidase (NAG), but not kidney injury molecule-1 (KIM-1) or neutrophil gelatinase-associated lipocalin (NGAL), were independent factors for predicting the presence of HN. In cases receiving interventions, vanin-1 decreased significantly from 1 week after the intervention in cases of moderate to severe obstructive nephropathy compared to RP values at baseline. Conclusion: Urinary vanin-1 is a useful biomarker to detect and monitor the clinical course of obstructive nephropathy.
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Ge C, Xu M, Qin Y, Gu T, Lou D, Li Q, Hu L, Nie X, Wang M, Tan J. Fisetin supplementation prevents high fat diet-induced diabetic nephropathy by repressing insulin resistance and RIP3-regulated inflammation. Food Funct 2019; 10:2970-2985. [DOI: 10.1039/c8fo01653d] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Obesity-related renal disease is related to caloric excess promoting deleterious cellular responses.
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Fan H, Zhao Y, Sun M, Zhu JH. Urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, N-acetyl-β-D-glucosaminidase levels and mortality risk in septic patients with acute kidney injury. Arch Med Sci 2018; 14:1381-1386. [PMID: 30393493 PMCID: PMC6209703 DOI: 10.5114/aoms.2018.79006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/30/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The aim of the study was to confirm whether higher levels of urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and N-acetyl-β-D-glucosaminidase (NAG) are associated with mortality risk scores in severe septic patients with acute kidney injury (AKI). MATERIAL AND METHODS A prospective observational study was performed in an adult critical care unit. A total of 135 patients were included. The levels of urinary NGAL, KIM-1 and NAG were compared between patients with acute physiology and chronic health evaluation (APACHE II) score > 25 (group A, n = 31) and APACHE II score ≤ 25 (group B, n = 104). RESULTS Median level of NGAL was 105.1 ng/ml (77.6-132.5) in group A versus 40.0 ng/ml (18.6-60.5) in group B (p < 0.001), KIM-1 was 16.2 ng/ml (10.2-22.3) versus 3.3 ng/ml (1.8-4.6) (p < 0.001), and NAG was 32.0 U/l (17.5-46.4) versus 15.0 U/l (7.7-22.3) (p < 0.001). The area under the receiver operating characteristic curve for NGAL was 0.70 (95% CI: 0.60-0.79), KIM-1 was 0.75 (95% CI: 0.66-0.83), and NAG was 0.69 (95% CI: 0.60-0.79). A NGAL level > 102.5 ng/ml had 95% sensitivity and 76% specificity, KIM-1 > 7.3 ng/ml had 96% sensitivity and 61% specificity, and NAG > 15.4 U/l had 86% sensitivity and 74% specificity. CONCLUSIONS In severe septic AKI patients, high levels of NGAL, KIM-1 and NAG are associated with mortality risk scores. Urinary NGAL, KIM-1 and NAG concentrations higher than 102.5 ng/ml, 7.3 ng/ml and 15.4 U/l respectively may be used to predict increased of death risk scores.
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Affiliation(s)
- Heng Fan
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
| | - Yu Zhao
- Department of Nephrology, Ningbo Urology and Nephrology Hospital, Ningbo, China
| | - Min Sun
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
| | - Jian-Hua Zhu
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
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Potential Novel Biomarkers of Obstructive Nephropathy in Children with Hydronephrosis. DISEASE MARKERS 2018; 2018:1015726. [PMID: 30327688 PMCID: PMC6171252 DOI: 10.1155/2018/1015726] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/09/2018] [Indexed: 01/12/2023]
Abstract
Obstructive nephropathy (ON) secondary to the congenital hydronephrosis (HN) is one of the most common causes of chronic kidney disease in children. Neither currently used imaging techniques nor conventional laboratory parameters are sufficient to assess the onset and outcome of this condition; hence, there is a need to prove the usefulness of newly discovered biomarkers of kidney injury in this respect. The purpose of the study was to assess the urinary excretion of alpha-GST, pi-GST, NGAL, and KIM-1 and the serum level of NGAL in children with congenital unilateral hydronephrosis secondary to ureteropelvic junction obstruction. The results were evaluated in relation to severity of HN, the presence of ON, relative function of an obstructed kidney, and the presence of proteinuria. The study comprised 45 children with HN of different grades and 21 healthy controls. Urinary and serum concentrations of biomarkers were measured using specific ELISA kits. Urinary biomarker excretions were expressed as a biomarker/creatinine (Cr) ratio. Patients with the highest grades of HN showed significantly increased values of all measured biomarkers, whereas those with the lowest grades of HN displayed only significant elevation of urinary alpha-GST and the serum NGAL. Urinary NGAL positively correlated with percentage loss of relative function of an obstructed kidney in renal scintigraphy. In patients with proteinuria, significantly higher urinary alpha-GST excretion was revealed as compared to those without this symptom. The ROC curve analysis showed the best diagnostic profile for urinary alpha-GST/Cr and NGAL/Cr ratios in the detection of ON. In conclusion, the results of the study showed that urinary alpha-GST and NGAL are promising biomarkers of ON. Ambiguous results of the remaining biomarkers, i.e., urinary pi-GST and KIM-1, and serum NGAL level may be related to a relatively small study group. Their utility in an early diagnosis of ON should be reevaluated.
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Urinary antimicrobial peptides: Potential novel biomarkers of obstructive uropathy. J Pediatr Urol 2018; 14:238.e1-238.e6. [PMID: 29706289 DOI: 10.1016/j.jpurol.2018.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 03/01/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antimicrobial peptides (AMPs) have historically been evaluated for their role in protecting against uropathogens. However, there is mounting evidence to support their expression in noninfectious injury, with unclear meaning as to their function. It is possible that AMPs represent urothelial injury. Urinary tract obstruction is known to alter the urothelium; however, AMPs have not been evaluated for expression in this noninfectious injury. OBJECTIVE A pilot study to compare urinary AMP expression in children undergoing surgical intervention for ureteropelvic junction obstruction (UPJO) with nonobstructed controls. STUDY DESIGN Bladder urine was collected from consenting/assenting pediatric patients with UPJO at intervention. Control bladder urines were obtained from age-matched and sex-matched healthy children without known obstruction or infection. Enzyme-linked immunosorbent assays were run for the following AMPs: β defense 1 (BD-1), neutrophil gelatinase-associated lipocalin (NGAL), cathelicidin (LL-37), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), and human α defensin 5 (HD-5); and normalized to urine creatinine. Results were analyzed with Student's t-test or Mann-Whitney U test, when appropriate, and receiver operating characteristic curves. A P-value of <0.05 was considered significant. RESULTS Thirty bladder urine samples were obtained from children with UPJO at the time of decompressive intervention. Mean patient age was 4.7 years (range 0.3-18.4); 20 (67%) patients were male. Fifteen bladder urine samples were obtained from age-matched and sex-matched controls. Urinary AMP levels were significantly higher in UPJO patients than controls for BD-1 (P = 0.015), NGAL (P < 0.001), LL-37 (P < 0.001), and HIP/PAP (P = 0.046). Optimal threshold values of these AMPs were determined, with each demonstrating significant odds ratios of predicting urinary obstruction. DISCUSSION Certain urinary AMPs are altered even in noninfectious urinary tract pathology. This represents a novel induction of AMP expression, as the current study is the first to report elevations in BD-1 and HIP/PAP in urinary tract obstruction. This suggests other roles for these AMPs outside of their antimicrobial properties, and likely is a reflection of the urothelial and tubular stress resulting from obstructive uropathy. CONCLUSIONS Induction of AMPs BD-1, NGAL, LL-37, and HIP/PAP was found to occur in urinary tract obstruction. Further evaluation of AMP expression as a biomarker of uroepithelial injury outside of infection is indicated.
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Undiagnosed Kidney Injury in Uninsured and Underinsured Diabetic African American Men and Putative Role of Meprin Metalloproteases in Diabetic Nephropathy. Int J Nephrol 2018; 2018:6753489. [PMID: 29854459 PMCID: PMC5949186 DOI: 10.1155/2018/6753489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/23/2018] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Diabetes is the leading cause of chronic kidney disease. African Americans are disproportionately burdened by diabetic kidney disease (DKD) and end stage renal disease (ESRD). Disparities in DKD have genetic and socioeconomic components, yet its prevalence in African Americans is not adequately studied. The current study used multiple biomarkers of DKD to evaluate undiagnosed DKD in uninsured and underinsured African American men in Greensboro, North Carolina. Participants consisted of three groups: nondiabetic controls, diabetic patients without known kidney disease, and diabetic patients with diagnosed DKD. Our data reveal undiagnosed kidney injury in a significant proportion of the diabetic patients, based on levels of both plasma and urinary biomarkers of kidney injury, namely, urinary albumin to creatinine ratio, kidney injury molecule-1, cystatin C, and neutrophil gelatinase-associated lipocalin. We also found that the urinary levels of meprin A, meprin B, and two kidney meprin targets (nidogen-1 and monocytes chemoattractant protein-1) increased with severity of kidney injury, suggesting a potential role for meprin metalloproteases in the pathophysiology of DKD in this subpopulation. The study also demonstrates a need for more aggressive tests to assess kidney injury in uninsured diabetic patients to facilitate early diagnosis and targeted interventions that could slow progression to ESRD.
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Tamimi A, Kord E, Rappaport YH, Cooper A, Abu Hamad R, Efrati S, Kenett RS, Zisman A, Siegel YI. Salivary Neutrophil Gelatinase-Associated Lipocalin Sampling Feasibility in Acute Renal Colic. J Endourol 2018; 32:566-571. [PMID: 29641349 DOI: 10.1089/end.2017.0864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Neutrophil gelatinase-associated lipocalin (NGAL) levels in the serum and urine are predictive biomarkers of acute kidney injury with correlation to complication and survival in major surgery. Salivary levels of NGAL during acute renal colic may reflect the degree of renal injury as it appears in different compartments encompassing body response in time perspective. Our aim is to evaluate and examine the feasibility and correlation of salivary NGAL with serum and urine levels in acute renal colic event. MATERIALS AND METHODS A prospective controlled study of all patients presenting to the emergency room with acute renal colic event diagnosed with single ureteral stone obstruction by noncontrast CT. Saliva, urine, and blood samples were collected in patients and a control group during the first morning of admission. RESULTS The study groups consisted of 44 patients and 13 controls, mean age 47 ± 15 years, body mass index 29 ± 6, mean stone size 6 ± 4 mm, mean creatinine levels 1.3 ± 0.7 mg/dL, mean white blood count 10,900 ± 3100 counts per field, and C-reactive protein 29 ± 55. Serum (190 ± 120 ng/mL vs 81 ± 24; p < 0.001) and predominantly salivary (474 ± 185 vs 328 ± 134 ng/mL; p < 0.05) NGAL levels were significantly elevated in patients compared with controls. CONCLUSIONS Salivary NGAL sampling is feasible during the acute phase of renal colic. High levels of salivary NGAL are observed in a single sampling during acute ureteral stone obstruction and may advance clinical decision-making.
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Affiliation(s)
- Ashraf Tamimi
- 1 Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel .,2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Eyal Kord
- 1 Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel .,2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yishai H Rappaport
- 1 Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel .,2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Amir Cooper
- 1 Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel .,2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Ramziya Abu Hamad
- 2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel .,3 Department of Nephrology, Assaf Harofeh Medical Center , Zerifin, Israel
| | - Shai Efrati
- 2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel .,3 Department of Nephrology, Assaf Harofeh Medical Center , Zerifin, Israel
| | - Ron S Kenett
- 4 The Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem , Jerusalem, Israel
| | - Amnon Zisman
- 1 Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel .,2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yoram I Siegel
- 1 Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel .,2 Affiliated to the Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
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Wu B, Gong X, Kennedy WA, Brooks JD. Identification of transcripts associated with renal damage due to ureteral obstruction as candidate urinary biomarkers. Am J Physiol Renal Physiol 2018; 315:F16-F26. [PMID: 29488389 DOI: 10.1152/ajprenal.00382.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal obstruction is a common cause of renal failure in adults and children and is suspected when hydronephrosis is detected on imaging. Because not all cases of hydronephrosis are associated with renal damage, biomarkers are needed to guide intervention to relieve obstruction. We performed gene expression profiling on the kidneys from adult mice over a detailed time course after obstruction and compared these data with a neonatal model of bilateral high-grade obstruction induced by conditional deletion of the calcineurin β1 gene. Having identified a set of 143 transcripts modulated in both adult and neonatal obstruction, we tested their expression in a model of short-term obstruction (1 day), where renal damage is transient and reversible, and long-term obstruction (5 days), where significant renal damage is permanent. A significant number of transcripts increased early after obstruction, and later normalized, while 26 transcripts remained elevated 10 and 28 days after relief of 5 days of ureteral obstruction. With the use of qPCR, elevated levels of several of these candidate RNA biomarkers of renal damage were detected in urine from obstructed mice. In addition, several of these candidate RNA biomarkers of damage resulting from obstruction were detectable in catheterized urine samples from children undergoing surgery for ureteropelvic junction obstruction. Measurement of urinary transcripts modulated in response to renal obstruction could serve as biomarkers of renal damage with important clinical applications.
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Affiliation(s)
- Bo Wu
- Department of Urology, Stanford University , Stanford, California
| | - Xue Gong
- Department of Urology, Stanford University , Stanford, California
| | | | - James D Brooks
- Department of Urology, Stanford University , Stanford, California
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Xin G, Chen R, Zhang X. Identification of key microRNAs, transcription factors and genes associated with congenital obstructive nephropathy in a mouse model of megabladder. Gene 2018; 650:77-85. [PMID: 29410288 DOI: 10.1016/j.gene.2018.01.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/21/2017] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The present study aimed to investigate the molecular mechanism underlying congenital obstructive nephropathy (CON). METHODS The microarray dataset GSE70879 was downloaded from the Gene Expression Omnibus, including 3 kidney samples of megabladder mice and 4 control kidneys. Using this dataset, differentially expressed miRNAs (DEMs) were identified between the kidney samples from megabladder mice and controls, followed by identification of the target genes for these DEMs and construction of a DEM and target gene interaction network. Additionally, the target genes were subjected to Gene Ontology and pathway enrichment analyses, and were used for construction of a protein-protein interaction (PPI) network. Finally, regulatory networks were constructed to analyze transcription factors for the key miRNAs. RESULTS From 17 DEMs identified between kidney samples of megabladder mice and controls, 3 key miRNAs were screened, including mmu-miR-150-5p, mmu-miR-374b-5p and mmu-miR-126a-5p. The regulatory networks identified vascular endothelial growth factor A (Vegfa) as the common target gene of mmu-miR-150-5p and five transcription factors, including nuclear receptor subfamily 4, group A, member 2 (Nr4a2), Jun dimerisation protein 2 (Jdp2), Kruppel-like factor 6 (Klf6), Neurexophilin-3 (Nxph3) and RNA binding motif protein 17 (Rbm17). The gene encoding phosphatase and tensin homolog (Pten) was found to be co-regulated by mmu-miR-374b-5p and high mobility group protein A1 (Hmga1), whereas the kirsten rat sarcoma viral oncogene (Kras) was identified as a common target gene of mmu-miR-126a-5p and paired box 6 (Pax6). CONCLUSIONS In summary, the above-listed key miRNAs, transcription factors and key genes may be involved in the development of CON.
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Affiliation(s)
- Guangda Xin
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Rui Chen
- Department of Pediatrics, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Xiaofei Zhang
- Department of Pediatrics, China-Japan Union Hospital of Jilin University, Changchun 130033, China.
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