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Saingam P, Jain T, Woicik A, Li B, Candry P, Redcorn R, Wang S, Himmelfarb J, Bryan A, Winkler MKH, Gattuso M. Integrating socio-economic vulnerability factors improves neighborhood-scale wastewater-based epidemiology for public health applications. WATER RESEARCH 2024; 254:121415. [PMID: 38479175 DOI: 10.1016/j.watres.2024.121415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 04/06/2024]
Abstract
Wastewater Based Epidemiology (WBE) of COVID-19 is a low-cost, non-invasive, and inclusive early warning tool for disease spread. Previously studied WBE focused on sampling at wastewater treatment plant scale, limiting the level at which demographic and geographic variations in disease dynamics can be incorporated into the analysis of certain neighborhoods. This study demonstrates the integration of demographic mapping to improve the WBE of COVID-19 and associated post-COVID disease prediction (here kidney disease) at the neighborhood level using machine learning. WBE was conducted at six neighborhoods in Seattle during October 2020 - February 2022. Wastewater processing and RT-qPCR were performed to obtain SARS-CoV-2 RNA concentration. Census data, clinical data of COVID-19, as well as patient data of acute kidney injury (AKI) cases reported during the study period were collected and the distribution across the city was studied using Geographic Information System (GIS) mapping. Further, we analyzed the data set to better understand socioeconomic impacts on disease prevalence of COVID-19 and AKI per neighborhood. The heterogeneity of eleven demographic factors (such as education and age among others) was observed within neighborhoods across the city of Seattle. Dynamics of COVID-19 clinical cases and wastewater SARS-CoV-2 varied across neighborhood with different levels of demographics. Machine learning models trained with data from the earlier stages of the pandemic were able to predict both COVID-19 and AKI incidence in the later stages of the pandemic (Spearman correlation coefficient of 0·546 - 0·904), with the most predictive model trained on the combination of wastewater data and demographics. The integration of demographics strengthened machine learning models' capabilities to predict prevalence of COVID-19, and of AKI as a marker for post-COVID sequelae. Demographic-based WBE presents an effective tool to monitor and manage public health beyond COVID-19 at the neighborhood level.
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Affiliation(s)
- Prakit Saingam
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, United States.
| | - Tanisha Jain
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, United States
| | - Addie Woicik
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, United States
| | - Bo Li
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, United States
| | - Pieter Candry
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, United States
| | - Raymond Redcorn
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, United States
| | - Sheng Wang
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, United States
| | - Jonathan Himmelfarb
- Kidney Research Institute, University of Washington, Seattle, WA, United States; Center for Dialysis Innovation, University of Washington, Seattle, WA, United States
| | - Andrew Bryan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Mari K H Winkler
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, United States
| | - Meghan Gattuso
- Seattle Public Utilities, Project Delivery and Engineering, 700 5th Ave, Seattle, WA 98104, United States
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Bufkin KB, Karim ZA, Silva J. Review of the limitations of current biomarkers in acute kidney injury clinical practices. SAGE Open Med 2024; 12:20503121241228446. [PMID: 38322582 PMCID: PMC10846001 DOI: 10.1177/20503121241228446] [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: 09/26/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Acute kidney injury is a prevalent disease in hospitalized patients and is continuously increasing worldwide. Various efforts have been made to define and classify acute kidney injury to understand the progression of this disease. Furthermore, deviations from structure and kidney function and the current diagnostic guidelines are not adequately placed due to baseline serum creatinine values, which are rarely known and estimated based on glomerular function rate, resulting in misclassification of acute kidney injury staging. Hence, the current guidelines are still developing to improve and understand the clinical implications of risk factors and earlier predictive biomarkers of acute kidney injury. Yet, studies have indicated disadvantages and limitations with the current acute kidney injury biomarkers, including lack of sensitivity and specificity. Therefore, the present narrative review brings together the most current evidenced-based practice and literature associated with the limitations of the gold standard for acute kidney injury diagnoses, the need for novel acute kidney injury biomarkers, and the process for biomarkers to be qualified for diagnostic use under the following sections and themes. The introduction section situates the anatomy and normal and abnormal kidney functions related to acute kidney injury disorders. Guidelines in providing acute kidney injury definitions and classification are then considered, followed by a discussion of the disadvantages of standard markers used to diagnose acute kidney injury. Characteristics of an ideal acute kidney injury biomarker are discussed concerning sensitivity, specificity, and anatomic location of injury. A particular focus on the role and function of emerging biomarkers is discussed in relation to their applications and significance to the prognosis and severity of acute kidney injury. Findings show emerging markers are early indicators of acute kidney injury prediction in different clinical settings. Finally, the process required for a biomarker to be applied for diagnostic use is explained.
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Affiliation(s)
- Kendra B Bufkin
- Department of Interdisciplinary Health Science, College of Allied Health Science, Augusta University, Augusta, GA, USA
| | - Zubair A Karim
- Department of Interdisciplinary Health Science, College of Allied Health Science, Augusta University, Augusta, GA, USA
| | - Jeane Silva
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA
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Wu K, Chen EH, Wirth F, Vitanova K, Lange R, Burschka D. Continuous Risk Estimation of Acute Kidney Failure with Dense Temporal Data for ICU Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083688 DOI: 10.1109/embc40787.2023.10340113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Acute kidney failure is a dangerous complication for ICU patients, and it is difficult to identify at early stage with conventional medical analysis. In recent years, machine learning approaches have been applied to tackle medical diagnosis tasks with great performance. In this work, we deploy machine learning models for early detection of acute kidney failure that can handle static, temporal, sparse and dense data of ICU patients. We investigate different pre-processing methods for patient data to achieve higher prediction performance and how they influence the contribution of different physiological signals in the prediction process.
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Wang DR, Pan J. Extracellular vesicles: Emerged as a promising strategy for regenerative medicine. World J Stem Cells 2023; 15:165-181. [PMID: 37181006 PMCID: PMC10173817 DOI: 10.4252/wjsc.v15.i4.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
Cell transplantation therapy has certain limitations including immune rejection and limited cell viability, which seriously hinder the transformation of stem cell-based tissue regeneration into clinical practice. Extracellular vesicles (EVs) not only possess the advantages of its derived cells, but also can avoid the risks of cell transplantation. EVs are intelligent and controllable biomaterials that can participate in a variety of physiological and pathological activities, tissue repair and regeneration by transmitting a variety of biological signals, showing great potential in cell-free tissue regeneration. In this review, we summarized the origins and characteristics of EVs, introduced the pivotal role of EVs in diverse tissues regeneration, discussed the underlying mechanisms, prospects, and challenges of EVs. We also pointed out the problems that need to be solved, application directions, and prospects of EVs in the future and shed new light on the novel cell-free strategy for using EVs in the field of regenerative medicine.
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Affiliation(s)
- Dian-Ri Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jian Pan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
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Pantic I, Cumic J, Dugalic S, Petroianu GA, Corridon PR. Gray level co-occurrence matrix and wavelet analyses reveal discrete changes in proximal tubule cell nuclei after mild acute kidney injury. Sci Rep 2023; 13:4025. [PMID: 36899130 PMCID: PMC10006226 DOI: 10.1038/s41598-023-31205-7] [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: 06/15/2022] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Acute kidney injury (AKI) relates to an abrupt reduction in renal function resulting from numerous conditions. Morbidity, mortality, and treatment costs related to AKI are relatively high. This condition is strongly associated with damage to proximal tubule cells (PTCs), generating distinct patterns of transcriptional and epigenetic alterations that result in structural changes in the nuclei of this epithelium. To this date, AKI-related nuclear chromatin redistribution in PTCs is poorly understood, and it is unclear whether changes in PTC chromatin patterns can be detected using conventional microscopy during mild AKI, which can progress to more debilitating forms of injury. In recent years, gray level co-occurrence matrix (GLCM) analysis and discrete wavelet transform (DWT) have emerged as potentially valuable methods for identifying discrete structural changes in nuclear chromatin architecture that are not visible during the conventional histopathological exam. Here we present findings indicating that GLCM and DWT methods can be successfully used in nephrology to detect subtle nuclear morphological alterations associated with mild tissue injury demonstrated in rodents by inducing a mild form of AKI through ischemia-reperfusion injury. Our results show that mild ischemic AKI is associated with the reduction of local textural homogeneity of PTC nuclei quantified by GLCM and the increase of nuclear structural heterogeneity indirectly assessed with DWT energy coefficients. This rodent model allowed us to show that mild ischemic AKI is associated with the significant reduction of textural homogeneity of PTC nuclei, indirectly assessed by GLCM indicators and DWT energy coefficients.
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Affiliation(s)
- Igor Pantic
- Faculty of Medicine, Department of Medical Physiology, Laboratory for Cellular Physiology, University of Belgrade, Visegradska 26/II, 11129, Belgrade, Serbia
- University of Haifa, 199 Abba Hushi Blvd, Mount Carmel, 3498838, Haifa, Israel
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, PO Box 127788, Abu Dhabi, UAE
| | - Jelena Cumic
- Faculty of Medicine, University of Belgrade, University Clinical Center of Serbia, Dr. Koste Todorovica 8, 11129, Belgrade, Serbia
| | - Stefan Dugalic
- Faculty of Medicine, University of Belgrade, University Clinical Center of Serbia, Dr. Koste Todorovica 8, 11129, Belgrade, Serbia
| | - Georg A Petroianu
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, PO Box 127788, Abu Dhabi, UAE
| | - Peter R Corridon
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, PO Box 127788, Abu Dhabi, UAE.
- Healthcare Engineering Innovation Center, Biomedical Engineering, Khalifa University of Science and Technology, PO Box 127788, Abu Dhabi, UAE.
- Center for Biotechnology, Khalifa University of Science and Technology, PO Box 127788, Abu Dhabi, UAE.
- Indiana Center for Biological Microscopy, Indiana University School of Medicine, Indianapolis, IN, USA.
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Tian M, Liu X, Chen L, Hu S, Zheng Z, Wang L, Wang X, Gao H, Sun W. Urine metabolites for preoperative prediction of acute kidney injury after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2023; 165:1165-1175.e3. [PMID: 33994002 DOI: 10.1016/j.jtcvs.2021.03.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Acute kidney injury is a common complication after on-pump coronary artery bypass grafting. Prediction of acute kidney injury remains a challenge. Our study aims to identify a panel of urine metabolites for preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting. METHODS A total of 159 patients undergoing isolated on-pump coronary artery bypass grafting were enrolled from July 7, 2017, to May 17, 2019. Preoperative urine samples were analyzed with the approach of liquid chromatography-mass spectrometry-based urine metabolomics. The study end point was the episode of acute kidney injury within 48 hours postoperatively. The predictive performance was determined by the area under the curve and calibration curve. The results were validated using bootstrap resampling. RESULTS The acute kidney injury (n = 55) and nonacute kidney injury (n = 104) groups showed significant different metabolic profiling. A total of 28 metabolites showed significant differences between the acute kidney injury and nonacute kidney injury groups. A metabolite panel of 5 metabolites (tyrosyl-gamma-glutamate, deoxycholic acid glycine conjugate, 5-acetylamino-6-amino-3-methyluracil, arginyl-arginine, and L-methionine) was discovered to have a good predicting performance (area under the curve, 0.89; 95% confidence interval, 0.82-0.93), which is higher than the clinical factor-based model (area under the curve, 0.63; 95% confidence interval, 0.53-0.72). Internal validation by bootstrap resampling showed an adjusted area under the curve of 0.88, and the calibration curve demonstrated good agreement between prediction and observation in the probability of postoperative acute kidney injury. Decision curve analysis revealed a superior net benefit of the metabolite model over the traditional clinical factor-based model. CONCLUSIONS We present 5 urine metabolites related to acute kidney injury after coronary artery bypass grafting. This metabolite model may serve as a preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting.
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Affiliation(s)
- Meice Tian
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Liang Chen
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhe Zheng
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liqing Wang
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xianqiang Wang
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huawei Gao
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Wei Sun
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
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Vagliano I, Chesnaye NC, Leopold JH, Jager KJ, Abu-Hanna A, Schut MC. Machine learning models for predicting acute kidney injury: a systematic review and critical appraisal. Clin Kidney J 2022; 15:2266-2280. [PMID: 36381375 PMCID: PMC9664575 DOI: 10.1093/ckj/sfac181] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The number of studies applying machine learning (ML) to predict acute kidney injury (AKI) has grown steadily over the past decade. We assess and critically appraise the state of the art in ML models for AKI prediction, considering performance, methodological soundness, and applicability. METHODS We searched PubMed and ArXiv, extracted data, and critically appraised studies based on the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS), and Prediction Model Risk of Bias Assessment Tool (PROBAST) guidelines. RESULTS Forty-six studies from 3166 titles were included. Thirty-eight studies developed a model, five developed and externally validated one, and three studies externally validated one. Flexible ML methods were used more often than deep learning, although the latter was common with temporal variables and text as predictors. Predictive performance showed an area under receiver operating curves ranging from 0.49 to 0.99. Our critical appraisal identified a high risk of bias in 39 studies. Some studies lacked internal validation, whereas external validation and interpretability of results were rarely considered. Fifteen studies focused on AKI prediction in the intensive care setting, and the US-derived Medical Information Mart for Intensive Care (MIMIC) data set was commonly used. Reproducibility was limited as data and code were usually unavailable. CONCLUSIONS Flexible ML methods are popular for the prediction of AKI, although more complex models based on deep learning are emerging. Our critical appraisal identified a high risk of bias in most models: Studies should use calibration measures and external validation more often, improve model interpretability, and share data and code to improve reproducibility.
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Affiliation(s)
- Iacopo Vagliano
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jan Hendrik Leopold
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martijn C Schut
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Hong C, Zhu Q, Li Y, Tang S, Lin S, Yang Y, Yuan S, Shao L, Wu Y, Liu B, Li B, Meng F, Chen Y, Hong M, Qi X. Acute kidney injury defined by cystatin C may be superior for predicting the outcomes of liver cirrhosis with acute gastrointestinal bleeding. Ren Fail 2022; 44:398-406. [PMID: 35225149 PMCID: PMC8890530 DOI: 10.1080/0886022x.2022.2039193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Acute kidney injury (AKI) is conventionally evaluated by a dynamic change of serum creatinine (Scr). Cystatin C (CysC) seems to be a more accurate biomarker for assessing kidney function. This retrospective multicenter study aims to evaluate whether AKI re-defined by CysC can predict the in-hospital outcomes of patients with liver cirrhosis and acute gastrointestinal bleeding. METHODS Overall, 677 cirrhotic patients with acute gastrointestinal bleeding, in whom both Scr and CysC levels were detected at admissions, were screened. eGFRScr, eGFRCysC, and eGFRScr-CysC were calculated. MELD-Na score and AKI were re-evaluated by CysC instead of Scr. Odds ratios (ORs) were calculated in the logistic regression analyses. The receiver operating characteristic (ROC) curve analyses were performed. RESULTS Univariate logistic regression analyses demonstrated that baseline Scr and CysC levels, eGFRScr, eGFRCysC, eGFRScr-CysC, original MELD-Na score defined by Scr, MELD-Na score re-defined by CysC, and AKI re-defined by CysC, but not conventional AKI defined by Scr, were significantly associated with in-hospital death. ROC analyses showed that baseline CysC level, eGFRScr, eGFRCysC, eGFRScr-CysC, original MELD-Na score defined by Scr, and MELD-Na score re-defined by CysC, but not baseline Scr level, could significantly predict the risk of in-hospital death. CONCLUSIONS AKI re-defined by CysC may be superior for predicting the in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding.
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Affiliation(s)
- Cen Hong
- Department of Gastroenterology, General Hospital of Northern Theater Command (formally called General Hospital of Shenyang Military Area), Shenyang, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong Frist Medical University, Jinan, China
| | - Yiling Li
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shanhong Tang
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, China
| | - Su Lin
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yida Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shanshan Yuan
- Department of Gastroenterology, Xi'an Central Hospital, Xi'an, China
| | - Lichun Shao
- Department of Gastroenterology, Air Force Hospital of Northern Theater Command, Shenyang, China
| | - Yunhai Wu
- Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Bang Liu
- Department of Hepatobiliary Disease, Fuzong Clinical Medical College of Fujian Medical University & 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Bimin Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fanping Meng
- Department of Biological Therapy, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yu Chen
- Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You’an Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Min Hong
- Department of Nephrology, General Hospital of Northern Theater Command (formally called General Hospital of Shenyang Military Area), Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formally called General Hospital of Shenyang Military Area), Shenyang, China
- CONTACT Xingshun Qi Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, Liaoning Province, China
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Shi Y, Wang H, Bai L, Wu Y, Zhang L, Zheng X, Lv JH, Pei HH, Bai ZH. The rate of acute kidney injury (AKI) alert detection by the attending physicians was associated with the prognosis of patients with AKI. Front Public Health 2022; 10:1031529. [PMID: 36466503 PMCID: PMC9712962 DOI: 10.3389/fpubh.2022.1031529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Early identification of AKI was always considered to improve patients' prognosis. Some studies found that AKI early warning tools didn't affect patients' prognosis. Therefore, additional studies were necessary to explore the reasons. Methods This study was a secondary analysis of a multicenter randomized controlled trial that found electronic health record warnings for AKI did not influence patients' prognoses. Univariate, multivariate, subgroup, curve fitting, and threshold effect analysis were used to explore the association between AKI warnings detected by attending physicians and the patient's prognosis. Results A total of 6,030 AKI patients were included in the study. The patients were classified into two groups based on the rate of AKI alerts detected by attending physicians: the partial group (n = 5,377), and the complete group (n = 653). In comparison to the partial group, the complete group significantly decreased 14-day AKI progression, 14-day dialysis, and 14-day mortality, with adjusted ORs of 0.48 (0.33, 0.70), 0.26 (0.09, 0.77), and 0.53 (0.33, 0.84) respectively, and the complete group significantly improve the discharge to home, with an OR value of 1.50 (1.21, 1.87). When the rate of AKI alerts detected by the attending physicians as a continuity variable, we found that the rate of alerts seen by attending physicians was associated with 14-day mortality and the discharge to home, with adjusted ORs of 1.76 (1.11, 2.81) and 1.42 (1.13, 1.80). The sensitivity analysis, curve-fitting analysis, and threshold effect analysis also showed that the rate of alert seen by the attending physician was correlated with the patient's prognosis. Conclusion The rate of AKI alert detection by attending physician were related to the patient's prognosis. The higher the rate of AKI alert detection by attending physicians, the better the prognosis of patients with AKI.
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Affiliation(s)
- Yu Shi
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ling Bai
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuan Wu
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Zhang
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin Zheng
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun-hua Lv
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong-hong Pei
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,*Correspondence: Hong-hong Pei
| | - Zheng-hai Bai
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Zheng-hai Bai
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Muacevic A, Adler JR, Shevchenko L. Features of Kidney Function in Patients With Comorbidity of Arterial Hypertension and Chronic Obstructive Pulmonary Disease. Cureus 2022; 14:e31828. [PMID: 36579215 PMCID: PMC9787688 DOI: 10.7759/cureus.31828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background and objective Chronic kidney disease (CKD) and hypertension are closely linked in terms of cause and effect. Decreased renal function is usually associated with increased blood pressure, and a steady increase in blood pressure accelerates the decline in renal function. In this study, we aimed to investigate laboratory parameters of renal function - blood creatinine level, urine creatinine level, urea blood level, urine albumin level, and in particular, serum cystatin C level - as early predictors of kidney damage and assess the filtration function of the kidneys based on the glomerular filtration rate (GFR) in patients with isolated arterial hypertension, those with a comorbid pathology of hypertension and chronic obstructive pulmonary disease (COPD). and those with isolated COPD. Materials and methods The study included a total of 101 patients (the final sample consisted of 88 patients) with hypertension and COPD, who were divided into three groups: Group I consisted of 38 patients with hypertension, Group II comprised 27 patients with hypertension and COPD, and Group III was made up of 23 patients with COPD. The average age of patients in groups - presented as mean [standard deviation (SD)] - was as follows - Group I: 55.7 (11.2) years, Group II: 59.3 (9.2) years, and Group III: 57.8 (9.1) years. For statistical data processing, the program Statistics 10 was used. Results The level of blood creatinine - presented as median (Me) and interquartile range (IQR) - was statistically significantly different between the groups, and the values in the three groups were as follows - Group I (patients with hypertension): 88.3 (84.2; 102.7) μmol/l, Group II (patients with comorbid pathology of arterial hypertension and COPD): 99.0 (80.0; 115.0) μmol/l, and Group III (patients with COPD): 84.6 (75.0; 94.2) μmol/l (p=0.008). The highest level was determined in patients with hypertension and comorbid COPD, while the lowest was in the comparison group, in patients with COPD. Urinary creatinine levels were as follows - Group I: 1081.0 (578.0; 1749.0) mg/l, Group II: 1318.5 (1124.0; 1817.0) mg/l, and Group III: 822.0 (625.0; 1320.5) mg/l (p=0.08). Blood urea values were as follows - Group I: 5.7 (5.2; 6.0) mmol/l, Group II: 5.7 (4.9; 6.6) mmol/l, Group III: 5.9 (4.4; 7.7) mmol/l. The calculation of GFR revealed a statistically significant difference between the three groups - Group I: 70.5 (56.0; 83.0) ml/min, Group II: 66.5 (57.0; 77.0) ml/min, and Group III: 81.5 (70.0; 88.0) ml/min (p=0.02). The cystatin C level was 1.16 (1.03; 1.27) mg/l in Group I, 1.3 (1.22; 1.38) mg/l in Group II, and 1.05 (0.96; 1.05) mg/l in Group III. Conclusions In patients of all three groups, there was a decrease in renal filtration function based on the results of creatinine and cystatin C levels. Even in the group of patients with COPD without kidney disease, a decrease in GFR was observed. We noted a negative aggravating effect of COPD on renal function in patients with hypertension, which can be attributed to increased endothelial dysfunction and increased general inflammation in this group of patients.
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McLaughlin C, Datta P, Singh YP, Lo A, Horchler S, Elcheva IA, Ozbolat IT, Ravnic DJ, Koduru SV. Mesenchymal Stem Cell-Derived Extracellular Vesicles for Therapeutic Use and in Bioengineering Applications. Cells 2022; 11:3366. [PMID: 36359762 PMCID: PMC9657427 DOI: 10.3390/cells11213366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 07/25/2023] Open
Abstract
Extracellular vesicles (EVs) are small lipid bilayer-delimited particles that are naturally released from cells into body fluids, and therefore can travel and convey regulatory functions in the distal parts of the body. EVs can transmit paracrine signaling by carrying over cytokines, chemokines, growth factors, interleukins (ILs), transcription factors, and nucleic acids such as DNA, mRNAs, microRNAs, piRNAs, lncRNAs, sn/snoRNAs, mtRNAs and circRNAs; these EVs travel to predecided destinations to perform their functions. While mesenchymal stem cells (MSCs) have been shown to improve healing and facilitate treatments of various diseases, the allogenic use of these cells is often accompanied by serious adverse effects after transplantation. MSC-produced EVs are less immunogenic and can serve as an alternative to cellular therapies by transmitting signaling or delivering biomaterials to diseased areas of the body. This review article is focused on understanding the properties of EVs derived from different types of MSCs and MSC-EV-based therapeutic options. The potential of modern technologies such as 3D bioprinting to advance EV-based therapies is also discussed.
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Affiliation(s)
- Caroline McLaughlin
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Pallab Datta
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER) Kolkata, West Bengal 700054, India
| | - Yogendra P. Singh
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of Life Sciences, Penn State University, University Park, PA 16802, USA
| | - Alexis Lo
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Summer Horchler
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Irina A. Elcheva
- Department of Pediatrics, Hematology/Oncology, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Ibrahim T. Ozbolat
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of Life Sciences, Penn State University, University Park, PA 16802, USA
| | - Dino J. Ravnic
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Srinivas V. Koduru
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, Hershey, PA 17033, USA
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Ranjbar E, Tavakol Afshari J, KhajaviRad A, Ebrahimzadeh-Bideskan A, Shafieian R. Insights into the protective capacity of human dental pulp stem cells and its secretome in cisplatin-induced nephrotoxicity: effects on oxidative stress and histological changes. J Basic Clin Physiol Pharmacol 2022; 34:349-356. [PMID: 36201655 DOI: 10.1515/jbcpp-2022-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Acute renal injury (AKI) is a major limiting factor for cisplatin administration. Recent evidence suggests the potential contribution of mesenchymal stem cells (MSCs) to rehabilitation from several disorders via both direct and indirect routes. Thus, the present study aimed, for the first time, to explore and compare the reno-protective potential of human dental pulp-derived stem cells (hDPSCs) vs. hDPSC-conditioned medium (hDPSC-CM) in recovery of impaired kidney tissues in a rat animal model of cisplatin-induced AKI. METHODS AKI was induced via cisplatin injection (n=36). One day after, 24 rats were treated with either hDPSCs or hDPSC-CM (n=12). An extra set of rats (n=12) served as sham group. On days 2 or 7 (n=6), rats were humanly sacrificed for further analysis. Renal injury was explored via measuring serum creatinine and BUN. Renal level of oxidative stress was assessed by determining malondialdehyde, and enzymatic activities of superoxide dismutase and catalase. Renal histopathological changes were scored for comparison among different experimental groups. RESULTS A single dose of cisplatin resulted in considerable renal dysfunction and oxidative stress. Treatment with hDPSCs or hDPSC-CM resulted in significantly restored renal function, reduced level of oxidative stress, and improved histopathological manifestations. Furthermore, as compared to hDPSC-CM, administration of hDPSCs led to superior results in AKI-induced animals. CONCLUSIONS The current study described the first comparative evidence of reno-protective potential of hDPSCs and their CM against cisplatin-induced nephrotoxicity in an AKI rat model, proposing them as useful adjunctive therapy in AKI. Yet, future explorations are still needed.
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Affiliation(s)
- Esmail Ranjbar
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jalil Tavakol Afshari
- Immunology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl KhajaviRad
- Department of Physiology and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ebrahimzadeh-Bideskan
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhaneh Shafieian
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Stem Cell and Regenerative Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Extracellular DNA concentrations in various aetiologies of acute kidney injury. Sci Rep 2022; 12:16812. [PMID: 36207374 PMCID: PMC9546839 DOI: 10.1038/s41598-022-21248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Extracellular DNA (ecDNA) in plasma is a non-specific biomarker of tissue damage. Urinary ecDNA, especially of mitochondrial origin, is a potential non-invasive biomarker of kidney damage. Despite prominent tissue damage, ecDNA has not yet been comprehensively analysed in acute kidney injury (AKI). We analysed different fractions of ecDNA, i.e. total, nuclear and mitochondrial, in plasma and urine of children, and different animal models of AKI. We also analysed the activity of the deoxyribonuclease (DNase), which is contributes to the degradation of ecDNA. Patients with AKI had higher total and nuclear ecDNA in both, plasma and urine (sixfold and 12-fold in plasma, and 800-fold in urine, respectively), with no difference in mitochondrial ecDNA. This was mainly found for patients with AKI due to tubulointerstitial nephritis and atypical haemolytic uremic syndrome. Increased plasma ecDNA was also found in animal models of AKI, including adenine nephropathy (fivefold), haemolytic uremic syndrome (fourfold), and ischemia–reperfusion injury (1.5-fold). Total urinary ecDNA was higher in adenine nephropathy and ischemia–reperfusion injury (1300-fold and twofold, respectively). DNase activity in urine was significantly lower in all animal models of AKI in comparison to controls. In conclusion, plasma total and nuclear ecDNA and urinary total ecDNA is increased in patients and animals with particular entities of AKI, suggesting a mechanism-dependent release of ecDNA during AKI. Further studies should focus on the dynamics of ecDNA and its potential role in the pathogenesis of AKI.
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Zou C, Wang C, Lu L. Advances in the study of subclinical AKI biomarkers. Front Physiol 2022; 13:960059. [PMID: 36091391 PMCID: PMC9449362 DOI: 10.3389/fphys.2022.960059] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) is a prevalent and serious illness in all clinical departments, with a high morbidity and death rate, particularly in intensive care units, where prevention and treatment are crucial. As a result, active prevention, early detection, and timely intervention for acute kidney injury are critical. The current diagnostic criteria for acute kidney injury are an increase in serum creatinine concentration and/or a decrease in urine output, although creatinine and urine output merely reflect changes in kidney function, and AKI suggests injury or damage, but not necessarily dysfunction. The human kidney plays a crucial functional reserve role, and dysfunction is only visible when more than half of the renal mass is impaired. Tubular damage markers can be used to detect AKI before filtration function is lost, and new biomarkers have shown a new subset of AKI patients known as “subclinical AKI.” Furthermore, creatinine and urine volume are only marginally effective for detecting subclinical AKI. As a result, the search for new biomarkers not only identifies deterioration of renal function but also allows for the early detection of structural kidney damage. Several biomarkers have been identified and validated. This study discusses some of the most promising novel biomarkers of AKI, including CysC, NGAL, KIM-1, lL-18, L-FABP, IGFBP7, TIMP-2, Clusterin, and Penkid. We examine their performance in the diagnosis of subclinical AKI, limitations, and future clinical practice directions.
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Affiliation(s)
- Chenchen Zou
- Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
- *Correspondence: Chenchen Zou, Lin Lu, mailto:
| | - Chentong Wang
- Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
| | - Lin Lu
- Department of Integrative Medicine-Geriatrics, Hongqi Hospital, Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
- *Correspondence: Chenchen Zou, Lin Lu, mailto:
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Zhang Y, Zhang X, Xi X, Dong W, Zhao Z, Chen S. Development and validation of AKI prediction model in postoperative critically ill patients: a multicenter cohort study. Am J Transl Res 2022; 14:5883-5895. [PMID: 36105045 PMCID: PMC9452309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication, especially among postoperative critically ill patients. Early identification of AKI is essential for reducing mortality. METHODS Multicenter data were used to develop an AKI prediction model for critically ill postoperative patients. A total of 1731 patients admitted to intensive care units (ICUs) were divided into a development set (n=1196) and a validation set (n=535) according to the principle of 7:3 randomization. Multivariate logistic regression analysis was performed on the predictors identified by univariate analysis, and a nomogram was created based on the predictors. The area under the receiver operating characteristic curve (AUROC) was used to assess the discrimination of the model. Calibration curves were generated, and the Hosmer-Lemeshow (HL) goodness of fit test was carried out. Decision curve analysis (DCA) was performed to assess the net clinical benefit. RESULTS The final model included 7 predictors: age, emergency surgery, abnormal basal creatinine level (BCr), chronic kidney disease (CKD), use of nephrotoxic drugs, diuretic use, and the Sequential Organ Failure Assessment (SOFA) score. A nomogram was drawn based on the predictors. The AUROC of the model in the development set was 0.725 (95% confidence interval (CI): 0.696-0.754). In the validation set, the AUROC was 0.706 (95% CI: 0.656-0.744). The model showed good discrimination (>70%) in both sets, and the HL test indicated that the model fit was good (P>0.05). DCA showed that our model is clinically useful. CONCLUSION The novel prediction model can be used to identify high-risk postoperative patients and provide a scientific and effective basis for clinicians to identify AKI early with a nomogram.
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Affiliation(s)
- Yu Zhang
- Xingtai People’s Hospital Postdoctoral Workstation, Hebei Province Xingtai People’s HospitalXingtai 054031, Hebei, China
- Postdoctoral Mobile Station, Hebei Medical UniversityShijiazhuang 050017, Hebei, China
- Department of Intensive Care Units, Tangshan People’s HospitalTangshan 063000, Hebei, China
| | - Xiaochong Zhang
- Department of Research and Education, Hebei Province Xingtai People’s HospitalXingtai 054031, Hebei, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical UniversityBeijing 100038, China
| | - Wei Dong
- Department of Intensive Care Units, Tangshan People’s HospitalTangshan 063000, Hebei, China
| | - Zongmao Zhao
- Postdoctoral Mobile Station, Hebei Medical UniversityShijiazhuang 050017, Hebei, China
- Department of Neurosurgery, The Second Hospital of Hebei Medical UniversityShijiazhuang 050000, Hebei, China
| | - Shubo Chen
- Xingtai People’s Hospital Postdoctoral Workstation, Hebei Province Xingtai People’s HospitalXingtai 054031, Hebei, China
- Department of Surgical Urology, Hebei Province Xingtai People’s HospitalXingtai 054031, Hebei, China
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Biomarkers of acute kidney injury after pediatric cardiac surgery: a meta-analysis of diagnostic test accuracy. Eur J Pediatr 2022; 181:1909-1921. [PMID: 35039910 DOI: 10.1007/s00431-022-04380-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 12/29/2022]
Abstract
UNLABELLED Acute kidney injury (AKI) occurs frequently after cardiac surgery in children. Although current diagnostic criteria rely on serum creatinine and urine output, changes occur only after considerable loss of kidney function. This meta-analysis aimed to synthesize the knowledge on novel biomarkers and compare their ability to predict AKI. PubMed/MEDLINE, Embase, Scopus, and reference lists were searched for relevant studies published by March 2021. Diagnostic accuracy parameters were extracted and analyzed using hierarchical summary receiver operating characteristic (HSROC) method. Pooled estimates of the area under the curve (AUC) were calculated using conventional random-effects meta-analysis. Fifty-six articles investigating 49 biomarkers in 8617 participants fulfilled our eligibility criteria. Data from 37 studies were available for meta-analysis. Of the 10 biomarkers suitable for HSROC analysis, urinary neutrophil gelatinase-associated lipocalin (uNGAL) to creatinine (Cr) ratio yielded the highest diagnostic odds ratio (91.0, 95% CI 90.1-91.9), with a sensitivity of 91.3% (95% CI 91.2-91.3%) and a specificity of 89.7% (95% CI 89.6-89.7%). These results were confirmed in pooled AUC analysis, as uNGAL-to-Cr ratio and uNGAL were the only elaborately studied biomarkers (> 5 observations) with pooled AUCs ≥ 0.800. Liver fatty acid-binding protein (L-FABP), serum cystatin C (sCysC), serum NGAL (sNGAL), and interleukin-18 (IL-18) all had AUCs ≥ 0.700. CONCLUSION A variety of biomarkers have been proposed as predictors of cardiac surgery-associated AKI in children, of which uNGAL was the most prominent with excellent diagnostic qualities. However, more consolidatory evidence will be required before these novel biomarkers may eventually help realize precision medicine in AKI management. WHAT IS KNOWN • Acute kidney injury (AKI) occurs in about 30-60% of children undergoing cardiac surgery and is associated with increased in-hospital mortality and adverse short-term outcomes. However, in current clinical practice, AKI definitions and detection often rely on changes in serum creatinine and urine output, which are late and insensitive markers of kidney injury. • Although various novel biomarkers have been studied for the diagnosis of AKI in children after cardiac surgery, it remains unclear how these compare to one another in terms of diagnostic accuracy. WHAT IS NEW • Pooled analyses suggest that for the diagnosis of AKI in children who underwent cardiac surgery, NGAL is the most accurate among the most frequently studied biomarkers. • A number of other promising biomarkers have been reported, although they will require further research into their diagnostic accuracy and clinical applicability.
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Abstract
How to cite this article: Ali U. Time for Precision Medicine in the Diagnosis of Acute Kidney Injury. Indian J Crit Care Med 2022;26(5):547–548.
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Affiliation(s)
- Uma Ali
- Department of Pediatric Nephrology, SRCC Children's Hospital, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
- Uma Ali, Department of Pediatric Nephrology, SRCC Children's Hospital, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India, e-mail:
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Circulating Lipocalin-2 level is positively associated with cognitive impairment in patients with metabolic syndrome. Sci Rep 2022; 12:4635. [PMID: 35302058 PMCID: PMC8931051 DOI: 10.1038/s41598-022-08286-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/04/2022] [Indexed: 02/07/2023] Open
Abstract
The association between Lipocalin-2 (LCN2) and cognition in patients with metabolic syndrome (MetS) has not been thoroughly investigated. We aimed to evaluate whether serum LCN2 levels are associated with the alteration of cognitive function in patients with MetS. The total of 191 non-demented participants with MetS were enrolled onto the study in 2015, and a cohort study was conducted in a subpopulation in 2020. After adjustment for sex, age, waist circumference, creatinine levels, and HbA1C, an association between the higher serum LCN2 levels and the lower Montreal cognitive assessment (MoCA) scores was observed (B = − 0.045; 95%CI − 0.087, − 0.004; p 0.030). A total of 30 participants were followed-up in 2020. Serum LCN2 levels were decreased in correlation with age (23.31 ± 12.32 ng/ml in 2015 and 15.98 ± 11.28 ng/ml in 2020, p 0.024), while other metabolic parameters were unchanged. Magnetic resonance imaging studies were conducted on a subsample of patients in 2020 (n = 15). Associations between high serum LCN2 levels from 2015 and 2020 and changes in brain volume of hippocampus and prefrontal cortex from 2020 have been observed. These findings suggest a relationship between changes of the level of circulating LCN2, cognitive impairment, and changes in brain volume in patients with MetS. However, further investigation is still needed to explore the direct effect of circulating LCN2 on the cognition of MetS patients.
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Early diagnosis of acute kidney injury subsequent to severe hypotension and fluid resuscitation in anaesthetised dogs. Vet Anaesth Analg 2022; 49:344-353. [DOI: 10.1016/j.vaa.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/30/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022]
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Yadav S, Chauhan M, Jain D, Aggarwal HK, Yadav RK. Renal Outcomes of Pregnancy-Related Acute Kidney Injury: a Single Centre Experience in India. MAEDICA 2022; 17:80-87. [PMID: 35733733 PMCID: PMC9168580 DOI: 10.26574/maedica.2022.17.1.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Objective:This study aimed to investigate the incidence, clinical characteristics, and outcomes of acute kidney injury (AKI) during pregnancy in Indian population. Materials and methods:A prospective observational study was conducted in pregnant patients admitted to Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. Acute kidney injury was assessed using Risk, Injury, Failure, Loss of function, and End-stage renal disease (RIFLE) criteria. Patients were analyzed on the basis of demographic data, detailed history, clinical examination, and laboratory investigations. The primary outcome was maternal renal outcome, including return to normal renal function and progression to chronic kidney disease (CKD). The secondary outcomes included the mode of delivery, complications of pregnancy, intensive care unit (ICU) admission, and maternal death. Results:A total of 51 patients with an average age of 29.5 years were included in the present study. About 49.9% of subjects had severe anemia and 41.2% were primigravida. The main cause of AKI was pre-eclampsia and postpartum hemorrhage. There was a marked improvement in renal outcome with 33 patients having complete renal recovery and six patients developed CKD was observed during three months follow-up period. The peaked median value of blood urea was 62.0 mg% in patients with normal renal function, 178.5 mg% in those with CKD and 120.0 mg% in expired patients (P=0.001). A statistically significant change in serum potassium (P=0.010) and creatinine levels (P<0.001) was observed during the follow-up period. Liver enzymes, including serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase, were high in all patients at the time of admission, but decreased to normal on follow-up. Conclusion:Our study indicates that pregnancy-related AKI patients present with multiorgan complications and many of them require mechanical ventilation and renal replacement therapy. Most of these patients have poor outcome. Hence, the management of pregnancy-related AKI presents a challenge that requires proper evaluation of causative factors to facilitate appropriate treatment.
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Affiliation(s)
- Sushma Yadav
- Department of Obstetrics and Gynaecology, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India
| | - Meenakshi Chauhan
- Department of Department of Obstetrics and Gynaecology, PGIMS, Rohtak, India
| | - Deepak Jain
- Department of Medicine, PGIMS, Rohtak, India
| | | | - R K Yadav
- Department of Nephrology, AIIMS, New Delhi, India
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Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest. J Clin Med 2022; 11:jcm11041024. [PMID: 35207297 PMCID: PMC8877349 DOI: 10.3390/jcm11041024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Acute kidney injury (AKI) is a common complication following thoracic aortic surgery (TAS), with moderate hypothermic circulatory arrest (MHCA). However, prediction of AKI with classical tools remains uncertain. Therefore, it was the aim of the present study to evaluate the role of new biomarkers in patients after MHCA. (2) Methods: 101 consecutive patients were prospectively enrolled. Measurements of urinary [TIMP-2]*[IGFBP7] and Cystatin C in the blood were performed perioperatively. Primary endpoint was the occurrence of AKI stage 2 or 3 (KDIGO-classification) within 48 h after surgery (AKI group). (3) Results: Mean age of patients was 69.1 ± 10.9 years, 35 patients were female (34%), and 13 patients (13%) met the primary endpoint. Patients in the AKI group had a prolonged ICU-stay (6.9 ± 7.4 days vs. 2.5 ± 3.1 days, p < 0.001) as well as a higher 30-day-mortality (9/28 vs. 1/74, p < 0.001). Preoperative serum creatinine (169.73 ± 148.97 μmol/L vs. 89.74 ± 30.04 μmol/L, p = 0.027) as well as Cystatin C (2.41 ± 1.54 mg/L vs. 1.13 ± 0.35 mg/L, p = 0.029) were higher in these patients. [TIMP-2]*[IGFBP7] increased significantly four hours after surgery (0.6 ± 0.69 mg/L vs. 0.37 ± 0.56 mg/L, p = 0.03) in the AKI group. Preoperative Cystatin C (AUC 0.828, p < 0.001) and serum creatinine (AUC 0.686, p = 0.002) as well as [TIMP-2]*[IGFBP7] 4 h after surgery (AUC 0.724, p = 0.020) were able to predict postoperative AKI. The predictive capacity of Cystatin C was superior to serum creatinine (p = 0.0211) (4) Conclusion: Cystatin C represents a very sensitive and specific biomarker to predict AKI in patients undergoing thoracic surgery with MHCA even before surgery, whereas the predictive capacity of [TIMP-2]*[IGFBP7] is only moderate and inferior to that of serum creatinine.
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Wei C, Zhang L, Feng Y, Ma A, Kang Y. Machine learning model for predicting acute kidney injury progression in critically ill patients. BMC Med Inform Decis Mak 2022; 22:17. [PMID: 35045840 PMCID: PMC8772216 DOI: 10.1186/s12911-021-01740-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Acute kidney injury (AKI) is a serve and harmful syndrome in the intensive care unit. Comparing to the patients with AKI stage 1/2, the patients with AKI stage 3 have higher in-hospital mortality and risk of progression to chronic kidney disease. The purpose of this study is to develop a prediction model that predict whether patients with AKI stage 1/2 will progress to AKI stage 3. Methods Patients with AKI stage 1/2, when they were first diagnosed with AKI in the Medical Information Mart for Intensive Care, were included. We used the Logistic regression and machine learning extreme gradient boosting (XGBoost) to build two models which can predict patients who will progress to AKI stage 3. Established models were evaluated by cross-validation, receiver operating characteristic curve, and precision–recall curves. Results We included 25,711 patients, of whom 2130 (8.3%) progressed to AKI stage 3. Creatinine, multiple organ failure syndromes were the most important in AKI progression prediction. The XGBoost model has a better performance than the Logistic regression model on predicting AKI stage 3 progression. Thus, we build a software based on our data which can predict AKI progression in real time. Conclusions The XGboost model can better identify patients with AKI progression than Logistic regression model. Machine learning techniques may improve predictive modeling in medical research.
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Zhou C, Chen Y, He X, Xue D. The value of cystatin C in predicting perioperative and long-term prognosis of renal transplantation. Scand J Clin Lab Invest 2022; 82:1-5. [PMID: 35012404 DOI: 10.1080/00365513.2021.1989714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate the value of cystatin C (Cys C) in predicting the perioperative and long-term prognosis of renal transplantation (RT). The clinical data of 198 RT recipients were collected. Blood samples were obtained daily until 7 d after transplantation and then discharge day to determine the serum levels of Cys C. The receiver-operating characteristic (ROC) analysis and the area under the curve (AUC) were used to determine the diagnostic accuracy of Cys C for delayed graft function (DGF). The presence of shrunken pore syndrome (SPS) with a cystatin C-based estimate of glomerular filtration rate less than 70% of a creatinine-based estimate, was also evaluated as a prognostic factor for the development of DGF. The serum Cys C levels of patients with DGF were higher than those of the non-DGF group. Cys C showed a higher AUC (0.928) in the ROC analysis than did sCr (0.862). Compared to the non-SPS group, there were more patients diagnosed with SPS in the DGF group (p < .05). The follow-up data showed that patients diagnosed with SPS had higher levels of sCr and Cys C compared to other patients, suggesting a poor long-term prognosis. Our findings suggest that Cys C is a sensitive indicator of renal function during the perioperative period. Cys C at a concentration of 4.9 mg/L had the highest sum of sensitivity and specificity for prediction of DGF, with a sensitivity of 0.889 and a specificity of 0.8. SPS is associated with the development of DGF and the poor long-term prognosis of RT.
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Affiliation(s)
- Cuixing Zhou
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yimeng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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Patel M, Gbadegesin RA. Update on prognosis driven classification of pediatric AKI. Front Pediatr 2022; 10:1039024. [PMID: 36340722 PMCID: PMC9634036 DOI: 10.3389/fped.2022.1039024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022] Open
Abstract
Acute kidney injury (AKI) affects a large proportion of hospitalized children and increases morbidity and mortality in this population. Initially thought to be a self-limiting condition with uniformly good prognosis, we now know that AKI can persist and progress to acute kidney disease (AKD) and chronic kidney disease (CKD). AKI is presently categorized by stage of injury defined by increase in creatinine, decrease in eGFR, or decrease in urine output. These commonly used biomarkers of acute kidney injury do not change until the injury is well established and are unable to detect early stage of the disease when intervention is likely to reverse injury. The kidneys have the ability to compensate and return serum creatinine to a normal or baseline level despite nephron loss in the setting of AKI possibly masking persistent dysfunction. Though these definitions are important, classifying children by their propensity for progression to AKD and CKD and defining these risk strata by other factors besides creatinine may allow for better prognosis driven discussion, expectation setting, and care for our patients. In order to develop a classification strategy, we must first be able to recognize children who are at risk for AKD and CKD based on modifiable and non-modifiable factors as well as early biomarkers that identify their risk of persistent injury. Prevention of initial injury, prompt evaluation and treatment if injury occurs, and mitigating further injury during the recovery period may be important factors in decreasing risk of AKD and CKD after AKI. This review will cover presently used definitions of AKI, AKD, and CKD, recent findings in epidemiology and risk factors for AKI to AKD to CKD progression, novel biomarkers for early identification of AKI and AKI that may progress to CKD and future directions for improving outcome in children with AKI.
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Affiliation(s)
- Mital Patel
- Department of Pediatrics, Division of Pediatric Nephrology, Duke University, Durham, NC, United State
| | - Rasheed A Gbadegesin
- Department of Pediatrics, Division of Pediatric Nephrology, Duke University, Durham, NC, United State
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Markarian T. Nouvelles approches diagnostiques de l’insuffisance rénale aiguë. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
L’insuffisance rénale, véritable problème de santé publique, concernerait plus de 82 000 personnes en France. On estime que 5 à 10 % de la population française souffriraient d’une maladie rénale pouvant conduire à une insuffisance rénale avec un taux de mortalité de plus de 10 % par an. À l’inverse de la maladie rénale chronique irréversible, l’insuffisance rénale aiguë est considérée comme un dysfonctionnement transitoire et réversible. Au-delà de l’intérêt de la prévention, le diagnostic précoce de l’insuffisance rénale aiguë permettrait de mettre en place des thérapeutiques adaptées et ciblées afin d’éviter l’évolution vers des lésions rénales irréversibles. Cependant, il demeure un véritable challenge pour le praticien puisque l’on présume que près de 10 % de la population française présenteraient des lésions rénales asymptomatiques. Bien que la définition de l’insuffisance rénale aiguë ait été simplifiée durant ces dernières années, il existe de nombreuses limites. En parallèle, des progrès majeurs ont été réalisés notamment en termes de diagnostic. L’objectif de cette mise au point est de faire un rappel sur l’évolution de l’insuffisance rénale aiguë, les définitions actuelles et de présenter les nouvelles approches diagnostiques en cours de développement.
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Biomarkers of persistent renal vulnerability after acute kidney injury recovery. Sci Rep 2021; 11:21183. [PMID: 34707157 PMCID: PMC8551194 DOI: 10.1038/s41598-021-00710-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2023] Open
Abstract
Acute kidney injury (AKI) is a risk factor for new AKI episodes, chronic kidney disease, cardiovascular events and death, as renal repair may be deficient and maladaptive, and activate proinflammatory and profibrotic signals. AKI and AKI recovery definitions are based on changes in plasma creatinine, a parameter mostly associated to glomerular filtration, but largely uncoupled from renal tissue damage. The evolution of structural and functional repair has been incompletely described. We thus aimed at identifying subclinical sequelae persisting after recovery from cisplatin-induced AKI in rats. Compared to controls, after plasma creatinine recovery, post-AKI kidneys showed histological alterations and attendant susceptibility to new AKI episodes. Tubular function (assessed by the furosemide stress test, FST) also remained affected. Lingering parenchymal and functional subclinical alterations were paralleled by tapering, but abnormally high levels of urinary albumin, transferrin, insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinases-2 (TIMP-2) and, especially, the [TIMP-2]*[IGFBP7] product. As subclinical surrogates of incomplete renal recovery, the FST and the urinary [TIMP-2]*[IGFBP7] product provide two potential diagnostic tools to monitor the sequelae and kidney vulnerability after the apparent recovery from AKI.
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Davis J, Raisis AL, Miller DW, Hosgood GL, Rossi G. Analytical validation and reference intervals for a commercial multiplex assay to measure five novel biomarkers for acute kidney injury in canine urine. Res Vet Sci 2021; 139:78-86. [PMID: 34261014 DOI: 10.1016/j.rvsc.2021.07.009] [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: 09/14/2020] [Revised: 05/02/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Novel urinary biomarkers are increasingly utilized for the diagnosis of acute kidney injury (AKI) in dogs. Magnetic-bead based immunoassays for the simultaneous measurement of multiple biomarkers represent a potentially efficient and cost effective tool for investigators; however there is limited data to support their reliable use in dogs. Analytical validation of a commercial multiplex assay for the measurement of five AKI biomarkers: clusterin, cystatin C, kidney-injury molecule 1 (KIM-1), monocyte chemoattractant protein 1 and neutrophil gelatinase-associated lipocalin (NGAL) in canine urine was performed. The effect of pre-analytical factors including potential interfering substances and sample storage methods were investigated. Urine from 110 healthy dogs was used to determine reference intervals for each biomarker measured, according to American Society of Veterinary Clinical Pathology guidelines. Additionally, urine from 21 dogs with pyuria was used to evaluate the impact of pyuria on biomarker concentration. The assay performed with acceptable accuracy and precision for the measurement of NGAL only. Clinically relevant urine concentrations of bilirubin, haemoglobin, and synthetic colloid solutions led to interference (mean percentage difference > +/- 15% compared to control) with measurement of all or some of the biomarkers. All biomarkers were stable in urine stored at 20-22 °C for 2 h, 4 °C for 12 h, or -20 °C for 6 months. Reference intervals could not be established for KIM-1 due to unacceptable measurement imprecision (intra- and inter assay coefficient of variation 45% and 20% respectively). Urine NGAL concentration was significantly elevated in pyuria (P < 0.001).
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Affiliation(s)
- Jennifer Davis
- School of Veterinary Medicine, College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia.
| | - Anthea L Raisis
- School of Veterinary Medicine, College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - David W Miller
- School of Veterinary Medicine, College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Giselle L Hosgood
- School of Veterinary Medicine, College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Gabriele Rossi
- Centre for Animal Production and Health, Murdoch University, Murdoch, Western Australia, Australia
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Tripathy S. Acute Kidney Injury in the Intensive Care Unit: The Most Reliable Way to Predict the Future is to Create It. Indian J Crit Care Med 2021; 25:747-749. [PMID: 34316165 PMCID: PMC8286389 DOI: 10.5005/jp-journals-10071-23911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Tripathy S. Acute Kidney Injury in the Intensive Care Unit: The Most Reliable Way to Predict the Future is to Create It. Indian J Crit Care Med 2021;25(7):747-749.
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Affiliation(s)
- Swagata Tripathy
- Department of Anesthesia and Intensive Care, AIIMS, Bhubaneswar, Odisha, India
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Kato T, Nakajima T, Fukuda T, Shibasaki I, Hasegawa T, Ogata K, Ogawa H, Hirota S, Ohashi H, Saito S, Takei Y, Tezuka M, Seki M, Kuwata T, Sakuma M, Abe S, Toyoda S, Inoue T, Fukuda H. Preoperative Serum GDF-15, Endothelin-1 Levels, and Intraoperative Factors as Short-Term Operative Risks for Patients Undergoing Cardiovascular Surgery. J Clin Med 2021; 10:jcm10091960. [PMID: 34063283 PMCID: PMC8125127 DOI: 10.3390/jcm10091960] [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: 03/11/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: The Society of Thoracic Surgeons (STS) risk score is widely used for the risk assessment of cardiac surgery. Serum biomarkers such as growth differentiation factor-15 (GDF-15) and endothelin-1 (ET-1) are also used to evaluate risk. We investigated the relationships between preoperative serum GDF-15, ET-1 levels, and intraoperative factors and short-term operative risks including acute kidney injury (AKI) for patients undergoing cardiovascular surgery. Methods: In total, 145 patients were included in this study (92 males and 53 females, age 68.4 ± 13.2 years). The preoperative STS score was determined, and the serum GDF-15 and ET-1 levels were measured by ELISA. These were related to postoperative risks, including AKI, defined according to the Acute Kidney Injury Network (AKIN) classification criteria. Results: AKI developed in 23% of patients. The GDF-15 and ET-1 levels correlated with the STS score. The STS score and GDF-15 and ET-1 levels all correlated with preoperative eGFR, Alb, Hb, and BNP levels; perioperative data (urine output); ICU stay period; and postoperative admission days. Patients with AKI had longer circulatory pulmonary bypass (CPB) time, and male patients with AKI had higher ET-1 levels than those without AKI. In multivariable logistic regression analysis, the preoperative ET-1 level and CPB time were the independent determinants of AKI, even adjusted by age, sex, and BMI. The preoperative GDF-15 level, CPB time, and RCC transfusion were independent determinants of 30-day mortality plus morbidity. Conclusion: Preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risks for patients undergoing cardiovascular surgery.
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Affiliation(s)
- Takashi Kato
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
- Department of Medical KAATSU Training, Dokkyo Medical University, Tochigi 321-0293, Japan;
- Correspondence:
| | - Taira Fukuda
- Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Kanagawa 238-8522, Japan;
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Takaaki Hasegawa
- Department of Medical KAATSU Training, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Koji Ogata
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Hironaga Ogawa
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Shotaro Hirota
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Hirotaka Ohashi
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Yusuke Takei
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Masahiro Tezuka
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Masahiro Seki
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Toshiyuki Kuwata
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
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Sacco E, Vittori M, Ferraro PM, Verde P, Scagliusi A, Baroni S, Masola V, Onisto M, Nicosia M, Bassi P. Renal effect of severe hypoxia evaluated By NGAL measurements: An in vivo and in vitro study. Urologia 2021; 89:38-43. [PMID: 33876675 DOI: 10.1177/03915603211009117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate possible renal damage in healthy men exposed to extreme hypobaric hypoxia, using urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) concentration as biomarker. The value of NGAL as a biomarker of proximal tubular cell damage under hypoxic conditions was also tested in vitro experiments. METHODS NGAL was assayed in a cohort of air cadets (n = 16) exposed to hypobaric hypoxia in a hypobaric chamber during their training program. In all subjects, urine creatinine (Cr) and urinary NGAL levels were measured immediately before, 3, and 24 h after hypobaric environment exposure. Three in vitro experiments using proximal tubular cell cultures were also performed to measure NGAL gene expression, NGAL secretion in the culture medium and to evaluate apoptosis under two cycles of hypoxia and reoxygenation. RESULTS In the in vivo study, geometric means of urinary NGAL/Cr ratio measured 24 h after hypobaric hypoxia in the hypobaric chamber were significantly lower than baseline values (13.4 vs 25.9 ng/mg, p = 0.01). In cell cultures, hypoxia down-regulated NGAL gene expression without significantly changing NGAL secretion in the culture medium. Hypoxia significantly increased the percentage of apoptotic/necrotic cells, especially after the second hypoxia-reoxygenation cycle. CONCLUSIONS Exposure to hypobaric-hypoxic environments does not cause significant and irreversible renal tubular injury in vivo and in vitro, except than in a late stage. The hypoxic insult does not seem to be mirrored by an increase of urinary NGAL in healthy men nor of NGAL gene expression in HK-2 cell culture or secretion in the culture medium in the in vitro conditions reported in the present study.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Pietro Manuel Ferraro
- Nephrology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Verde
- Italian Air Force, Flight Experimental Center, Aerospace Medicine Department, Pratica di Mare, Italy
| | - Alessandro Scagliusi
- Italian Air Force, Flight Experimental Center, Aerospace Medicine Department, Pratica di Mare, Italy
| | - Silvia Baroni
- Clinical Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Masola
- Renal Unit, Department of Medicine, Integrated University Hospital of Verona, Verona, Veneto, Italy
| | - Maurizio Onisto
- Department of Biomedical Sciences, University of Padua, Padova, Veneto, Italy
| | - Maria Nicosia
- Clinical Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - PierFrancesco Bassi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Yang Y, Ge B, Liu Y, Feng J. The efficacy of biomarkers in the diagnosis of acute kidney injury secondary to liver cirrhosis. Medicine (Baltimore) 2021; 100:e25411. [PMID: 33832138 PMCID: PMC8036071 DOI: 10.1097/md.0000000000025411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT This study is to investigate the role of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine in the diagnosis of acute kidney injury (AKI) secondary to liver cirrhosis.A total of 825 patients (including 540 liver cirrhosis patients and 285 healthy controls) were enrolled. Liver cirrhosis patients were further subdivided into AKI secondary to liver cirrhosis group (AKI group, 210 patients) and simple liver cirrhosis group (LC group, 330 patients). Serum NGAL/urine NGAL (sNGAL/uNGAL), and serum creatinine (sCr) levels as well as estimated glomerular filtration rates were measured. The diagnostic performances of these indicators in AKI secondary to liver cirrhosis were evaluated.The levels of sNGAL, uNGAL, CysC and sCr in the AKI group were significantly higher than those of LC and healthy control groups. However, the eGFR and c-aGFR of AKI group were significantly lower. With the progression of AKI (AKI-S1→AKI-S2→AKI-S3), the levels of sNGAL, uNGAL, CysC and sCr increased gradually, while the levels of c-aGFR and eGFR decreased gradually. The sNGAL, uNGAL and CysC were positively correlated with sCr (r = 0.638, 0.635, and 0.650), but negatively correlated with c-aGFR (r = -0.617, -0.606 and -0.655). However, eGFR had a negative correlation with sCr (r = -0.711), but a positive correlation with c-aGFR (r = 0.736). ROC curve analysis showed that the area under the curve for uNGAL was the largest (0.976), followed by sNGAL (0.967). The diagnostic efficacy of uNGAL and sNGAL in AKI group were 0.907 and 0.870, and the risk degrees were OR = 54.524 and 5.115, respectively.NGAL might perform better than sCr and CysC in the diagnosis of AKI secondary to liver cirrhosis, while uNGAL might be a better indicator than sNGAL in AKI diagnosis.
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Affiliation(s)
- Yuwei Yang
- Department of Laboratory Medicine, Mianyang Central Hospital, Affiliated to Southwest Medical University, Mianyang
| | - Bin Ge
- Department of Laboratory Medicine, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Yan Liu
- Department of Laboratory Medicine, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Jiafu Feng
- Department of Laboratory Medicine, Mianyang Central Hospital, Affiliated to Southwest Medical University, Mianyang
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32
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Gang D, Yu CJ, Zhu S, Zhu P, Nasser MI. Application of mesenchymal stem cell-derived exosomes in kidney diseases. Cell Immunol 2021; 364:104358. [PMID: 33839596 DOI: 10.1016/j.cellimm.2021.104358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023]
Abstract
Kidney injury (KI) has high morbidity and mortality; there has been no ideal practical treatment available in clinical practice until now. Exosomes are formed from fusing multisubunit body membranes and are secreted into the extracellular matrix, intercellular communication membracusses. As a cell-free treatment, it offers a new approach to the treatment of KI. Exosomes are spherical vesicles with or no separator cup that shapes proteins, and RNA acts on the target cells through various means to promote tissue damage and mitigate apoptosis, both inflammation and oxidative stress. Exosomes derived from mesenchymal stem cells (MSC) have a paracrine function in promoting tissue repair and immune regulation. The MSC-Exos provide specific benefits over the MSCs. The urinary exosomes closely follow the functions and diseases of the kidneys. Though much of the research in this field is only at the preliminary stages, previous research has demonstrated that MSC-Exos damaged tissues to offer proteins, mRNAs, and microRNAs as remedies for kidney injury. Although exosomes' role in tissue repair is currently is greatly debated, several key issues remain unaddressed. This is a summarization of the work done concerning MSC in the treatment of KI.
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Affiliation(s)
- Deng Gang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China; School of Medicine, South China University of Technology, Guangzhou, Guangdong 510006, China
| | - Chang Jiang Yu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Shuoji Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China.
| | - M I Nasser
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China.
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33
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Jing L, Chen W, Guo L, Zhao L, Liang C, Chen J, Wang C. Acute kidney injury after lung transplantation: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:717. [PMID: 33987415 PMCID: PMC8106087 DOI: 10.21037/atm-20-7644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) is a commonly recognized complication after lung transplantation (LT) and is related to increased mortality and morbidity. With the improvement of survival after LT and the increasing number of lung transplant recipients, the detrimental impact of current management on renal function has become increasingly apparent. Multifarious risk factors in the perioperative setting contribute to the development of AKI, including the preoperative status and complications of the recipient, complex perioperative problems especially hemodynamic fluctuation, and exposure to nephrotoxic agents, mainly calcineurin inhibitors (CNIs) and antimicrobial drugs. Identification and minimization of the effects of these risk factors can relieve AKI severity and incidence in high-risk patients. Close monitoring of urine output and serum creatinine (sCr) levels and of specific biomarkers may promote early recognition of AKI and rapid nephrology intervention to improve outcomes. This review summarizes advances in the epidemiology, diagnostic criteria, biological markers of AKI, and further recommends appropriate treatment strategies for the long-term management of AKI related manifestations in lung transplant recipients. Future work will need to focus on developing more accurate measures of renal function and identifying patients before the occurrence of early renal damage. Combining renal protection strategies with the use of new biomarkers to develop early kidney risk identification and protection protocols is a promising idea that requires further investigation.
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Affiliation(s)
- Lei Jing
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Wenhui Chen
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Lijuan Guo
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Li Zhao
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Chaoyang Liang
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Jingyu Chen
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
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Leyssens K, Van Regenmortel N, Roelant E, Guerti K, Couttenye MM, Jorens PG, Verbrugghe W, Van Craenenbroeck AH. Beta-Trace Protein as a Potential Marker of Acute Kidney Injury: A Pilot Study. Kidney Blood Press Res 2021; 46:185-195. [PMID: 33784671 DOI: 10.1159/000514173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous glomerular filtration rate marker. The aim of this study was to explore the role of BTP as a marker of AKI. METHODS Patients admitted to the ICU undergoing surgery were included. BTP, sCr, Cystatin C (CysC), and neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively, postoperatively (post-op), and at the first (D1) and second (D2) post-op day. AKI was defined as an increase of sCr to ≥1.5-fold from baseline within 2 days after surgery. RESULTS Of the 52 patients studied, 10 patients (19%) developed AKI. Patients with AKI were older (69.6 ± 10.7 vs. 58.1 ± 16.7 years, p = 0.043) and had a longer length of ICU stay (13 [IQR 6-49] vs. 6 [IQR 5-8] days, p = 0.032). Between the 2 groups, the evolution of BTP, sCr, CysC, and NGAL over time differed significantly, with overall higher values in the AKI group. ROC analysis for the detection of AKI within 2 days after surgery showed a great accuracy for BTP. The area under the curve (AUC) for BTP post-op; D1; and D2 was, respectively, 0.869 ± 0.049; 0.938 ± 0.035; and 0.943 ± 0.032. The discriminative power of a BTP measurement on D1 was superior in detecting AKI compared to NGAL (adjusted p value = 0.027). We could not detect a significant difference between the AUCs of other biomarkers (NGAL, sCr, and CysC). CONCLUSION Serum BTP is a promising marker for diagnosing AKI in ICU patients undergoing surgery.
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Affiliation(s)
- Katrien Leyssens
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | | | - Ella Roelant
- Clinical Trial Center (CTC), Antwerp University Hospital, Edegem, Belgium
| | - Khadija Guerti
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Marie Madeleine Couttenye
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Walter Verbrugghe
- Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology and Renal Transplantation, University Hospital Leuven, Leuven, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Ji C, Zhang J, Zhou Z, Shi H, Liu W, Sun F, Zhang C, Zhang L, Sun Z, Qian H. Platelet-rich plasma promotes MSCs exosomes paracrine to repair acute kidney injury via AKT/Rab27 pathway. Am J Transl Res 2021; 13:1445-1457. [PMID: 33841669 PMCID: PMC8014389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Acute kidney injury (AKI) is defined by rapid deterioration of renal function, and is a common complication in hospitalized patients. Among the recent therapeutic options, mesenchymal stem cells (MSCs) are considered a promising therapeutic strategy for damaged tissue repair. Platelet rich plasma (PRP) regulates mesenchymal cells to repair tissue damage through the release of growth factors. In this study, we proposed a possible therapeutic use of MSCs stimulated by platelet-rich plasma (PRP-MSCs) in a glycerin-induced AKI murine model. In vivo and in vitro studies, showed that PRP-MSCs could significantly attenuate serum blood urea nitrogen and creatinine levels, and reverse the histopathological kidney damage. PRP-MSCs treatment reduced renal tubular cell apoptosis stimulated by glycerin. We confirmed that PRP promoted the proliferation and reinforced the stemness of MSCs by inducing YAP nucleus expression, and that PRP promoted MSCs exosomes in a paracrine manner to repair AKI through an activated AKT/Rab27 pathway. Our results revealed that the PRP stimulated MSCs paracrine pathway could effectively alleviate glycerin-induced AKI. Therefore, PRP pretreatment may be a new method to improve the therapeutic effect of MSCs.
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Affiliation(s)
- Cheng Ji
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Jiahui Zhang
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Zixuan Zhou
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Hui Shi
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Wanzhu Liu
- Department of Emergency, The Affiliated People’s Hospital of Jiangsu UniversityZhenjiang 212002, China
| | - Fengtian Sun
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Chenxiao Zhang
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Leilei Zhang
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Zixuan Sun
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
| | - Hui Qian
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu UniversityZhenjiang 212013, Jiangsu, China
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Wittlinger T, Maus M, Kutschka I, Baraki H, Friedrich MG. Identification of risk factors for renal failure after cardiac surgery by RFILE classification. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:155-163. [PMID: 33815931 PMCID: PMC8012284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Acute kidney injury (AKI) is a major complication after cardiovascular surgery. The unclear etiology of this highly complex event challenges definition, diagnosis and prediction of AKI, and hence hampers adequate patient management. Identification of associated risk factors have the potential to overcome this limitation. METHODS This retrospective study comprised 3574 patients who underwent cardiac surgery in a hospital in Germany. The patient cohort was interrogated for risk factors for AKI. RESULTS The analysis identified risk factors for AKI development, such as type of surgery (particularly bypass surgery) (P = 0.02), previous coronary surgeries (P < 0.01), the application of intra-aortic balloon pump in surgery (P < 0.01), and blood loss during surgery (P < 0.01). In addition, old age, duration of surgery as well as ischemia, perfusion and reperfusion times contributed to AKI development (P < 0.01). Further, perioperative hypothermia also appeared as putative risk factor in the analysis (P < 0.01). CONCLUSIONS This study identified several risk factors for the development of AKI after cardiac surgery. Further validation of these risk factors could allow the implementation of adequate patient management, and the appropriate implementation of risk-adverse interventions in cardiovascular surgery.
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Affiliation(s)
- Thomas Wittlinger
- Department of Cardiology, Asklepios Harzklinikum. Köslinerstr 1238642 Goslar, Germany
| | - Martin Maus
- Department Major Surgery, St. Elisabeth HospitalBonn, Germany
| | - Ingo Kutschka
- Department of Cardio-Thoracic and Vascular Surgery, University Hospital GöttingenGermany
| | - Hassina Baraki
- Department of Cardio-Thoracic and Vascular Surgery, University Hospital GöttingenGermany
| | - Martin G Friedrich
- Department of Cardio-Thoracic and Vascular Surgery, University Hospital GöttingenGermany
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Huang H, Liu Y, Wu M, Gao Y, Yu X. Development and validation of a risk stratification model for predicting the mortality of acute kidney injury in critical care patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:323. [PMID: 33708950 PMCID: PMC7944298 DOI: 10.21037/atm-20-5723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This study aimed to develop and validate a model for mortality risk stratification of intensive care unit (ICU) patients with acute kidney injury (AKI) using the machine learning technique. Methods Eligible data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Calibration, discrimination, and risk classification for mortality prediction were evaluated using conventional scoring systems and the new algorithm. A 10-fold cross-validation was performed. The predictive models were externally validated using the eICU database and also patients treated at the Second People’s Hospital of Shenzhen between January 2015 to October 2018. Results For the new model, the areas under the receiver operating characteristic curves (AUROCs) for mortality during hospitalization and at 28 and 90 days after discharge were 0.91, 0.87, and 0.87, respectively, which were higher than for the Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA). For external validation, the AUROC was 0.82 for in-hospital mortality, higher than SOFA, SAPS II, and Acute Physiology and Chronic Health Evaluation (APACHE) IV in the eICU database, but for the 28- and 90-day mortality, the new model had AUROCs (0.79 and 0.80, respectively) similar to that of SAPS II in the SZ2 database. The reclassification indexes were superior for the new model compared with the conventional scoring systems. Conclusions The new risk stratification model shows high performance in predicting mortality in ICU patients with AKI.
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Affiliation(s)
- Haofan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yong Liu
- Department of Intensive Care Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Ming Wu
- Department of Critical Care Medicine & Infection Prevention and Control, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China
| | - Yi Gao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
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Zhang X, Wang N, Huang Y, Li Y, Li G, Lin Y, Atala AJ, Hou J, Zhao W. Extracellular vesicles from three dimensional culture of human placental mesenchymal stem cells ameliorated renal ischemia/reperfusion injury. Int J Artif Organs 2021; 45:181-192. [PMID: 33467948 DOI: 10.1177/0391398820986809] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Three-dimensional (3D) culture has been reported to increase the therapeutic potential of mesenchymal stem cells (MSCs). The present study assessed the therapeutic efficacy of extracellular vesicles (EVs) from 3D cultures of human placental MSCs (hPMSCs) for acute kidney injury (AKI). METHODS The supernatants from monolayer culture (2D) and 3D culture of hPMSCs were ultra-centrifuged for EVs isolation. C57BL/6 male mice were submitted to 45 min bilateral ischemia of kidney, followed by renal intra-capsular administration of EVs within a 72 h reperfusion period. Histological, immunohistochemical, and ELISA analyses of kidney samples were performed to evaluate cell death and inflammation. Kidney function was evaluated by measuring serum creatinine and urea nitrogen. The miRNA expression profiles of EVs from 2D and 3D culture of hPMSCs were evaluated using miRNA microarray analysis. RESULTS The 3D culture of hPMSCs formed spheroids with different diameters depending on the cell density seeded. The hPMSCs produced significantly more EVs in 3D culture than in 2D culture. More importantly, injection of EVs from 3D culture of hPMSCs into mouse kidney with ischemia-reperfusion (I/R)-AKI was more beneficial in protecting from progression of I/R than those from 2D culture. The EVs from 3D culture of hPMSCs were more efficient against apoptosis and inflammation than those from 2D culture, which resulted in a reduction in tissue damage and amelioration of renal function. MicroRNA profiling analysis revealed that a set of microRNAs were significantly changed in EVs from 3D culture of hPMSCs, especially miR-93-5p. CONCLUSION The EVs from 3D culture of hPMSCs have therapeutic potential for I/R-AKI.
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Affiliation(s)
- Xuefeng Zhang
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Nan Wang
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Li
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Gang Li
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxin Lin
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Anthony J Atala
- Wake of Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianquan Hou
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weixin Zhao
- Wake of Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Massa M, Croce S, Campanelli R, Abbà C, Lenta E, Valsecchi C, Avanzini MA. Clinical Applications of Mesenchymal Stem/Stromal Cell Derived Extracellular Vesicles: Therapeutic Potential of an Acellular Product. Diagnostics (Basel) 2020; 10:diagnostics10120999. [PMID: 33255416 PMCID: PMC7760121 DOI: 10.3390/diagnostics10120999] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
In the last decade, the secreting activity of mesenchymal stem/stromal cells (MSCs) has been widely investigated, due to its possible therapeutic role. In fact, MSCs release extracellular vesicles (EVs) containing relevant biomolecules such as mRNAs, microRNAs, bioactive lipids, and signaling receptors, able to restore physiological conditions where regenerative or anti-inflammatory actions are needed. An actual advantage would come from the therapeutic use of EVs with respect to MSCs, avoiding the possible immune rejection, the lung entrapment, improving the safety, and allowing the crossing of biological barriers. A number of concerns still have to be solved regarding the mechanisms determining the beneficial effect of MSC-EVs, the possible alteration of their properties as a consequence of the isolation/purification methods, and/or the best approach for a large-scale production for clinical use. Most of the preclinical studies have been successful, reporting for MSC-EVs a protecting role in acute kidney injury following ischemia reperfusion, a potent anti-inflammatory and anti-fibrotic effects by reducing disease associated inflammation and fibrosis in lung and liver, and the modulation of both innate and adaptive immune responses in graft versus host disease (GVHD) as well as autoimmune diseases. However, the translation of MSC-EVs to the clinical stage is still at the initial phase. Herein, we discuss the therapeutic potential of an acellular product such as MSC derived EVs (MSC-EVs) in acute and chronic pathologies.
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Affiliation(s)
- Margherita Massa
- Biochemistry, Biotechnology and Advanced Diagnostics Laboratory, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (M.M.); (C.A.)
| | - Stefania Croce
- General Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Department of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Rita Campanelli
- Center for the Study of Myelofibrosis, Biochemistry, Biotechnology and Advanced Diagnostics Laboratory, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy;
| | - Carlotta Abbà
- Biochemistry, Biotechnology and Advanced Diagnostics Laboratory, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (M.M.); (C.A.)
| | - Elisa Lenta
- Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy;
| | - Chiara Valsecchi
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy;
| | - Maria Antonietta Avanzini
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy;
- Correspondence:
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Ability of different assay platforms to measure renal biomarker concentrations during ischaemia-reperfusion acute kidney injury in dogs. Res Vet Sci 2020; 135:547-554. [PMID: 33223120 DOI: 10.1016/j.rvsc.2020.11.005] [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: 09/14/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 12/31/2022]
Abstract
Several protein biomarkers have been shown to be useful for the early diagnosis of acute kidney injury (AKI) in animals and people. Multiplex assays for measurement of a panel of renal biomarkers in canine samples have recently become available. This study compared the use of two such assays, versus previously validated ELISAs, to measure five biomarkers in canine samples during ischaemia-reperfusion (IR) AKI. Blood and urine was collected from six male anaesthetised greyhounds that underwent 1-h of renal ischaemia (severe hypotension induced by acute haemorrhage) and 2-h of reperfusion (intravenous fluid resuscitation). Histology confirmed presence of acute tubular injury at 2 h of reperfusion. Concentrations of clusterin, cystatin C, kidney-injury molecule 1 (KIM-1), monocyte chemoattractant protein 1, and neutrophil gelatinase-associated lipocalin (NGAL) at baseline and following IR, measured by two different multiplex assays and previously-validated single analyte immunoassays, were compared. Only NGAL was significantly elevated following IR with all assays investigated. Whether concentrations of the other four biomarkers were significantly increased following IR depended on the assay used. Concentrations of cystatin C and KIM-1 measured with the multiplex assays were of a vast magnitude lower than those measured with the corresponding single analyte ELISAs. We conclude that further validation is required before these assays can reliably be used to measure AKI biomarkers in canine samples.
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Predicting Acute Kidney Injury: A Machine Learning Approach Using Electronic Health Records. INFORMATION 2020. [DOI: 10.3390/info11080386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Acute kidney injury (AKI) is a common complication in hospitalized patients and can result in increased hospital stay, health-related costs, mortality and morbidity. A number of recent studies have shown that AKI is predictable and avoidable if early risk factors can be identified by analyzing Electronic Health Records (EHRs). In this study, we employ machine learning techniques to identify older patients who have a risk of readmission with AKI to the hospital or emergency department within 90 days after discharge. One million patients’ records are included in this study who visited the hospital or emergency department in Ontario between 2014 and 2016. The predictor variables include patient demographics, comorbid conditions, medications and diagnosis codes. We developed 31 prediction models based on different combinations of two sampling techniques, three ensemble methods, and eight classifiers. These models were evaluated through 10-fold cross-validation and compared based on the AUROC metric. The performances of these models were consistent, and the AUROC ranged between 0.61 and 0.88 for predicting AKI among 31 prediction models. In general, the performances of ensemble-based methods were higher than the cost-sensitive logistic regression. We also validated features that are most relevant in predicting AKI with a healthcare expert to improve the performance and reliability of the models. This study predicts the risk of AKI for a patient after being discharged, which provides healthcare providers enough time to intervene before the onset of AKI.
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Davis J, Raisis AL, Miller DW, Rossi G. Validation of a commercial magnetic bead-based multiplex assay for 5 novel biomarkers of acute kidney injury in canine serum. J Vet Diagn Invest 2020; 32:656-663. [PMID: 32627718 DOI: 10.1177/1040638720939520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Interest is growing in measurement of novel biomarkers for the diagnosis of acute kidney injury. Multiplex assays may provide a rapid and cost-effective way of measurement; however, sparse information is published regarding their use in dogs. We aimed to validate a commercial magnetic bead-based assay for 5 biomarkers: clusterin (Clus), cystatin C (CysC), kidney injury molecule 1 (KIM-1), monocyte chemoattractant protein 1 (MCP-1), and neutrophil gelatinase-associated lipocalin (NGAL). Intra- and inter-assay imprecision, linearity under dilution (LUD), spike recovery (S-R), and hemoglobin interference were evaluated using serum from healthy and diseased dogs. Additionally, the effect of sample type (serum vs. plasma) was investigated. All values for Clus and MCP-1 were outside the assay's measurable range. Intra- and inter-assay precision were acceptable for NGAL (CVs 8.8% and 13.2%, respectively). Regression analysis of LUD and S-R indicated good linearity for CysC and NGAL. Hemolysis did not affect measurement of any biomarker. Measured concentrations of CysC (p = 0.018) and NGAL (p = 0.015) were significantly lower in sodium citrate plasma compared to serum. We conclude that this magnetic bead-based assay is precise and accurate for NGAL measurement in canine serum. Inappropriate standards for MCP-1 and Clus, and poor accuracy for KIM-1 measurement, suggest that this assay cannot reliably quantify those biomarkers in canine blood. Measurements of CysC in canine blood using this assay must be interpreted with caution given inter-assay imprecision.
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Affiliation(s)
- Jennifer Davis
- College of Veterinary Medicine, School of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Anthea L Raisis
- College of Veterinary Medicine, School of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - David W Miller
- College of Veterinary Medicine, School of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Gabriele Rossi
- College of Veterinary Medicine, School of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Western Australia, Australia
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Vaara ST, Glassford N, Eastwood GM, Canet E, Mårtensson J, Bellomo R. Point-of-care creatinine measurements to predict acute kidney injury. Acta Anaesthesiol Scand 2020; 64:766-773. [PMID: 32057092 DOI: 10.1111/aas.13564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Plasma creatinine (Cr) is a marker of kidney function and typically measured once daily. We hypothesized that Cr measured by point-of-care technology early after ICU admission would be a good predictor of acute kidney injury (AKI) the next day in critically ill patients. METHODS We conducted a retrospective database audit in a single tertiary ICU database. We included patients with normal first admission Cr (CrF ) and identified a Cr value (CrP ) obtained within 6-12 hours from ICU admission. We used their difference converted into percentage (delta-Cr-%) to predict subsequent AKI (based on Cr and/or need for renal replacement therapy) the next day. We assessed predictive value by calculating area under the receiver characteristic curve (AUC), logistic regression models for AKI with and without delta-Cr-%, and the category-free net reclassifying index (cfNRI). RESULTS We studied 780 patients. Overall, 70 (9.0%) fulfilled the Cr AKI definition by CrP measurement. On day 2, 148 patients (19.0%) were diagnosed with AKI. AUC (95% CI) for delta-Cr-% to predict AKI on day 2 was 0.82 (95% CI 0.78-0.86), and 0.74 (95% CI 0.69-0.80) when patients with AKI based on the CrP were excluded. Using a cut-off of 17% increment, the positive likelihood ratio (95% CI) for delta-Cr-% to predict AKI was 3.5 (2.9-4.2). The cfNRI was 90.0 (74.9-106.1). CONCLUSIONS Among patients admitted with normal Cr, early changes in Cr help predict AKI the following day.
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Affiliation(s)
- Suvi T. Vaara
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
| | - Neil Glassford
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
- Intensive Care Unit Royal Melbourne Hospital Melbourne Health Melbourne Vic Australia
- Department of Epidemiology and Preventative Medicine School of Public Health and Preventative Medicine Monash University Melbourne Vic Australia
- Centre for Integrated Critical Care Department of Medicine & Radiology Melbourne Medical School The University of Melbourne Melbourne Vic Australia
| | - Glenn M. Eastwood
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
| | - Emmanuel Canet
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
- Intensive Care Unit Nantes University Hospital University of Nantes Nantes France
| | - Johan Mårtensson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Rinaldo Bellomo
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
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Hayek SS, Leaf DE, Samman Tahhan A, Raad M, Sharma S, Waikar SS, Sever S, Camacho A, Wang X, Dande RR, Ibrahim NE, Baron RM, Altintas MM, Wei C, Sheikh-Hamad D, Pan JSC, Holliday MW, Januzzi JL, Weisbord SD, Quyyumi AA, Reiser J. Soluble Urokinase Receptor and Acute Kidney Injury. N Engl J Med 2020; 382:416-426. [PMID: 31995687 PMCID: PMC7065830 DOI: 10.1056/nejmoa1911481] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute kidney injury is common, with a major effect on morbidity and health care utilization. Soluble urokinase plasminogen activator receptor (suPAR) is a signaling glycoprotein thought to be involved in the pathogenesis of kidney disease. We investigated whether a high level of suPAR predisposed patients to acute kidney injury in multiple clinical contexts, and we used experimental models to identify mechanisms by which suPAR acts and to assess it as a therapeutic target. METHODS We measured plasma levels of suPAR preprocedurally in patients who underwent coronary angiography and patients who underwent cardiac surgery and at the time of admission to the intensive care unit in critically ill patients. We assessed the risk of acute kidney injury at 7 days as the primary outcome and acute kidney injury or death at 90 days as a secondary outcome, according to quartile of suPAR level. In experimental studies, we used a monoclonal antibody to urokinase plasminogen activator receptor (uPAR) as a therapeutic strategy to attenuate acute kidney injury in transgenic mice receiving contrast material. We also assessed cellular bioenergetics and generation of reactive oxygen species in human kidney proximal tubular (HK-2) cells that were exposed to recombinant suPAR. RESULTS The suPAR level was assessed in 3827 patients who were undergoing coronary angiography, 250 who were undergoing cardiac surgery, and 692 who were critically ill. Acute kidney injury developed in 318 patients (8%) who had undergone coronary angiography. The highest suPAR quartile (vs. the lowest) had an adjusted odds ratio of 2.66 (95% confidence interval [CI], 1.77 to 3.99) for acute kidney injury and 2.29 (95% CI, 1.71 to 3.06) for acute kidney injury or death at 90 days. Findings were similar in the surgical and critically ill cohorts. The suPAR-overexpressing mice that were given contrast material had greater functional and histologic evidence of acute kidney injury than wild-type mice. The suPAR-treated HK-2 cells showed heightened energetic demand and mitochondrial superoxide generation. Pretreatment with a uPAR monoclonal antibody attenuated kidney injury in suPAR-overexpressing mice and normalized bioenergetic changes in HK-2 cells. CONCLUSIONS High suPAR levels were associated with acute kidney injury in various clinical and experimental contexts. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Salim S Hayek
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - David E Leaf
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Ayman Samman Tahhan
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Mohamad Raad
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Shreyak Sharma
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Sushrut S Waikar
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Sanja Sever
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Alex Camacho
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Xuexiang Wang
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Ranadheer R Dande
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Nasrien E Ibrahim
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Rebecca M Baron
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Mehmet M Altintas
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Changli Wei
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - David Sheikh-Hamad
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Jenny S-C Pan
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Michael W Holliday
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - James L Januzzi
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Steven D Weisbord
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Arshed A Quyyumi
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Jochen Reiser
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
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Fan W, Ankawi G, Zhang J, Digvijay K, Giavarina D, Yin Y, Ronco C. Current understanding and future directions in the application of TIMP-2 and IGFBP7 in AKI clinical practice. Clin Chem Lab Med 2019; 57:567-576. [PMID: 30179848 DOI: 10.1515/cclm-2018-0776] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
NephroCheck® is the commercial name of a combined product of two urinary biomarkers, tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), expressed as [TIMP-2]·[IGFBP7], used to identify patients at high risk of acute kidney injury (AKI). AKI is a common and harmful complication especially in critically-ill patients, which can induce devastating short- and long-term outcomes. Over the past decade, numerous clinical studies have evaluated the utility of several biomarkers (e.g. neutrophil gelatinase-associated lipocalin, interleukin-18, liver-type fatty acid binding protein and kidney injury molecule-1, cystatin C) in the early diagnosis and risk stratification of AKI. Among all these biomarkers, [TIMP-2]·[IGFBP7] was confirmed to be superior in early detection of AKI, before the decrease of renal function is evident. In 2014, the US Food and Drug Administration permitted marketing of NephroCheck® (Astute Medical) (measuring urinary [TIMP-2]·[IGFBP7]) to determine if certain critically-ill patients are at risk of developing moderate to severe AKI. It has since been applied to clinical work in many hospitals of the United States and Europe to improve the diagnostic accuracy and outcomes of AKI patients. Now, more and more research is devoted to the evaluation of its application value, meaning and method in different clinical settings. In this review, we summarize the current research status of [TIMP-2]·[IGFBP7] and point out its future directions.
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Affiliation(s)
- Weixuan Fan
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, P.R. China.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Ghada Ankawi
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Internal Medicine and Nephrology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jingxiao Zhang
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, P.R. China.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Kumar Digvijay
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Yongjie Yin
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Ziqiang Street No. 218, 130021 Changchun, P.R. China
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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Grange C, Papadimitriou E, Dimuccio V, Pastorino C, Molina J, O'Kelly R, Niedernhofer LJ, Robbins PD, Camussi G, Bussolati B. Urinary Extracellular Vesicles Carrying Klotho Improve the Recovery of Renal Function in an Acute Tubular Injury Model. Mol Ther 2019; 28:490-502. [PMID: 31818691 PMCID: PMC7000999 DOI: 10.1016/j.ymthe.2019.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/08/2023] Open
Abstract
Acute kidney injury, defined by a rapid deterioration of renal function, is a common complication in hospitalized patients. Among the recent therapeutic options, the use of extracellular vesicles (EVs) is considered a promising strategy. Here we propose a possible therapeutic use of renal-derived EVs isolated from normal urine (urine-derived EVs [uEVs]) in a murine model of acute injury generated by glycerol injection. uEVs accelerated renal recovery, stimulating tubular cell proliferation, reducing the expression of inflammatory and injury markers, and restoring endogenous Klotho loss. When intravenously injected, labeled uEVs localized within injured kidneys and transferred their microRNA cargo. Moreover, uEVs contained the reno-protective Klotho molecule. Murine uEVs derived from Klotho null mice lost the reno-protective effect observed using murine EVs from wild-type mice. This was regained when Klotho-negative murine uEVs were reconstituted with recombinant Klotho. Similarly, ineffective fibroblast EVs acquired reno-protection when engineered with human recombinant Klotho. Our results reveal a novel potential use of uEVs as a new therapeutic strategy for acute kidney injury, highlighting the presence and role of the reno-protective factor Klotho.
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Affiliation(s)
- Cristina Grange
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Elli Papadimitriou
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Veronica Dimuccio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Cecilia Pastorino
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Jordi Molina
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Ryan O'Kelly
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Laura J Niedernhofer
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Paul D Robbins
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Giovanni Camussi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.
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48
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Abdelaziz TS, Fouda R, Hussin WM, Elyamny MS, Abdelhamid YM. Preventing acute kidney injury and improving outcome in critically ill patients utilizing risk prediction score (PRAIOC-RISKS) study. A prospective controlled trial of AKI prevention. J Nephrol 2019; 33:325-334. [PMID: 31712987 DOI: 10.1007/s40620-019-00671-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/06/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) has significant impact on mortality and morbidity in critically ill patients. METHODS A prospective controlled interventional pilot study composed of observation and intervention arms was run at two different Intensive care unit (ICU) sites. A recently validated risk prediction score was used to predict the AKI in critically ill patients at high risk of developing AKI. All patients with established AKI at the time of recruitment were excluded from the study. A package of early preventive measures, including an early nephrology review was applied to high risk patients in the intervention arm to prevent AKI development. RESULTS We have recruited 108 patients at the intervention site and 98 patients at the observation site. The primary outcome measure was the AKI incidence. AKI incidence was significantly lower in the intervention arm than its incidence in the observation arm (11% vs 26%, p = 0.002). The median Time till recovery of AKI episodes was significantly lower in the intervention arm (3(1) vs. 5(2) days, p = 0.014) 0.30 day mortality was lower in the intervention arm, however, not statistically significant. CONCLUSION Our pilot study showed that it was feasible to apply a simple risk score to implement early preventive measures to high risk patients, consequently, mitigating the risk of AKI development and reducing the time till recovery of AKI episodes. Multicentre studies are needed to confirm this favourable effect.
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Affiliation(s)
- Tarek Samy Abdelaziz
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt.
| | - Ragai Fouda
- Medical ICU, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
| | - Wessam M Hussin
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed S Elyamny
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
| | - Yasser M Abdelhamid
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
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Stem Cell-Derived Extracellular Vesicles and Kidney Regeneration. Cells 2019; 8:cells8101240. [PMID: 31614642 PMCID: PMC6830104 DOI: 10.3390/cells8101240] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023] Open
Abstract
Extracellular vesicles (EVs) are membranous vesicles containing active proteins, lipids, and different types of genetic material such as miRNAs, mRNAs, and DNAs related to the characteristics of the originating cell. They possess a distinctive capacity to communicate over long distances. EVs have been involved in the modulation of several pathophysiological conditions and, more importantly, stem cell-derived EVs appear as a new promising therapeutic option. In fact, several reports provide convincing evidence of the regenerative potential of EVs released by stem cells and, in particular, mesenchymal stromal cells (MSCs) in different kidney injury models. Described mechanisms involve the reprogramming of injured cells, cell proliferation and angiogenesis, and inhibition of cell apoptosis and inflammation. Besides, the therapeutic use of MSC-EVs in clinical trials is under investigation. This review will focus on MSC-EV applications in preclinical models of acute and chronic renal damage including recent data on their use in kidney transplant conditioning. Moreover, ongoing clinical trials are described. Finally, new strategies to broaden and enhance EV therapeutic efficacy by engineering are discussed.
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50
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Role of anemia and proteinuria in the development of subsequent renal function deterioration in a general population with preserved glomerular filtration rate: a community-based cohort study. J Nephrol 2019; 32:775-781. [DOI: 10.1007/s40620-019-00605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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