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Docherty NG, Delles C, López-Hernández FJ. Reframing acute kidney injury as a pathophysiological continuum of disrupted renal excretory function. Acta Physiol (Oxf) 2024; 240:e14181. [PMID: 38808913 DOI: 10.1111/apha.14181] [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: 12/04/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect "sub-clinical" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.
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Grants
- Instituto de Salud Carlos III
- European Commission
- Consejería de Educación, Junta de Castilla y León
- This study was supported by grants from the Instituto de Salud Carlos III (ISCIII), Spain (PI18/00996, PI21/01226), co-funded by FEDER, Fondo Europeo de Desarrollo Regional "Una manera de hacer Europa", co-funded by the the European Union, Red de Investigación Renal RICORS2040 (Kidney Disease) RD21/0005/0004 funded by the European Union - NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR), and from the Consejería de Educación, Junta de Castilla y León (IES160P20), Spain, co-funded by FEDER funds from the European Union.
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Affiliation(s)
- Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
- Disease and Theranostic Modelling (DisMOD) Working Group
| | - Christian Delles
- Disease and Theranostic Modelling (DisMOD) Working Group
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Francisco J López-Hernández
- Disease and Theranostic Modelling (DisMOD) Working Group
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL); Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, Salamanca, Spain
- National Network for Kidney Research RICORS2040 RD21/0005/0004, Instituto de Salud Carlos III, Madrid, Spain
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2
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Sancho-Martínez SM, López-Hernández FJ. Pathophysiology of Acute Kidney Frailty. Physiology (Bethesda) 2023; 38:0. [PMID: 37738019 DOI: 10.1152/physiol.00011.2023] [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] [Received: 04/27/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 09/23/2023] Open
Abstract
Acute kidney frailty is a premorbid condition of diminished renal functional reserve that predisposes to acute kidney injury; this condition results from subclinical wear or distortion of renal homeostatic responses that protect the renal excretory function. Knowledge of its pathophysiological basis is critical for the development of diagnostic and therapeutic strategies that allow for prophylactic intervention and disease prevention.
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Affiliation(s)
- Sandra M Sancho-Martínez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Departamento de Fisiología y Farmacología, Universidad de Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- National Network for Kidney Research RICORS2040 RD21/0005/0004, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J López-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Departamento de Fisiología y Farmacología, Universidad de Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- National Network for Kidney Research RICORS2040 RD21/0005/0004, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
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3
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Pejchinovski I, Turkkan S, Pejchinovski M. Recent Advances of Proteomics in Management of Acute Kidney Injury. Diagnostics (Basel) 2023; 13:2648. [PMID: 37627907 PMCID: PMC10453063 DOI: 10.3390/diagnostics13162648] [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: 06/28/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Acute Kidney Injury (AKI) is currently recognized as a life-threatening disease, leading to an exponential increase in morbidity and mortality worldwide. At present, AKI is characterized by a significant increase in serum creatinine (SCr) levels, typically followed by a sudden drop in glomerulus filtration rate (GFR). Changes in urine output are usually associated with the renal inability to excrete urea and other nitrogenous waste products, causing extracellular volume and electrolyte imbalances. Several molecular mechanisms were proposed to be affiliated with AKI development and progression, ultimately involving renal epithelium tubular cell-cycle arrest, inflammation, mitochondrial dysfunction, the inability to recover and regenerate proximal tubules, and impaired endothelial function. Diagnosis and prognosis using state-of-the-art clinical markers are often late and provide poor outcomes at disease onset. Inappropriate clinical assessment is a strong disease contributor, actively driving progression towards end stage renal disease (ESRD). Proteins, as the main functional and structural unit of the cell, provide the opportunity to monitor the disease on a molecular level. Changes in the proteomic profiles are pivotal for the expression of molecular pathways and disease pathogenesis. Introduction of highly-sensitive and innovative technology enabled the discovery of novel biomarkers for improved risk stratification, better and more cost-effective medical care for the ill patients and advanced personalized medicine. In line with those strategies, this review provides and discusses the latest findings of proteomic-based biomarkers and their prospective clinical application for AKI management.
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Affiliation(s)
- Ilinka Pejchinovski
- Department of Quality Assurance, Nikkiso Europe GmbH, 30885 Langenhagen, Germany; (I.P.); (S.T.)
| | - Sibel Turkkan
- Department of Quality Assurance, Nikkiso Europe GmbH, 30885 Langenhagen, Germany; (I.P.); (S.T.)
| | - Martin Pejchinovski
- Department of Analytical Instruments Group, Thermo Fisher Scientific, 82110 Germering, Germany
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4
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Vicente-Vicente L, Casanova AG, Tascón J, Prieto M, Morales AI. New Challenges in the Diagnosis of Kidney Damage Due to Immune Checkpoint Inhibitors Therapy: An Observational Clinical Study. Diagnostics (Basel) 2023; 13:2524. [PMID: 37568887 PMCID: PMC10416935 DOI: 10.3390/diagnostics13152524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
In recent years, immunotherapy has been postulated as one of the most effective strategies in the fight against cancer. The greatest success in this field has been achieved with the inhibition of molecules involved in slowing down the adaptive immune response by immune checkpoint inhibitors (ICIs). Despite its efficacy, ICI treatment has side effects. Regarding kidney damage, it is estimated that 4.9% of patients treated with ICIs develop renal injury. Furthermore, cancer patients who develop renal dysfunction have a worse prognosis. Current diagnostics are insufficient to predict the underlying renal injury and to identify the type of damage. Our hypothesis is that the renal injury could be subclinical, so the possibility of using new urinary biomarkers could be a useful diagnostic tool that would allow these patients to be managed in a preventive (risk biomarkers) and early (early biomarkers) way and even to clarify whether the renal damage is due to this therapy or to other factors (differential diagnostic biomarkers). A prospective study to validate risk and early and differential biomarkers in patients treated with ICIs is proposed to test this hypothesis. The results derived from this study will improve the clinical practice of cancer treatment with ICIs and therefore the life expectancy and quality of life of patients. Trial Registration: ClinicalTrials.gov, NCT04902846.
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Affiliation(s)
- Laura Vicente-Vicente
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfredo G. Casanova
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Tascón
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Prieto
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana I. Morales
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
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Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers. Int J Mol Sci 2023; 24:ijms24031826. [PMID: 36768149 PMCID: PMC9916069 DOI: 10.3390/ijms24031826] [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: 12/03/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Acute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) provide no etiological distinction, anamnestic and additional biochemical criteria complement AKI diagnosis. Traditional, etiology-defining biochemical parameters, including the fractional excretion of sodium, the urinary-to-plasma creatinine ratio and the renal failure index are individually limited by confounding factors such as diuretics. To minimize distortion, we generated a composite biochemical criterion based on the congruency of at least two of the three biochemical ratios. Patients showing at least two ratios indicative of intrinsic AKI were classified within this category, and those with at least two pre-renal ratios were considered as pre-renal AKI patients. In this study, we demonstrate that the identification of intrinsic AKI by a collection of urinary injury biomarkers reflective of tubular damage, including NGAL and KIM-1, more closely and robustly coincide with the biochemical than with the anamnestic classification. Because there is no gold standard method for the etiological classification of AKI, the mutual reinforcement provided by the biochemical criterion and urinary biomarkers supports an etiological diagnosis based on objective diagnostic parameters.
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6
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Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: State of the Art and Perspectives. J Clin Med 2022; 11:jcm11154576. [PMID: 35956190 PMCID: PMC9370029 DOI: 10.3390/jcm11154576] [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: 06/30/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk.
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7
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Early Diagnosis of Kidney Damage Associated with Tobacco Use: Preventive Application. J Pers Med 2022; 12:jpm12071032. [PMID: 35887529 PMCID: PMC9325290 DOI: 10.3390/jpm12071032] [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: 05/18/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Although long-term smoking has been associated with chronic kidney disease, its effect on kidney function in early stages has not been clarified. Therefore, the proposed objectives were: (1) to identify subclinical kidney damage in smokers, through a panel of biomarkers; (2) to evaluate the progression of subclinical kidney damage after two years of consumption in these patients; and (3) study whether quitting smoking reduces kidney damage. A prospective study was carried out (patients recruited from a primary care centre and a clinical smoking unit). Kidney function was assessed using a panel of biomarkers and compared between smokers and non-smokers, taking into account potential risk factors for kidney damage. These results show, for the first time in the literature, the relationship between smoking and early (subclinical) kidney damage and provide a panel of biomarkers capable of detecting this condition (Neutrophil gelatinase-associated lipocalin, Kidney injury molecule-1, N-acetyl-beta-D-glucosaminidase, transferrin, and ganglioside-activating protein GM2). This study also indicates that subclinical damage is maintained when use continues, but can be reversed if patients stop smoking. The use of these biomarkers as diagnostic tools can be a preventive measure in the development of chronic kidney disease associated with smoking and in the prevention of acute events associated with potentially nephrotoxic pharmacological treatment in smokers. Trial registration number: NCT03850756.
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8
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Kong Y, Akatsuka S, Motooka Y, Zheng H, Cheng Z, Shiraki Y, Mashimo T, Imaoka T, Toyokuni S. BRCA1 haploinsufficiency promotes chromosomal amplification under fenton reaction-based carcinogenesis through ferroptosis-resistance. Redox Biol 2022; 54:102356. [PMID: 35667247 PMCID: PMC9168618 DOI: 10.1016/j.redox.2022.102356] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/25/2022] [Indexed: 12/16/2022] Open
Abstract
Germline-mutation in BRCA1 tumor suppressor gene is an established risk for carcinogenesis not only in females but also in males. Deficiency in the repair of DNA double-strand breaks is hypothesized as a responsible mechanism for carcinogenesis. However, supporting data is insufficient both in the mutation spectra of cancers in the patients with BRCA1 germline-mutation and in murine knockout/knock-in models of Brca1 haploinsufficiency. Furthermore, information on the driving force toward carcinogenesis in BRCA1 mutation carriers is lacking. Here we applied Fenton reaction-based renal carcinogenesis to a rat heterozygously knockout model of BRCA1 haploinsufficiency (mutant [MUT] model; L63X/+). Rat MUT model revealed significant promotion of renal cell carcinoma (RCC) induced by ferric nitrilotriacetate (Fe-NTA). Array-based comparative genome hybridization of the RCCs identified significant increase in chromosomal amplification, syntenic to those in breast cancers of BRCA1 mutation carriers, including c-Myc, in comparison to those in the wild-type. Subacute-phase analysis of the kidney after repeated Fe-NTA treatment in the MUT model revealed dysregulated iron metabolism with mitochondrial malfunction assessed by expression microarray and electron microscopy, leading to renal tubular proliferation with iron overload. In conclusion, we for the first time demonstrate that biallelic wild-type BRCA1 provides more robust protection for mitochondrial metabolism under iron-catalyzed oxidative stress, preventing the emergence of neoplastic cells with chromosomal amplification. Our results suggest that oxidative stress via excess iron is a major driving force for carcinogenesis in BRCA1 haploinsufficiency, which can be a target for cancer prevention and therapeutics. Rat BRCA1 haploinsufficiency promoted Fenton reaction-based renal carcinogenesis. BRCA1 haploinsufficiency allowed chromosomal amplification under excess iron. BRCA1 haploinsufficiency caused more mitochondrial damage with ferroptosis resistance.
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Sancho-Martínez SM, Herrero M, Fontecha-Barriuso M, Mercado-Hernández J, López-Hernández FJ. The Urinary Level of Injury Biomarkers Is Not Univocally Reflective of the Extent of Toxic Renal Tubular Injury in Rats. Int J Mol Sci 2022; 23:ijms23073494. [PMID: 35408856 PMCID: PMC8998362 DOI: 10.3390/ijms23073494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
Nephrotoxicity is a major cause of intrinsic acute kidney injury (AKI). Because renal tissue damage may occur independently of a reduction in glomerular filtration rate and of elevations in plasma creatinine concentration, so-called injury biomarkers have been proposed to form part of diagnostic criteria as reflective of tubular damage independently of renal function status. We studied whether the urinary level of NGAL, KIM-1, GM2AP, t-gelsolin, and REGIIIb informed on the extent of tubular damage in rat models of nephrotoxicity, regardless of the etiology, moment of observation, and underlying pathophysiology. At a time of overt AKI, urinary biomarkers were measured by Western blot or ELISA, and tubular necrosis was scored from histological specimens stained with hematoxylin and eosin. Correlation and regression studies revealed that only weak relations existed between biomarkers and tubular damage. Due to high interindividual variability in the extent of damage for any given biomarker level, urinary injury biomarkers did not necessarily reflect the extent of the underlying tissue injury in individual rats. We contended, in this work, that further pathophysiological contextualization is necessary to understand the diagnostic significance of injury biomarkers before they can be used for renal tubular damage severity stratification in the context of nephrotoxic and, in general, intrinsic AKI.
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Affiliation(s)
- Sandra M. Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (S.M.S.-M.); (J.M.-H.)
- Departamento de Fisiología y Farmacología, Universidad de Salamanca (USAL), 37007 Salamanca, Spain; (M.H.); (M.F.-B.)
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Herrero
- Departamento de Fisiología y Farmacología, Universidad de Salamanca (USAL), 37007 Salamanca, Spain; (M.H.); (M.F.-B.)
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
| | - Miguel Fontecha-Barriuso
- Departamento de Fisiología y Farmacología, Universidad de Salamanca (USAL), 37007 Salamanca, Spain; (M.H.); (M.F.-B.)
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
| | - Joana Mercado-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (S.M.S.-M.); (J.M.-H.)
- Departamento de Fisiología y Farmacología, Universidad de Salamanca (USAL), 37007 Salamanca, Spain; (M.H.); (M.F.-B.)
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
| | - Francisco J. López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (S.M.S.-M.); (J.M.-H.)
- Departamento de Fisiología y Farmacología, Universidad de Salamanca (USAL), 37007 Salamanca, Spain; (M.H.); (M.F.-B.)
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), 42002 Soria, Spain
- Group of Biomedical Research on Critical Care (BioCritic), 47003 Valladolid, Spain
- Correspondence:
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10
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Pellicer-Valero ÓJ, Massaro GA, Casanova AG, Paniagua-Sancho M, Fuentes-Calvo I, Harvat M, Martín-Guerrero JD, Martínez-Salgado C, López-Hernández FJ. Neural Network-Based Calculator for Rat Glomerular Filtration Rate. Biomedicines 2022; 10:biomedicines10030610. [PMID: 35327412 PMCID: PMC8945373 DOI: 10.3390/biomedicines10030610] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Glomerular filtration is a pivotal process of renal physiology, and its alterations are a central pathological event in acute kidney injury and chronic kidney disease. Creatinine clearance (ClCr), a standard method for glomerular filtration rate (GFR) measurement, requires a long and tedious procedure of timed (usually 24 h) urine collection. We have developed a neural network (NN)-based calculator of rat ClCr from plasma creatinine (pCr) and body weight. For this purpose, matched pCr, weight, and ClCr trios from our historical records on male Wistar rats were used. When evaluated on the training (1165 trios), validation (389), and test sets (660), the model committed an average prediction error of 0.196, 0.178, and 0.203 mL/min and had a correlation coefficient of 0.863, 0.902, and 0.856, respectively. More importantly, for all datasets, the NN seemed especially effective at comparing ClCr among groups within individual experiments, providing results that were often more congruent than those measured experimentally. ACLARA, a friendly interface for this calculator, has been made publicly available to ease and expedite experimental procedures and to enhance animal welfare in alignment with the 3Rs principles by avoiding unnecessary stressing metabolic caging for individual urine collection.
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Affiliation(s)
- Óscar J. Pellicer-Valero
- Intelligent Data Analysis Laboratory (IDAL), Department Electronic Engineering, School of Engineering (ETSE-UV), Universitat de València, 46100 Valencia, Spain; (Ó.J.P.-V.); (M.H.); (J.D.M.-G.)
| | - Giampiero A. Massaro
- Institute of Biomedical Research of Salamanca, 37007 Salamanca, Spain; (G.A.M.); (A.G.C.); (M.P.-S.); (I.F.-C.); (C.M.-S.)
- Departmento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, 42002 Soria, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfredo G. Casanova
- Institute of Biomedical Research of Salamanca, 37007 Salamanca, Spain; (G.A.M.); (A.G.C.); (M.P.-S.); (I.F.-C.); (C.M.-S.)
- Departmento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, 42002 Soria, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Paniagua-Sancho
- Institute of Biomedical Research of Salamanca, 37007 Salamanca, Spain; (G.A.M.); (A.G.C.); (M.P.-S.); (I.F.-C.); (C.M.-S.)
- Departmento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, 42002 Soria, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Isabel Fuentes-Calvo
- Institute of Biomedical Research of Salamanca, 37007 Salamanca, Spain; (G.A.M.); (A.G.C.); (M.P.-S.); (I.F.-C.); (C.M.-S.)
- Departmento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mykola Harvat
- Intelligent Data Analysis Laboratory (IDAL), Department Electronic Engineering, School of Engineering (ETSE-UV), Universitat de València, 46100 Valencia, Spain; (Ó.J.P.-V.); (M.H.); (J.D.M.-G.)
| | - José D. Martín-Guerrero
- Intelligent Data Analysis Laboratory (IDAL), Department Electronic Engineering, School of Engineering (ETSE-UV), Universitat de València, 46100 Valencia, Spain; (Ó.J.P.-V.); (M.H.); (J.D.M.-G.)
- Disease and Theranostic Modelling Consortium (DisMOD), 37007 Salamanca, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca, 37007 Salamanca, Spain; (G.A.M.); (A.G.C.); (M.P.-S.); (I.F.-C.); (C.M.-S.)
- Departmento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Disease and Theranostic Modelling Consortium (DisMOD), 37007 Salamanca, Spain
| | - Francisco J. López-Hernández
- Institute of Biomedical Research of Salamanca, 37007 Salamanca, Spain; (G.A.M.); (A.G.C.); (M.P.-S.); (I.F.-C.); (C.M.-S.)
- Departmento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, 42002 Soria, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), 37007 Salamanca, Spain
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Disease and Theranostic Modelling Consortium (DisMOD), 37007 Salamanca, Spain
- Group of Biomedical Research on Critical Care (BioCritic), 47003 Valladolid, Spain
- Correspondence:
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Zuo M, Meng C, Song Q, Gao Z, Cui X, Wang J, Li Y, Li X, Shan C, Yang J, Chang B. Beta-Hydroxybutyric Acid Inhibits Renal Tubular Reabsorption via the AKT/DAB2/Megalin Signalling Pathway. J Diabetes Res 2022; 2022:3411123. [PMID: 36330072 PMCID: PMC9626228 DOI: 10.1155/2022/3411123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
AIM Patients with diabetic ketosis often exhibit albuminuria. We previously found that acute hyperglycaemia can cause nephrotoxic injury. Here, we explored whether an excessive ketone body level causes kidney injury and the potential underlying mechanism. METHODS Fifty-six type 2 diabetes without ketosis (NDK group), 81 type 2 diabetes with ketosis (DK group), and 38 healthy controls (NC group) were enrolled. Clinical data were collected before and after controlling diabetic ketosis. Beta-hydroxybutyric acid (BOHB), an AKT activator, an AKT inhibitor, or plasmids encoding DAB2 were transformed into human renal proximal tubule epithelial cells (HK-2 cells). RESULTS The urinary albumin-to-creatinine ratio (ACR), transferrin (TF), immunoglobulin G (IgG), Beta2-microglobulin (β2-MG), retinol-binding protein (RBP), N-acetyl-beta-glucosaminidase (NAG), and Beta-galactosidase (GAL) were higher in the DK than NC and NDK groups. The proportion of patients with an increased urinary level of TF, IgG, β2-MG, RBP, NAG, or GAL was higher in the DK group too. After controlling ketosis, urinary microalbumin, TF, IgG, β2-MG, and RBP decreased significantly. In HK-2 cells, albumin endocytosis and megalin expression decreased with increasing BOHB concentration. Compared with BOHB treatment, BOHB with AKT activator significantly increased the DAB2, megalin levels and albumin endocytosis; the AKT inhibitor treatment exhibited the opposite effects. Compared with BOHB treatment, megalin expression and albumin endocytosis were significantly increased after BOHB with DAB2 overexpression treatment. CONCLUSIONS Patients with diabetic ketosis may suffer from glomerular and tubular injuries that recover after ketosis control. High concentrations of BOHB downregulate megalin expression by inhibiting the AKT/DAB2/megalin signalling pathway and albumin endocytosis in proximal renal tubules.
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Affiliation(s)
- Minxia Zuo
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
- Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan 430070, China
| | - Cheng Meng
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Qian Song
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Zhongai Gao
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Xiao Cui
- Department of Respiratory and Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing 100069, China
| | - Jingyu Wang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Yongmei Li
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Xiaochen Li
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Chunyan Shan
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Juhong Yang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
| | - Baocheng Chang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital, And Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
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Zhang Z, Cheng X, Jiang H, Gu J, Yin Y, Shen Z, Xu C, Pu Z, Li JB, Xu G. Quantitative proteomic analysis of glycosylated proteins enriched from urine samples with magnetic ConA nanoparticles identifies potential biomarkers for small cell lung cancer. J Pharm Biomed Anal 2021; 206:114352. [PMID: 34509662 DOI: 10.1016/j.jpba.2021.114352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/21/2021] [Accepted: 08/28/2021] [Indexed: 01/08/2023]
Abstract
Lung cancer has high morbidity and mortality and small cell lung cancer (SCLC) is a highly invasive malignant tumor with a very unfavorable survival rate. Early diagnosis and treatment can result in better prognosis for the SCLC patients but current diagnostic methods are either invasive or incapable for large-scale screen. Therefore, discovering biomarkers for early diagnosis of SCLC is of importance. In this work, we covalently coupled Concanavalin A (ConA) to functionalized magnetic nanoparticles to obtain magnetic ConA-nanoparticles (ConA-NPs) for the enrichment of glycosylated proteins. We then purified glycosylated proteins in 36 urine samples from 9 healthy controls, 9 SCLC patients, 9 lung adenocarcinoma (LUAD) patients, and 9 lung squamous cell carcinoma (LUSC) patients. The purified glycosylated proteins were digested and analyzed by LC-MS/MS for identification and quantification. Among the 398 identified proteins, 20, 15, and 1 glycosylated protein(s), respectively, were upregulated in the urine of SCLC, LUAD, and LUSC patients. Immunoblotting experiments further demonstrated that cathepsin C and transferrin were significantly upregulated in the ConA-NP purified urine of SCLC patients. This work suggests that glycosylated cathepsin C and transferrin might be able to serve as potential biomarkers for the noninvasive diagnosis of SCLC patients.
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Affiliation(s)
- Zhiyu Zhang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China; Medical School of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China
| | - Xinyu Cheng
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China; Medical School of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China
| | - Honglv Jiang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China
| | - Jingyu Gu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China; Medical School of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China
| | - Yunfei Yin
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China; Medical School of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China
| | - Zhijia Shen
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China; Medical School of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China
| | - Changgang Xu
- School of Materials Science and Engineering, Xi'an University of Science and Technology, Xi'an 710054, China
| | - Zhongjian Pu
- Department of Oncology, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, China
| | - Jia-Bin Li
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China.
| | - Guoqiang Xu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu 215123, China.
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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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Albuminuria Pre-Emptively Identifies Cardiac Patients at Risk of Contrast-Induced Nephropathy. J Clin Med 2021; 10:jcm10214942. [PMID: 34768464 PMCID: PMC8584615 DOI: 10.3390/jcm10214942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is a complication associated with the administration of contrast media (CM). The CIN diagnosis is based on creatinine, a biomarker late and insensitive. The objective proposed was to evaluate the ability of novel biomarkers to detect patients susceptible to suffering CIN before CM administration. The study was carried out with patients undergoing cardiac catheterization involving CM. Patients were divided into two groups: (1) CIN, patients who developed this pathology; (2) control, patients who did not suffer CIN. Prior to the administration of CM, urine samples were collected to measure proteinuria, N-acetyl-β-d-glucosaminidase, neutrophil gelatinase-associated lipocalin and kidney injury molecule-1, albumin, transferrin, t-gelsolin and GM2 ganglioside activator protein (GM2AP). The risk factors advanced age, low body mass index and low estimated glomerular filtration rate; and the urinary biomarkers albumin, transferrin and GM2AP showed significant predictive capacity. Of all of them, albuminuria demonstrated the highest diagnostic power. When a cutoff point was established for albuminuria at values still considered subclinical (10–30 µg/mg Cru), it was found that there was a high incidence of CIN (40–75%). Therefore, albuminuria could be applied as a new diagnostic tool to prevent and predict CIN with P4 medicine criteria, independently of risk factors and comorbidities.
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Laudanski K, Okeke T, Hajj J, Siddiq K, Rader DJ, Wu J, Susztak K. Longitudinal urinary biomarkers of immunological activation in covid-19 patients without clinically apparent kidney disease versus acute and chronic failure. Sci Rep 2021; 11:19675. [PMID: 34608231 PMCID: PMC8490434 DOI: 10.1038/s41598-021-99102-5] [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] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/16/2021] [Indexed: 02/08/2023] Open
Abstract
Kidney function is affected in COVID-19, while kidney itself modulates the immune response. Here, hypothesize if COVID-19 urine biomarkers level can assess immune activation vs. clinical trajectory. Considering the kidney's critical role in modulating the immune response, we sought to analyze activation markers in patients with pre-existing dysfunction. This was a cross-sectional study of 68 patients. Blood and urine were collected within 48 h of hospital admission (H1), followed by 96 h (H2), seven days (H3), and up to 25 days (H4) from admission. Serum level ferritin, procalcitonin, IL-6 assessed immune activation overall, while the response to viral burden was gauged with serum level of spike protein and αspike IgM and IgG. 39 markers correlated highly between urine and blood. Age and race, and to a lesser extend gender, differentiated several urine markers. The burden of pre-existing conditions correlated with urine DCN, CAIX and PTN, but inversely with IL-5 or MCP-4. Higher urinary IL-12 and lower CAIX, CCL23, IL-15, IL-18, MCP-1, MCP-3, MUC-16, PD-L1, TNFRS12A, and TNFRS21 signified non-survivors. APACHE correlated with urine TNFRS12, PGF, CAIX, DCN, CXCL6, and EGF. Admission urine LAG-3 and IL-2 predicted death. Pre-existing kidney disease had a unique pattern of urinary inflammatory markers. Acute kidney injury was associated, and to a certain degree, predicted by IFNg, TWEAK, MMP7, and MUC-16. Remdesavir had a more profound effect on the urine biomarkers than steroids. Urinary biomarkers correlated with clinical status, kidney function, markers of the immune system activation, and probability of demise in COVID-19.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, The University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute for Healthcare Economics, The University of Pennsylvania, Philadelphia, PA, USA.
| | - Tony Okeke
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Jihane Hajj
- School of Nursing, Widener University, Philadelphia, PA, USA
| | - Kumal Siddiq
- College of Arts and Sciences, Drexel University, Philadelphia, PA, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Junnan Wu
- Department of Genetics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- Division of Renal Electrolyte and Hypertension, Department of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Katalin Susztak
- Department of Genetics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- Division of Renal Electrolyte and Hypertension, Department of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
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16
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Paniagua-Sancho M, Quiros Y, Casanova AG, Blanco-Gozalo V, Agüeros-Blanco C, Benito-Hernández A, Ramos-Barron MA, Gómez-Alamillo C, Arias M, Sancho-Martínez SM, López-Hernández FJ. Urinary Plasminogen Activator Inhibitor-1: A Biomarker of Acute Tubular Injury. Am J Nephrol 2021; 52:714-724. [PMID: 34518454 DOI: 10.1159/000518455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a threatening, multiaetiological syndrome encompassing a variety of forms and damage patterns. AKI lacks sufficiently specific diagnostic tools to evaluate the distinct combination of pathophysiological events underlying each case, which limits personalized and optimized handling. Therefore, a pathophysiological diagnosis based on new urinary biomarkers is sought for practical (readiness and noninvasiveness) and conceptual reasons, as the urine is a direct product of the kidneys. However, biomarkers found in the urine may also have extrarenal origin, thus conveying pathophysiological information from other organs or tissues. Urinary plasminogen activator inhibitor-1 (PAI-1) has been associated to AKI, although its origin and traffic to the urine are not known. METHODS Herein, we studied the blood or renal origin of urinary PAI-1 (uPAI-1) in experimental AKI in Wistar rats, by means of the in situ renal perfusion method. For this purpose, urine was collected while the kidneys of rats with AKI showing increased uPAI-1 excretion, and controls, were in situ perfused with a saline solution. RESULTS Our results show that during perfusion, PAI-1 remained in the urine of AKI rats, suggesting that renal cells shed this protein directly to the urine. PAI-1 is also significantly increased in the urine of AKI patients. Its low correlation with other urinary markers such as NGAL or NAG suggests that PAI-1 provides complementary and distinct phenotypical information. CONCLUSION In conclusion, uPAI-1 is a biomarker produced by damaged kidneys following AKI, whose precise pathophysiological meaning in AKI needs to be further investigated.
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Affiliation(s)
- María Paniagua-Sancho
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Yaremi Quiros
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Alfredo G Casanova
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Consuelo Agüeros-Blanco
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Adalberto Benito-Hernández
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - María A Ramos-Barron
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Arias
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
- Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
- Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
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Adverse Health Effects in Women Farmers Indirectly Exposed to Pesticides. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115909. [PMID: 34072924 PMCID: PMC8198255 DOI: 10.3390/ijerph18115909] [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] [Received: 03/24/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 12/20/2022]
Abstract
Farmers are among the most vulnerable populations because of the exposure to low levels of pesticides. Acetylcholinesterase and butyrylcholinesterase activities are considered as biomarkers of pesticides poisoning. However, biomarkers of oxidative stress are also playing an important role in toxicity of these contaminants. Further, increased activities of gamma-glutamyltransferase, alanine aminotransferase, urea and creatinine have been linked with hepatic and nephrotoxic cell damage, respectively. The aim of this study was to ascertain if the indirect exposure to pesticides leads to some biochemical parameter changes. Thus, cholinesterase activities, oxidative stress status (lipid and protein oxidation), hepatic function (AST and ALT levels), hormonal function (TSH, T4, FSH, LH and AMH), renal function (serum creatinine and urea), as well as possible subclinical kidney damage (urinary proteins and biomarkers of early kidney damage) were evaluated in farmer women who collect fruits and vegetables comparing with a group of women non-occupational exposed to pesticides but living in the same rural environment. Samples were taken periodically along one year to relate the observed effects to a chronic exposure. Our main results showed for the first time a subclinical kidney damage in a rural setting with indirect chronic exposure to pesticides.
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Casanova AG, Fuentes-Calvo I, Hernández-Sánchez MT, Quintero M, Toral P, Caballero MT, Martínez-Salgado C, Morales AI, Layton AT, Eleno N, López-Hernández FJ. The furosemide stress test and computational modeling identify renal damage sites associated with predisposition to acute kidney injury in rats. Transl Res 2021; 231:76-91. [PMID: 33253980 DOI: 10.1016/j.trsl.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/29/2022]
Abstract
Acute kidney injury (AKI) diagnosis relies on plasma creatinine concentration (Crpl), a relatively insensitive, surrogate biomarker of glomerular filtration rate that increases only after significant damage befalls. However, damage in different renal structures may occur without increments in Crpl, a condition known as subclinical AKI. Thus, detection of alterations in other aspects of renal function different from glomerular filtration rate must be included in an integral diagnosis of AKI. With this aim, we adapted to and validated in rats (for preclinical research) the furosemide stress test (FST), a tubular function test hitherto performed only in humans. We also tested its sensitivity in detecting subclinical tubular alterations. In particular, we predisposed rats to AKI with 3 mg/kg cisplatin and subsequently subjected them to a triggering insult (ie, 50 mg/kg/d gentamicin for 6 days) that had no effect on nonpredisposed animals but caused an overt AKI in predisposed rats. The FST was performed immediately before adding the triggering insult. Predisposed animals showed a reduced response to the FST (namely, reduced furosemide-induced diuresis and K+ excretion), whereas nonpredisposed animals showed no alteration, compared to the controls. Computational modeling of epithelial transport of solutes and water along the nephrons applied to experimental data suggested that proximal tubule transport was only minimally reduced, the sodium-chloride symporter was upregulated by 50%, and the renal outer medullary potassium channel was downregulated by 85% in predisposed animals. In conclusion, serial coupling of the FST and computational modeling may be used to detect and localize subclinical tubular alterations.
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Affiliation(s)
- Alfredo G Casanova
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain; Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Fuentes-Calvo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - María T Hernández-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Quintero
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Toral
- Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - María T Caballero
- Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain; Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain; Disease and Theranostic Modeling (DisMOD) International Consortium, Salamanca, Spain
| | - Ana I Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain; Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain; Disease and Theranostic Modeling (DisMOD) International Consortium, Salamanca, Spain
| | - Anita T Layton
- Departments of Applied Mathematics and Biology, and Schools of Computer Science and Pharmacology, University of Waterloo, Waterloo, Ontario, Canada; Disease and Theranostic Modeling (DisMOD) International Consortium, Salamanca, Spain.
| | - Nélida Eleno
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain; Department of Physiology and Pharmacology, University of Salamanca (USAL), Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain, National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain; Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain; Disease and Theranostic Modeling (DisMOD) International Consortium, Salamanca, Spain.
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Sun X, Wang Y, Jiang T, Yuan X, Ren Z, Tuffour A, Liu H, Zhou Y, Gu J, Shi H. Nephrotoxicity Profile of Cadmium Revealed by Proteomics in Mouse Kidney. Biol Trace Elem Res 2021; 199:1929-1940. [PMID: 32803525 DOI: 10.1007/s12011-020-02312-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022]
Abstract
Cadmium (Cd) is a highly toxic metal and kidney is its main target. However, the molecular effects and associated potential impacts of Cd-accumulated kidney have not been well investigated. In this study, mouse was used as a model to investigate the Cd-induced proteomic profile change in kidney, and a total of 34 differentially expressed proteins were detected by two-dimensional gel electrophoresis (2-DE) and further identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Through Gene Ontology analysis and KEGG pathway annotation, it showed that Cd-regulated kidney metabolism and promoted renal damage and cell migration. By validation of Western blotting and RT-qPCR, metastasis-related proteins LIM and SH3 domain protein 1 (LASP1) and phosphoenolpyruvate carboxykinase/cytosolic [GTP] (PEPCK1) were confirmed to be upregulated; Acyl-CoA synthetase medium-chain family member 3 (ACSM3) was downregulated. Furthermore, carcinoma development-related proteins initiation factor 4A (eIF4A) and pyridoxine-5'-phosphate oxidase (PNPO) were upregulated, and pyridoxal kinase (PK) was downregulated. The downregulation of Na(+)/H(+) exchange regulatory cofactor (NHERF3) might promote renal damage which associated with decrease of transferrin (TRF) in kidney. Taken together, our results revealed proteomic profile of Cd-induced nephrotoxicity and provided data for further insights into the mechanisms of Cd toxicity.
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Affiliation(s)
- Xi Sun
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Yanwei Wang
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Tingya Jiang
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Xiao Yuan
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Zhen Ren
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Alex Tuffour
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Haitao Liu
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Yang Zhou
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Jie Gu
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Haifeng Shi
- Institute of Life Sciences, Jiangsu University, Zhenjiang, 212013, Jiangsu, China.
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, 212013, Jiangsu, China.
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Wang M, Xiong H, Chen H, Li Q, Ruan XZ. Renal Injury by SARS-CoV-2 Infection: A Systematic Review. KIDNEY DISEASES (BASEL, SWITZERLAND) 2021; 7:100-110. [PMID: 33821207 PMCID: PMC7705946 DOI: 10.1159/000512683] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND SARS-CoV-2 infection can cause renal involvement, and severe renal dysfunction is more common among patients with chronic comorbid conditions, especially patients with chronic kidney disease. Angiotensin-converting enzyme 2 (ACE2) has been proven to be the major receptor of SARS-CoV-2 in kidneys, suggesting that ACE2-related changes may be involved in renal injury during the infection. In this review, we systematically reviewed the literature to summarize findings on the mechanism of renal injury caused by SARS-COV-2 infection, in order to provide a theoretical basis for renal protection therapy. SUMMARY For patients with SARS-CoV-2 infection, renal injury mainly manifests as increased serum creatinine, variable degrees of proteinuria and hematuria, and radiographic abnormalities of the kidneys. In this review, we summarize the pathogenesis of renal injury deriving from SARS-CoV-2 infection by focusing on its etiology, pathology, and clinical manifestations. The virus causes kidney injury by either direct infection or systemic effects, including host immune clearance and immune tolerance disorders, endothelium-mediated vasculitis, thrombus formation, glucose and lipid metabolism disorder, and hypoxia. KEY MESSAGES Renal injury by SARS-CoV-2 is the result of multiple factors. Via highly expressed ACE2 in renal tissue, SARS-CoV-2 infection fundamentally initiates a mechanism of renal injury. Systemic effects such as host immune clearance and immune tolerance disorders, endothelial cell injury, thrombus formation, glucose and lipid metabolism disorder, and hypoxia aggravate this renal injury.
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Affiliation(s)
- Mo Wang
- Department of Nephrology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Huaying Xiong
- Department of Nephrology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Han Chen
- Department of Nephrology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qiu Li
- Department of Nephrology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiong Zhong Ruan
- Centre for Lipid Research and Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
- Moorhead Research Laboratory, Department of Renal Medicine, University College London, London, United Kingdom
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21
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Casanova AG, Prieto M, Colino CI, Gutiérrez-Millán C, Ruszkowska-Ciastek B, de Paz E, Martín Á, Morales AI, López-Hernández FJ. A Micellar Formulation of Quercetin Prevents Cisplatin Nephrotoxicity. Int J Mol Sci 2021; 22:E729. [PMID: 33450917 PMCID: PMC7828436 DOI: 10.3390/ijms22020729] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/18/2022] Open
Abstract
The antioxidant flavonoid quercetin has been shown to prevent nephrotoxicity in animal models and in a clinical study and is thus a very promising prophylactic candidate under development. Quercetin solubility is very low, which handicaps clinical application. The aim of this work was to study, in rats, the bioavailability and nephroprotective efficacy of a micellar formulation of Pluronic F127-encapsulated quercetin (P-quercetin), with improved hydrosolubility. Intraperitoneal administration of P-quercetin leads to an increased plasma concentration and bioavailability of quercetin compared to the equimolar administration of natural quercetin. Moreover, P-quercetin retains overall nephroprotective properties, and even slightly improves some renal function parameters, when compared to natural quercetin. Specifically, P-quercetin reduced the increment in plasma creatinine (from 3.4 ± 0.5 to 1.2 ± 0.3 mg/dL) and urea (from 490.9 ± 43.8 to 184.1 ± 50.1 mg/dL) and the decrease in creatinine clearance (from 0.08 ± 0.02 to 0.58 ± 0.19 mL/min) induced by the nephrotoxic chemotherapeutic drug cisplatin, and it ameliorated histological evidence of tubular damage. This new formulation with enhanced kinetic and biopharmaceutical properties will allow for further exploration of quercetin as a candidate nephroprotector at lower dosages and by administration routes oriented towards its clinical use.
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Affiliation(s)
- Alfredo G. Casanova
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (A.G.C.); (M.P.); (C.I.C.); (C.G.-M.)
- Department of Physiology and Pharmacology, University of Salamanca, 37007 Salamanca, Spain
- Toxicology Unit, University of Salamanca, 37007 Salamanca, Spain
| | - Marta Prieto
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (A.G.C.); (M.P.); (C.I.C.); (C.G.-M.)
- Department of Physiology and Pharmacology, University of Salamanca, 37007 Salamanca, Spain
- Toxicology Unit, University of Salamanca, 37007 Salamanca, Spain
| | - Clara I. Colino
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (A.G.C.); (M.P.); (C.I.C.); (C.G.-M.)
- Area of Pharmacy and Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Salamanca, 37007 Salamanca, Spain
| | - Carmen Gutiérrez-Millán
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (A.G.C.); (M.P.); (C.I.C.); (C.G.-M.)
- Area of Pharmacy and Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Salamanca, 37007 Salamanca, Spain
| | - Barbara Ruszkowska-Ciastek
- Department of Pathophysiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-796 Bydgoszcz, Poland;
| | - Esther de Paz
- High Pressure Processes Group, BioEcoUVa, Bioeconomy Research Institute, Department of Chemical Engineering and Environmental Technology, University of Valladolid, 47011 Valladolid, Spain; (E.d.P.); (Á.M.)
| | - Ángel Martín
- High Pressure Processes Group, BioEcoUVa, Bioeconomy Research Institute, Department of Chemical Engineering and Environmental Technology, University of Valladolid, 47011 Valladolid, Spain; (E.d.P.); (Á.M.)
| | - Ana I. Morales
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (A.G.C.); (M.P.); (C.I.C.); (C.G.-M.)
- Department of Physiology and Pharmacology, University of Salamanca, 37007 Salamanca, Spain
- Toxicology Unit, University of Salamanca, 37007 Salamanca, Spain
| | - Francisco J. López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (A.G.C.); (M.P.); (C.I.C.); (C.G.-M.)
- Department of Physiology and Pharmacology, University of Salamanca, 37007 Salamanca, Spain
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[Clinical analysis of early damage in multiple extra-pulmonary organs in COVID-19]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1518-1524. [PMID: 33118517 PMCID: PMC7606245 DOI: 10.12122/j.issn.1673-4254.2020.10.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To analyze the clinical manifestations of heart, liver and kidney damages in the early stage of COVID-19 to identify the indicators for these damages. METHODS We analyzed the clinical features, underlying diseases, and indicators of infection in 12 patients with COVID-19 on the second day after their admission to our hospital between January 20 and February 20, 2020.The data including CK-MB, aTnI, BNP, heart rate, changes in ECG, LVEF (%), left ventricular general longitudinal strain (GLS, measured by color Doppler ultrasound) were collected.The changes of liver function biochemical indicators were dynamically reviewed.BUN, UCR, eGFR, Ccr, and UACR and the levels of MA, A1M, IGU, and TRU were recorded. RESULTS The 12 patients included 2 severe cases, 8 common type cases, and 2 mild cases.Four of the patients presented with sinus tachycardia, ECG changes and abnormal GLS in spite of normal aTNI and LVEF; 1 patient had abnormal CKMB and BNP.On the first and third days following admission, the patients had normal ALT, AST and GGT levels.On day 7, hepatic function damage occurred in the severe cases, manifested by elevated ALT and AST levels.Abnormalities of eGFR, Ccr and UACR occurred in 8, 5 and 5 of the patients, respectively.Abnormal elevations of MA, A1M, IGU and TRU in urine protein were observed in 4, 4, 5, and 2 of the patients, respectively. CONCLUSIONS In patients with COVID-19, heart damage can be identified early by observing the GLS and new abnormalities on ECG in spite of normal aTNI and LVEF.Early liver injury is not obvious in these patients, but dynamic monitoring of the indicators of should be emplemented, especially in severe cases. In cases with normal CR and BUN, kidney damage can be detected early by calculating eGFR, Ccr and UACR and urine protein tests.
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