1
|
Tubular Mitochondrial Dysfunction, Oxidative Stress, and Progression of Chronic Kidney Disease. Antioxidants (Basel) 2022; 11:antiox11071356. [PMID: 35883847 PMCID: PMC9311633 DOI: 10.3390/antiox11071356] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 12/23/2022] Open
Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) are interconnected conditions, and CKD is projected to become the fifth leading global cause of death by 2040. New therapeutic approaches are needed. Mitochondrial dysfunction and oxidative stress have emerged as drivers of kidney injury in acute and chronic settings, promoting the AKI-to-CKD transition. In this work, we review the role of mitochondrial dysfunction and oxidative stress in AKI and CKD progression and discuss novel therapeutic approaches. Specifically, evidence for mitochondrial dysfunction in diverse models of AKI (nephrotoxicity, cytokine storm, and ischemia-reperfusion injury) and CKD (diabetic kidney disease, glomerulopathies) is discussed; the clinical implications of novel information on the key role of mitochondria-related transcriptional regulators peroxisome proliferator-activated receptor gamma coactivator 1-alpha, transcription factor EB (PGC-1α, TFEB), and carnitine palmitoyl-transferase 1A (CPT1A) in kidney disease are addressed; the current status of the clinical development of therapeutic approaches targeting mitochondria are updated; and barriers to the clinical development of mitochondria-targeted interventions are discussed, including the lack of clinical diagnostic tests that allow us to categorize the baseline renal mitochondrial dysfunction/mitochondrial oxidative stress and to monitor its response to therapeutic intervention. Finally, key milestones for further research are proposed.
Collapse
|
2
|
Paes-Leme FDO, Souza EM, Paes PRO, Gomes MG, Muniz FS, Campos MTG, Peixoto RB, Vaz de Melo PD, Arndt MHL, Costa Val A. Cystatin C and Iris: Advances in the Evaluation of Kidney Function in Critically Ill Dog. Front Vet Sci 2021; 8:721845. [PMID: 34820434 PMCID: PMC8606825 DOI: 10.3389/fvets.2021.721845] [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] [Received: 06/07/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Critically ill hospitalized dogs are subject to certain complications, being acute kidney injury (AKI) a common one. Early diagnosis is crucial, and Cystatin C (CysC) is a reliable and early biomarker. The International Society of Renal Interest (IRIS) states that AKI severity can be assessed by mild changes in creatinine serum levels or reduction of urine output that cannot be considered biomarkers of renal injury but failure or insufficiency. Twenty-eight dogs admitted to the Intensive Care Unit under risk factors for the development of AKI were evaluated. Blood samples were collected for determination of sCr and CysC at admission and after 24, 48, and 72 h. Urine output was measured by daily monitoring, measured by collection in a closed system. The results showed the incidence of AKI was 67.9% based on the IRIS criteria and 78.6% based on cystatin C in critically ill patients' dogs. The measurement of serum cystatin C immediately on admission to the ICU was superior in the early identification of patients with AKI when compared to the IRIS classification and serum creatinine in critically ill dogs.
Collapse
Affiliation(s)
| | - Eliana M Souza
- Department of Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Maderleine Geisa Gomes
- Department of Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Santos Muniz
- Department of Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Barbosa Peixoto
- Department of Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Adriane Costa Val
- Department of Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
3
|
Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan. Crit Care Res Pract 2020; 2020:8753764. [PMID: 34703627 PMCID: PMC8542064 DOI: 10.1155/2020/8753764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality.
Collapse
|
4
|
Fontecha-Barriuso M, Martin-Sanchez D, Martinez-Moreno JM, Monsalve M, Ramos AM, Sanchez-Niño MD, Ruiz-Ortega M, Ortiz A, Sanz AB. The Role of PGC-1α and Mitochondrial Biogenesis in Kidney Diseases. Biomolecules 2020; 10:biom10020347. [PMID: 32102312 PMCID: PMC7072614 DOI: 10.3390/biom10020347] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is one of the fastest growing causes of death worldwide, emphasizing the need to develop novel therapeutic approaches. CKD predisposes to acute kidney injury (AKI) and AKI favors CKD progression. Mitochondrial derangements are common features of both AKI and CKD and mitochondria-targeting therapies are under study as nephroprotective agents. PGC-1α is a master regulator of mitochondrial biogenesis and an attractive therapeutic target. Low PGC-1α levels and decreased transcription of its gene targets have been observed in both preclinical AKI (nephrotoxic, endotoxemia, and ischemia-reperfusion) and in experimental and human CKD, most notably diabetic nephropathy. In mice, PGC-1α deficiency was associated with subclinical CKD and predisposition to AKI while PGC-1α overexpression in tubular cells protected from AKI of diverse causes. Several therapeutic strategies may increase kidney PGC-1α activity and have been successfully tested in animal models. These include AMP-activated protein kinase (AMPK) activators, phosphodiesterase (PDE) inhibitors, and anti-TWEAK antibodies. In conclusion, low PGC-1α activity appears to be a common feature of AKI and CKD and recent characterization of nephroprotective approaches that increase PGC-1α activity may pave the way for nephroprotective strategies potentially effective in both AKI and CKD.
Collapse
Affiliation(s)
- Miguel Fontecha-Barriuso
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
| | - Diego Martin-Sanchez
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
| | - Julio Manuel Martinez-Moreno
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
| | - Maria Monsalve
- Instituto de Investigaciones Biomédicas “Alberto Sols” (CSIC-UAM), 28029 Madrid, Spain;
| | - Adrian Mario Ramos
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
| | - Maria Dolores Sanchez-Niño
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
| | - Marta Ruiz-Ortega
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
- School of Medicine, UAM, 28029 Madrid, Spain
| | - Alberto Ortiz
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
- School of Medicine, UAM, 28029 Madrid, Spain
- IRSIN, 28040 Madrid, Spain
| | - Ana Belen Sanz
- Research Institute-Fundacion Jimenez Diaz, Autonoma University, 28040 Madrid, Spain; (M.F.-B.); (D.M.-S.); (J.M.M.-M.); (A.M.R.); (M.D.S.-N.); (M.R.-O.); (A.O.)
- REDINREN, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-91-550-48-00
| |
Collapse
|
5
|
|
6
|
Rodríguez García E, Pascual Santos J. ¿Cuándo iniciar diálisis en la insuficiencia renal aguda en pacientes críticos? Nefrologia 2017; 37:563-566. [DOI: 10.1016/j.nefro.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/24/2016] [Accepted: 12/10/2016] [Indexed: 10/18/2022] Open
|
7
|
Evaluation of acute kidney injury (AKI) with RIFLE, AKIN, CK, and KDIGO in critically ill trauma patients. Eur J Trauma Emerg Surg 2017; 44:597-605. [PMID: 28717983 DOI: 10.1007/s00068-017-0820-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of our study was to evaluate the effects of AKI development on mortality with four different classification systems (RIFLE, AKIN, CK, KDIGO) in critically ill trauma patients followed in the intensive care unit. METHODS A retrospective review of 2034 patients in our intensive care unit was conducted between July 2010 and August 2013. A total of 198 patients with primary trauma were included in the study to evaluate the development of AKI. RESULTS When the presence of AKI was investigated according to the four criteria (RIFLE, AKIN, CK, and KDIGO), the highest incidence of AKI was found according to the KDIGO classification (74.2%), followed by AKIN (72.2%), RIFLE (69.7%), and CK (59.1%). It was observed that more AKI developed according to KDIGO in patients with multiple trauma and thoracic trauma (p = 0.031, p = 0.029). Sixty-two (31%) of the 198 trauma patients monitored in the intensive care unit died; mortality was frequently found high in AKI stage 2 and 3 patients. According to the CK classification, there was a significant increase in mortality in patients with AKI on the first day (p = 0.045). AKI classifications by RIFLE, AKIN, CK, and KDIGO were independently associated with the risk of in-hospital death. CONCLUSION In this study, the presence of AKI was found to be an independent risk factor in the development of in-hospital mortality according to all classification systems (RIFLE, AKIN, CK, and KDIGO) in critically traumatic patients followed in ICU, and the compatibility between RIFLE, AKIN, and KDIGO was the highest among the classification systems.
Collapse
|
8
|
Martin-Sanchez D, Poveda J, Fontecha-Barriuso M, Ruiz-Andres O, Sanchez-Niño MD, Ruiz-Ortega M, Ortiz A, Sanz AB. Targeting of regulated necrosis in kidney disease. Nefrologia 2017. [PMID: 28647049 DOI: 10.1016/j.nefro.2017.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The term acute tubular necrosis was thought to represent a misnomer derived from morphological studies of human necropsies and necrosis was thought to represent an unregulated passive form of cell death which was not amenable to therapeutic manipulation. Recent advances have improved our understanding of cell death in acute kidney injury. First, apoptosis results in cell loss, but does not trigger an inflammatory response. However, clumsy attempts at interfering with apoptosis (e.g. certain caspase inhibitors) may trigger necrosis and, thus, inflammation-mediated kidney injury. Second, and most revolutionary, the concept of regulated necrosis emerged. Several modalities of regulated necrosis were described, such as necroptosis, ferroptosis, pyroptosis and mitochondria permeability transition regulated necrosis. Similar to apoptosis, regulated necrosis is modulated by specific molecules that behave as therapeutic targets. Contrary to apoptosis, regulated necrosis may be extremely pro-inflammatory and, importantly for kidney transplantation, immunogenic. Furthermore, regulated necrosis may trigger synchronized necrosis, in which all cells within a given tubule die in a synchronized manner. We now review the different modalities of regulated necrosis, the evidence for a role in diverse forms of kidney injury and the new opportunities for therapeutic intervention.
Collapse
Affiliation(s)
- Diego Martin-Sanchez
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - Jonay Poveda
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - Miguel Fontecha-Barriuso
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - Olga Ruiz-Andres
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - María Dolores Sanchez-Niño
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - Marta Ruiz-Ortega
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - Alberto Ortiz
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain
| | - Ana Belén Sanz
- Research Institute-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; IRSIN, Madrid, Spain; REDINREN, Madrid, Spain.
| |
Collapse
|