Evaluation of KIM-1 as an early biomarker of snakebite-induced AKI in mice

Inflammation and Oxidative Stress in Snakebite Envenomation: A Brief Descriptive Review and Clinical Implications

Snakebite envenoming is a pathological condition which may occur in response to the injection of venom. Snake venoms contain a complex mixture of biologically active molecules which are responsible for a broad spectrum of clinical manifestations, ranging from local tissue injuries to fatal complications. Snake venom administration commonly provokes local tissue injury often associated with systemic effects, including neurotoxic and cardiotoxic manifestations, bleeding, acute kidney injury, and rhabdomyolysis. An important spectrum of pathogenesis of snake envenomation is the generation of reactive oxygen species (ROS), which can directly provoke tissue damage and also potentiate the deleterious consequences of inflammation at the bite site. Snake venom components known to induce oxidative stress include phospholipases A₂, metalloproteinases, three-finger toxins, and L-amino acid oxidase. Clear evidence is mounting suggesting that inflammation and oxidative stress participate in the destructive effects of envenoming, including acute renal failure, tissue necrosis, and unusual susceptibility to bleed (hemorrhage), mostly due to hypocoagulability, neuro/cardio toxicity, and myonecrosis. Impaired regulation of oxidative stress may also set the stage for secondary/long-term complications of snakebite envenomation such as musculoskeletal disabilities. Some aspects of natural antioxidant therapeutic options are discussed in this review.

Snake bite associated with acute kidney injury

Acute kidney injury (AKI) is a well-known life-threatening systemic effect of snake envenomation which commonly happens secondary to snake bites from families of Viperidae and Elapidae. Enzymatic toxins in snake venom result in injuries to all kidney cell types including glomerular, tubulo-interstitial and kidney vasculature. Pathogenesis of kidney injury due to snake envenomation includes ischaemia secondary to decreased kidney blood flow caused by systemic bleeding and vascular leakage, proteolytic degradation of the glomerular basement membrane by snake venom metalloproteinases (SVMPs), deposition of microthrombi in the kidney microvasculature (thrombotic microangiopathy), direct cytotoxic action of venom, systemic myotoxicity (rhabdomyolysis) and accumulation of large amounts of myoglobin in kidney tubules. Clinical features of AKI include fatigue, loss of appetite, headache, nausea, vomiting, oliguria and anuria. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Early initiation of anti-snake venom and early diagnosis of AKI are always desirable. Biomarkers which will help in early prediction of AKI are being explored, and current studies suggest that urinary clusterin, urinary neutrophil gelatinase-associated lipocalin, and serum cystatin C may play an important clinical role in the future. Apart from fluid and electrolyte management, kidney support including early and prompt initiation of kidney replacement therapy when indicated forms the bedrock in managing snake bite-associated AKI. Long-term follow-up is important because of chances of progression towards CKD.

Correlation and Diagnostic Value of Serum Cys-C, RBP4, and NGAL with the Condition of Patients with Traumatic Acute Kidney Injury

There is a lack of targeted biomarkers that can diagnose Acute Kidney Injury (AKI) early and accurately, which leads to deterioration of renal function and even death in patients who do not receive timely and effective treatment. In recent years, an increasing number of studies have shown that AKI-related markers such as cystatin C (Cys-C) and retinol-binding protein (RBP) can be used for early diagnosis of AKI to a certain extent. A total of 262 subjects were included in this study, of which 132 patients with traumatic AKI were enrolled in one group and named as the AKI group; 130 healthy subjects were enrolled in another group and named as the healthy group. AKI patients with different conditions were classified into AKI phase I, II, and III according to the KDIGO AKI diagnostic criteria, with 45, 59, and 28 in each group. In this study, we examined and compared serum Cys-C, RBP4, and neutrophil gelatinase-associated lipid transport protein (NGAL) levels between the AKI and healthy groups and between patients with AKI of different conditions, and the correlation and diagnostic value of three serum markers with the condition of traumatic AKI patients were also analyzed. The results showed that serum Cys-C, RBP4, and NGAL were significantly higher in the AKI group compared with the healthy group (P < 0.05), and the mean concentrations of the three serum markers increased as the severity of the disease increased, while correlation analysis showed that all three serum markers were positively correlated with serum Scr levels (P < 0.001). Further ROC curve analysis was performed, and the diagnostic values of serum Cys C, RBP4, and NGAL alone and in combination for traumatic AKI were 0.769, 0.741, 0.771, and 0.905, respectively. In short, serum Cys C, RBP4, NGAL have important value for the assessment and diagnosis of traumatic AKI patients.

Value Analysis of Using Urinary Microalbumin in Artificial Intelligence Medical Institutions to Detect Early Renal Damage in Diabetes

As the scale and depth of artificial intelligence network models continue to increase, their accuracy in albumin recognition tasks has increased rapidly. However, today's small medical datasets are the main reason for the poor recognition of artificial intelligence techniques in this area. The sample size in this article is based on the data analysis and research on urine albumin detection of diabetes in the EI database. It is assumed that the observation group has at least 20 mg UAER difference from the control group, and the standard deviation of the UAER change from baseline to 12 weeks is 30 mg. Therefore, the sample size of the two groups is 77 cases. Assuming that the rate of loss to follow-up during the follow-up period is 20%, at least 92 patients are needed. The final enrollment in this study is 100 patients. Studies have shown that DR is used as an indicator to diagnose NDRD, and its OR value is as high as 28.198, indicating that non-DR can be used as an indicator to distinguish DN from NDRD. The meta-analysis found that DR has a sensitivity of 0.65 and a specificity of 0.75 in distinguishing DN from NDRD in patients with type 2 diabetes, and it is emphasized that PDR is highly specific in the diagnosis of DN. Using a meta-analysis to systematically analyze 45 studies, it was found that the sensitivity of DR to diagnose DN was 0.67, the specificity was 0.78, and the specificity of PDR to predict DN was 0.99, indicating that DR is a good indicator for predicting DN, and the team's latest research has also verified this point of view. They have established a new model for diagnosing DN. In addition to including traditional proteinuria, glycosylated hemoglobin, FR, blood pressure, and other indicators into the diagnostic model, it will also include the presence or absence of DR. The final external verification accuracy rate of this model is 0.875.

Bothrops alternatus Snake Venom Induces Cytokine Expression and Oxidative Stress on Renal Function

BACKGROUND

Envenomation caused by Bothrops alternatus is common in Southern Brazil. Acute Kidney Injury occurs after Bothrops snakebite and more information is necessaryrequired to understand its mechanism.

OBJECTIVE

The objective was to evaluate the effect of Bothrops alternatus venom (BaV) on renal cells and rat isolated kidney function.

METHODS

Wistar rats (n = 6, weighing 260-320 g) were perfused with a Krebs-Henseleit solution containing 6 g 100 mL-1 of bovine serum albumin. After 30 minutes, the kidneys were perfused with BaV to a final concentration of 1 and 3 μgmL-1; and subsequently were evaluated for Perfusion Pressure (PP), Renal Vascular Resistance (RVR), Urinary Flow (UF), Glomerular Filtration Rate (GFR), and percentage of electrolyte tubular transport. Renal histological analysis, cytokine release, oxidative stress and cytotoxicity in renal proximal tubular cells were assessed.

RESULTS

BaV reduced PP, RVR, GFR, UF, total and proximal sodium transport (%TNa+), and chloride (%TCl-) in the isolated kidney perfusion model. Histological analysis of perfused kidneys disclosed the presence of proteinaceous material in the glomeruli and renal tubules, vacuolar tubular epithelial cell degeneration, Bowman's capsule degeneration, swelling of glomerular epithelial cells, glomerular atrophy and degeneration, and the presence of intratubular protein. Cytokine release (TNF-α, IL-1β, IL-10) and oxidative stress were increased in the kidneys. The viability of LLC-MK2 cells (IC50: 221.3 μg/mL) was decreased by BaV and necrosis was involved in cell death.

CONCLUSION

These findings indicate that BaV modifies functional parameters in an isolated perfused kidney model and has cytotoxic effects on renal lineage cells.

Dexmedetomidine protects against lipopolysaccharide-induced early acute kidney injury by inhibiting the iNOS/NO signaling pathway in rats

Increasing evidence has demonstrated that dexmedetomidine (DEX) possesses multiple pharmacological actions. Herein, we explored the protective effect and potential molecular mechanism of DEX on lipopolysaccharide (LPS)-induced early acute kidney injury (AKI) from the perspective of antioxidant stress. We found that DEX (30 μg/kg, i.p.) ameliorated the renal dysfunction and histopathological damage (tubular necrosis, vacuolar degeneration, infiltration of inflammatory cells and cast formation) induced by LPS (10 mg/kg). DEX also attenuated renal oxidative stress remarkably in LPS-induced early AKI, as evidenced by reduction in production of reactive nitrogen species, decreasing malondialdehyde levels, as well as increasing superoxide dismutase activity and glutathione content. DEX prevented activator protein-1 translocation, inhibited phosphorylation of I-kappa B (IκB) and activation of nuclear factor kappa B (NF-κB) in LPS-induced early AKI, as assessed by real-time quantitative polymerase chain reaction and protein levels of c-Jun, c-Fos, IκB and NF-κB. Notably, DEX pretreatment had the same effect as intraperitoneal injection of an inhibitor of inducible nitric oxide synthase inhibitor (1400W; 15 mg/kg), and inhibited the activity of renal inducible nitric oxide synthase (iNOS) and decreased the expression of iNOS mRNA and NO production. However, the protective effect of DEX on LPS-induced early AKI was reversed by the alpha 2 adrenal receptor (α₂-AR) inhibitor atipamezole, whereas the imidazoline receptor inhibitor idazoxan did not. Taken together, DEX protects against LPS-induced early AKI in rats by inhibiting the iNOS/NO signaling pathway, mainly by acting on α₂-ARs instead of IRs.

Baseline Serum Cystatin C Is a Potential Predictor for Acute Kidney Injury in Patients with Acute Pancreatitis

Aims

The study is aimed at studying the incidence of acute kidney injury (AKI) and exploring the potential predictor for AKI in patients with acute pancreatitis.

Methods

A retrospective study adopting a stratified cohort sampling design was performed in a cohort of patients (n = 237) diagnosed with acute pancreatitis without any renal injury. The following information including age, gender, serum creatinine, serum urea nitrogen, serum uric acid, serum cystatin C, fasting serum glucose, serum amylase, serum lipase, serum choline esterase, total protein, albumin, globulin, total bilirubin, direct bilirubin, total bile acids, glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase, gamma glutamyl transpeptidase, and alkaline phosphatase were collected from each patient when they were diagnosed with acute pancreatitis. Student t-test was conducted to figure out the difference between patients with and without AKI. Univariate and multivariate logistic regression analyses were used for investigating the predictors for AKI in patients with acute pancreatitis.

Results

18 (7.6%) patients in total had developed AKI among the study group. Compared with patients without AKI (1.01 ± 0.26 mg/L), the level of baseline serum cystatin C (CYS-C) was significantly higher in patients with AKI (3.64 ± 2.17 mg/L, P < 0.001). Baseline serum CYS-C (OR = 203.594, P < 0.001) was the independent and significant predictor for AKI in patients with acute pancreatitis. AKI in patients with acute pancreatitis could be identified with a sensitivity of 88.9% at specificity of 100% (AUC = 0.948, 95% CI 0.879–1.000) by baseline serum CYS-C (cut-off value = 1.865 mg/L).

Conclusions

Baseline serum CYS-C shall be adopted to predict the potential risk of AKI in patients with acute pancreatitis.

Venomous Arachnid Diagnostic Assays, Lessons from Past Attempts

Diagnostic tests for arachnid accidents remain unavailable for patients and clinicians. Together with snakes, these accidents are still a global medical concern, and are recognized as neglected tropical issues. Due to arachnid toxins’ fast mechanism of action, quick detection and quantification of venom is required to accelerate treatment decisions, rationalize therapy, and reduce costs and patient risks. This review aims to understand the current limitations for arachnid venom identification and quantification in biological samples. We benchmarked the already existing initiatives regarding test requirements (sample or biomarkers of choice), performances (time, detection limit, sensitivity and specificity) and their validation (on animal models or on samples from envenomed humans). Our analysis outlines unmet needs for improving diagnosis and consequently treatment of arachnid accidents. Hence, based on lessons from past attempts, we propose a road map for raising best practice guidelines, leading to recommendations for future progress in the development of arachnid diagnostic assays.