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Blanco-Gozalo V, Quiros Y, Vicente-Vicente L, Casanova AG, Sancho-Martínez SM, López-Hernández FJ. Urinary GM2AP coincides with renal cortical damage and grades cisplatin nephrotoxicity severity in rats. Toxicology 2024; 508:153919. [PMID: 39137829 DOI: 10.1016/j.tox.2024.153919] [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: 06/20/2024] [Revised: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 08/15/2024]
Abstract
Nephrotoxicity, including electrolytic disorders and acute kidney injury (AKI), limits the clinical dosage and utility of platinated antineoplastics such as cisplatin. Cisplatin nephrotoxicity embodies a tubulopathy involving the medullary S2 and S3 segments of the proximal and the distal tubules. Higher dosage extends damage over the cortical S1 segment and intensifies overall injury. However, the standard diagnosis based on plasma creatinine as well as novel injury biomarkers lacks enough pathophysiological specificity. Further granularity in the detection of renal injury would help understand the implications of individual damage patterns needed for personalized patient handling. In this article, we studied the association of urinary ganglioside GM2 activator protein (GM2AP) with the patterns of tubular damage produced by 5 and 10 mg/kg cisplatin in rats. Our results show that GM2AP appears in the urine only following damage to the cortical segment of the proximal tubule. The information provided by GM2AP is not redundant with but distinct and complementary to that provided by urinary neutrophil gelatinase-associated lipocalin (NGAL). Similarly, treatment with 150 mg/kg/day gentamicin damages the renal cortex and increases GM2AP urinary excretion; whereas renal ischemia, which does not affect the cortex, has no effect on GM2AP. Because of the key role of the cortical proximal tubule in renal function, we contend GM2AP as a potential diagnostic biomarker to stratify AKI patients according to the underlying damage and follow their evolution and prognosis. Prospectively, urinary GM2AP may help grade the severity of platinated antineoplastic nephrotoxicity by forming part of a non-invasive liquid biopsy.
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Affiliation(s)
- Víctor Blanco-Gozalo
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain; Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Yaremi Quiros
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain; Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, Salamanca, Spain; Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Laura Vicente-Vicente
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain; Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, 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
| | - Alfredo G Casanova
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain; Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, 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
| | - Sandra M Sancho-Martínez
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain; Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, 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
- Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain; Universidad de Salamanca (USAL), Departamento de Fisiología y Farmacología, 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.
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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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3
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Scurt FG, Bose K, Mertens PR, Chatzikyrkou C, Herzog C. Cardiac Surgery-Associated Acute Kidney Injury. KIDNEY360 2024; 5:909-926. [PMID: 38689404 PMCID: PMC11219121 DOI: 10.34067/kid.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
AKI is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (cardiac surgery-associated AKI [CSA-AKI]) on the basis of changes in serum creatinine and/or urine output. There are various preoperative, intraoperative, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence, and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio, other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention, and treatment management.
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Affiliation(s)
- Florian G. Scurt
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katrin Bose
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christos Chatzikyrkou
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Carolin Herzog
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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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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5
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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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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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Hernández FJL. The furosemide stress test: Perspectives for acute kidney injury diagnosis. J Bras Nefrol 2021; 43:452-454. [PMID: 34747433 PMCID: PMC8940107 DOI: 10.1590/2175-8239-jbn-2021-e010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Francisco J López Hernández
- Instituto de Investigación Biomédica de Salamanca, Grupo de Investigación Traslacional en Enfermedades Renales y Cardiovasculares, Salamanca, España.,Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, Soria, España.,Universidad de Salamanca, Departamento de Fisiología y Farmacología, Salamanca, España.,Instituto de Salud Carlos III, National Network for Kidney Research REDINREN, RD016/0009/0025, Madrid, Spain.,Grupo de investigación en Biomedicina en Cuidados Críticos, Valladolid, España
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8
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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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Regression Modeling of the Antioxidant-to-Nephroprotective Relation Shows the Pivotal Role of Oxidative Stress in Cisplatin Nephrotoxicity. Antioxidants (Basel) 2021; 10:antiox10091355. [PMID: 34572987 PMCID: PMC8464812 DOI: 10.3390/antiox10091355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
The clinical utility of the chemotherapeutic drug cisplatin is significantly limited by its nephrotoxicity, which is characterized by electrolytic disorders, glomerular filtration rate decline, and azotemia. These alterations are consequences of a primary tubulopathy causing injury to proximal and distal epithelial cells, and thus tubular dysfunction. Oxidative stress plays a role in cisplatin nephrotoxicity and cytotoxicity, but its relative contribution to overall toxicity remains unknown. We studied the relation between the degree of oxidative reduction (provided by antioxidant treatment) and the extent of nephrotoxicity amelioration (i.e., nephroprotection) by means of a regression analysis of studies in animal models. Our results indicate that a linear relation exists between these two parameters, and that this relation very nearly crosses the value of maximal nephroprotection at maximal antioxidant effect, suggesting that oxidative stress seems to be a pivotal and mandatory mechanism of cisplatin nephrotoxicity, and, hence, an interesting, rationale-based target for clinical use. Our model also serves to identify antioxidants with enhanced effectiveness by comparing their actual nephroprotective power with that predicted by their antioxidant effect. Among those, this study identified nanoceria, erythropoietin, and maltol as highly effective candidates affording more nephroprotection than expected from their antioxidant effect for prospective clinical development.
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