1
|
Möckel T, Boegel S, Schwarting A. Transcriptome analysis of renal ischemia/reperfusion (I/R) injury in BAFF and BAFF-R deficient mice. PLoS One 2023; 18:e0291619. [PMID: 37751458 PMCID: PMC10522044 DOI: 10.1371/journal.pone.0291619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/02/2023] [Indexed: 09/28/2023] Open
Abstract
Acute kidney injury (AKI) accompanies with high morbidity and mortality. Incomplete renal recovery can lead to chronic and finally end-stage kidney disease, which results in the requirement of lifelong dialysis or kidney transplantation. Consequently, finding predictive biomarker and therefore developing preventive therapeutic approaches is an urgent need. For this purpose, a better understanding of the mechanism underlying AKI is necessary. The cytokine BAFF (B cell activating factor) is related to AKI by supporting B cells, which in turn play an important role in inflammatory processes and the production of antibodies. In our study, we investigated the role of BAFF and its receptor BAFF-R in the early phase of AKI. Therefore, we performed the well-established ischemia/reperfusion (I/R) model in BAFF (B6.129S2-Tnfsf13btm1Msc/J) and BAFF-R (B6(Cg)-Tnfrsf13ctm1Mass/J) deficient mice. Transcriptome of ischemic and contralateral control kidneys was analyzed and compared to wildtype littermates. We detected the upregulation of Lcn2, Lyz2, Cd44, Fn1 and Il1rn in ischemic kidneys as well as the downregulation of Kl. Furthermore, we revealed different expression patterns in BAFF and BAFF-R knockout mice. Compared to wildtype littermates, up- and downregulation of each investigated gene were higher in BAFF-R knockout and lower in BAFF knockout. Our findings indicate a positive impact of BAFF knockout in early phase of AKI, while BAFF-R knockout seems to worsen I/R injury. In addition, our study shows for the first time a remarkable renal upregulation of Lyz2 in a murine I/R model. Therefore, we consider Lyz2 as conceivable predictive or early biomarker in case of I/R and AKI.
Collapse
Affiliation(s)
- Tamara Möckel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Boegel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Schwarting
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Rheumatic Disease Rhineland-Palatinate GmbH, Bad Kreuznach, Germany
| |
Collapse
|
2
|
Groves AM, Johnston CJ, Beutner GG, Dahlstrom JE, Koina M, O'Reilly MA, Porter G, Brophy PD, Kent AL. Neonatal hypoxic ischemic encephalopathy increases acute kidney injury urinary biomarkers in a rat model. Physiol Rep 2022; 10:e15533. [PMID: 36541220 PMCID: PMC9768655 DOI: 10.14814/phy2.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
Hypoxic ischemic encephalopathy (HIE) is associated with acute kidney injury (AKI) in neonates with birth asphyxia. This study aimed to utilize urinary biomarkers to characterize AKI in an established neonatal rat model of HIE. Day 7 Sprague-Dawley rat pups underwent HIE using the Rice-Vannucci model (unilateral carotid ligation followed by 120 mins of 8% oxygen). Controls included no surgery and sham surgery. Weights and urine for biomarkers (NGAL, osteopontin, KIM-1, albumin) were collected the day prior, daily for 3 days post-intervention, and at sacrifice day 14. Kidneys and brains were processed for histology. HIE pups displayed histological evidence of kidney injury including damage to the proximal tubules, consistent with resolving acute tubular necrosis, and had significantly elevated urinary levels of NGAL and albumin compared to sham or controls 1-day post-insult that elevated for 3 days. KIM-1 significantly increased for 2 days post-HIE. HIE did not significantly alter osteopontin levels. Seven days post-start of experiment, controls were 81.2% above starting weight compared to 52.1% in HIE pups. NGAL and albumin levels inversely correlated with body weight following HIE injury. The AKI produced by the Rice-Vannucci HIE model is detectable by urinary biomarkers, which can be used for future studies of treatments to reduce kidney injury.
Collapse
Affiliation(s)
- Angela M. Groves
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
- Department of Radiation OncologyUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Carl J. Johnston
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Gisela G. Beutner
- Division of CardiologyUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Jane E. Dahlstrom
- Department of Anatomical Pathology, ACT PathologyCanberra Health ServicesCanberraAustralia
- College of Health and MedicineAustralian National UniversityCanberraAustralia
| | - Mark Koina
- Department of Anatomical Pathology, ACT PathologyCanberra Health ServicesCanberraAustralia
- College of Health and MedicineAustralian National UniversityCanberraAustralia
| | - Michael A. O'Reilly
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - George Porter
- Division of CardiologyUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Patrick D. Brophy
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
- Division of Nephrology, University of Rochester School of Medicine and DentistryGolisano Children's Hospital at University of Rochester Medical CenterNew YorkRochesterUSA
| | - Alison L. Kent
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
- College of Health and MedicineAustralian National UniversityCanberraAustralia
| |
Collapse
|
3
|
Oudmaijer CAJ, Minnee RC, Pol RA, van den Boogaard WMC, Komninos DSJ, van de Wetering J, van Heugten MH, Hoorn EJ, Sanders JSF, Hoeijmakers JHJ, Vermeij WP, IJzermans JNM. Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial. Trials 2022; 23:18. [PMID: 34991694 PMCID: PMC8733810 DOI: 10.1186/s13063-021-05950-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the main effectors on the quality of life of living-kidney donors is postoperative fatigue. Caloric restriction (CR) and short-term fasting (STF) are associated with improved fitness and increased resistance to acute stress. CR/STF increases the expression of cytoprotective genes, increases immunomodulation via increased anti-inflammatory cytokine production, and decreases the expression of pro-inflammatory markers. As such, nutritional preconditioning by CR or STF represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and postoperative fatigue. To investigate whether preoperative STF contributes to a reduction in fatigue after living-kidney donation, a randomized clinical trial is indicated. METHODS We aim to determine whether 2.5 days of fasting reduces postoperative fatigue score in subjects undergoing living-kidney donation. In this randomized study, the intervention group will follow a preoperative fasting regime for 2.5 days with a low-dose laxative, while the control group will receive standard care. The main study endpoint is postoperative fatigue, 4 weeks after living-kidney donation. Secondary endpoints include the effect of preoperative fasting on postoperative hospital admission time, the feasibility of STF, and the postoperative recovery of donor and recipient kidney function. This study will provide us with knowledge of the feasibility of STF and confirm its effect on postoperative recovery. DISCUSSION Our study will provide clinically relevant information on the merits of caloric restriction for living-kidney donors and recipients. We expect to reduce the postoperative fatigue in living-kidney donors and improve the postoperative recovery of living-kidney recipients. It will provide evidence on the clinical merits and potential caveats of preoperative dietary interventions. TRIAL REGISTRATION Netherlands Trial Register NL9262 . EudraCT 2020-005445-16 . MEC Erasmus MC MEC-2020-0778. CCMO NL74623.078.21.
Collapse
Affiliation(s)
- C. A. J. Oudmaijer
- Erasmus MC Transplant Institute, Department of Surgery, Division of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, RG-220, 3015 GD Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - R. C. Minnee
- Erasmus MC Transplant Institute, Department of Surgery, Division of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, RG-220, 3015 GD Rotterdam, the Netherlands
| | - R. A. Pol
- Department of Transplantation Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - W. M. C. van den Boogaard
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - D. S. J. Komninos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - J. van de Wetering
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M. H. van Heugten
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E. J. Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J. S. F. Sanders
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Groningen, Groningen, the Netherlands
| | - J. H. J. Hoeijmakers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
- Erasmus MC Cancer Institute, Department of Molecular Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
- Institute for Genome Stability in Ageing and Disease, Medical Faculty, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases (CECAD), Centre for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - W. P. Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - J. N. M. IJzermans
- Erasmus MC Transplant Institute, Department of Surgery, Division of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, RG-220, 3015 GD Rotterdam, the Netherlands
| |
Collapse
|
4
|
Moreno JCA, Bahmad HF, Febres-Aldana CA, Pirela A, Azuero A, Salami A, Poppiti R. Post-mortem assessment of vimentin expression as a biomarker for renal tubular regeneration following acute kidney injury. J Pathol Transl Med 2021; 55:369-379. [PMID: 34638220 PMCID: PMC8601956 DOI: 10.4132/jptm.2021.08.03] [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: 04/20/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common cause of morbidity and mortality. It mainly targets the renal tubular epithelium with pathological changes, referred to as acute tubular injury. The latter is followed by a regenerative response that is difficult to visualize on routine hematoxylin and eosin (H&E) stains. In this study, we examined the regenerative capacity of renal tubules by correlating vimentin (VIM) immunohistochemical (IHC) expression and pathological findings of AKI and renal tubular regeneration (RTR) on H&E. METHODS We reviewed 23 autopsies performed in the clinical setting of AKI and RTR. VIM expression was scored in the renal cortical tubular epithelium using a statistical cutoff ≥ 3% for high expression and < 3% for low expression. RESULTS Of the 23 kidney tissues examined, seven (30.4%) had low VIM expression, and 16 (69.6%) had high VIM expression. Kidney tissues with evidence of AKI and RTR had significantly higher VIM expression. Renal peritubular microenvironment features showing regenerative changes on H&E were associated with high VIM expression. In the univariate model, kidney tissues with RTR were 18-fold more likely to have high VIM expression. CONCLUSIONS In conclusion, our findings suggest that VIM could serve as an IHC marker for RTR following AKI. However, correlation with H&E findings remains critical to excluding chronic tubular damage. Collectively, our preliminary results pave the way for future studies including a larger sample size to validate the use of VIM as a reliable biomarker for RTR.
Collapse
Affiliation(s)
- Juan Carlos Alvarez Moreno
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Hisham F Bahmad
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christopher A Febres-Aldana
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Andrés Pirela
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Andres Azuero
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ali Salami
- Department of Mathematics, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Robert Poppiti
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| |
Collapse
|
5
|
Effect of Geumgwe-Sinkihwan on Renal Dysfunction in Ischemia/Reperfusion-Induced Acute Renal Failure Mice. Nutrients 2021; 13:nu13113859. [PMID: 34836115 PMCID: PMC8618572 DOI: 10.3390/nu13113859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Renal ischemia-reperfusion (I/R) injury is an important cause of acute renal failure (ARF). Geumgwe-sinkihwan (GSH) was recorded in a traditional Chines medical book named “Bangyakhappyeon” in 1884. GSH has been used for treatment for patients with diabetes and glomerulonephritis caused by deficiency of kidney yang and insufficiency of kidney gi. Here we investigate the effects of GSH in mice model of ischemic acute kidney injury. The mice groups are as follows; sham group: C57BL6 male mice, I/R group: C57BL6 male mice with I/R surgery, GSH low group: I/R + 100 mg/kg/day GSH, and GSH high group: I/R + 300 mg/kg/day GSH. Ischemia was induced by clamping both renal arteries and reperfusion. Mice were orally given GSH (100 and 300 mg/kg/day) during 3 days after surgery. Treatment with GSH significantly ameliorated creatinine clearance, creatinine, and blood urea nitrogen levels. Treatment with GSH reduced neutrophil gelatinase associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1), specific renal injury markers. GSH also reduced the periodic acid–Schiff and picro sirius red staining intensity in kidney of I/R group. Western blot and real-time RT-qPCR analysis demonstrated that GSH decreased protein and mRNA expression levels of the inflammatory cytokines in I/R-induced ARF mice. Moreover, GSH inhibited protein and mRNA expression of inflammasome-related protein including NLRP3 (NOD-like receptor pyrin domain-containing protein 3, cryoprin), ASC (Apoptosis-associated speck-like protein containing a CARD), and caspase-1. These findings provided evidence that GSH ameliorates renal injury including metabolic dysfunction and inflammation via the inhibition of NLRP3-dependent inflammasome in I/R-induced ARF mice.
Collapse
|
6
|
Chatzeli L, Teshima THN, Hajihosseini MK, Gaete M, Proctor GB, Tucker AS. Comparing development and regeneration in the submandibular gland highlights distinct mechanisms. J Anat 2021; 238:1371-1385. [PMID: 33455001 PMCID: PMC8128775 DOI: 10.1111/joa.13387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
A common question in organ regeneration is the extent to which regeneration recapitulates embryonic development. To investigate this concept, we compared the expression of two highly interlinked and essential genes for salivary gland development, Sox9 and Fgf10, during submandibular gland development, homeostasis and regeneration. Salivary gland duct ligation/deligation model was used as a regenerative model. Fgf10 and Sox9 expression changed during regeneration compared to homeostasis, suggesting that these key developmental genes play important roles during regeneration, however, significantly both displayed different patterns of expression in the regenerating gland compared to the developing gland. Regenerating glands, which during homeostasis had very few weakly expressing Sox9-positive cells in the striated/granular ducts, displayed elevated expression of Sox9 within these ducts. This pattern is in contrast to embryonic development, where Sox9 expression was absent in the proximally developing ducts. However, similar to the elevated expression at the distal tip of the epithelium in developing salivary glands, regenerating glands displayed elevated expression in a subpopulation of acinar cells, which during homeostasis expressed Sox9 at lower levels. A shift in expression of Fgf10 was observed from a widespread mesenchymal pattern during organogenesis to a more limited and predominantly epithelial pattern during homeostasis in the adult. This restricted expression in epithelial cells was maintained during regeneration, with no clear upregulation in the surrounding mesenchyme, as might be expected if regeneration recapitulated development. As both Fgf10 and Sox9 were upregulated in proximal ducts during regeneration, this suggests that the positive regulation of Sox9 by Fgf10, essential during development, is partially reawakened during regeneration using this model. Together these data suggest that developmentally important genes play a key role in salivary gland regeneration but do not precisely mimic the roles observed during development.
Collapse
Affiliation(s)
- Lemonia Chatzeli
- Centre for Craniofacial and Regenerative BiologyKing's College LondonLondonUK
| | - Tathyane H. N. Teshima
- Centre for Craniofacial and Regenerative BiologyKing's College LondonLondonUK
- Department of Oral MedicineUCL Eastman Dental InstituteLondonUK
| | | | - Marcia Gaete
- Centre for Craniofacial and Regenerative BiologyKing's College LondonLondonUK
- Department of AnatomyFaculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Gordon B. Proctor
- Centre for Host‐Microbiome InteractionsKing's College of LondonLondonUK
| | - Abigail S. Tucker
- Centre for Craniofacial and Regenerative BiologyKing's College LondonLondonUK
| |
Collapse
|
7
|
Al-ghareebaw AM, Al-Okaily BN, Ibrahim OMS, Mohammed AD. Role of Olive leaves Zinc Oxide Nanoparticles in Alleviating The Molecular and Histological Changes of Kidney in Female Goats-Induced by Gentamicin (Part III). THE IRAQI JOURNAL OF VETERINARY MEDICINE 2020. [DOI: 10.30539/ijvm.v44i(e0).1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study aimed to investigate the protective influence of olive leave extract zinc oxide nanoparticles (OLEZnONPs) complex against gentamicin–induced kidney dysfunctions in goats. Twenty five adult female goats were randomly divided into five equal groups and treated as follows: control group (C) administered sterile distilled water (IM) for 10 days, group G administered 25 mg/kg BW gentamicin (IM) for 7 days, group Z administered 10 ìg/kg BW of OLEZnONPs (IP) for 3 days, group GTZ administered 25 mg/kg BW gentamicin (IM) for 7 days and then 10 ìg/kg BW of OLEZnONPs (IP) for 3 days, group GWZ administered 25 mg/kg BWs gentamicin (IM) and 10 ìg/kg BW of OLEZnONPs (IP) together for first 3 days and then followed by gentamicin only for 4 days. After seven days of the experiment, the gene expression of kidney injury molcule-1(KIM-1) and neutrophil gelatinase-association lipocalin (NGAL) gene expression of kidney tissue were measured. In addition, samples of kidney were obtained for histopathological examination. Gentamicin medication induced a marked elevation in kidney tissue KIM-1 and NGAL gene expression in G and GTZ groups compared to control and other groups. Intraperitoneal treatment of goats with OLEZnONPs did not significantly affect NGAL and KIM-1 gene expression in Z, GWZ, and control groups. Histologically, in contrast to control, gentamicin induced more extensive kidney damages such as necrotized glomeruli, atrophic glomeruli, and renal tubular epithelial necrosis, while it was found that these alterations in kidney tissues wereimproved in goats given OLEZnONPs with gentamicin compared to group G. In conclusion, our results demonstrate that OLEZnONPs reduce the deleterious effects of gentamicin with significantly decreasing of KIM-1 and NGAL gene expression and remodeling the histological changes of kidney in goats.
Collapse
|
8
|
McGalliard RJ, McWilliam SJ, Maguire S, Jones CA, Jennings RJ, Siner S, Newland P, Peak M, Chesters C, Jeffers G, Broughton C, McColl L, Lane S, Paulus S, Cunliffe NA, Baines P, Carrol ED. Identifying critically ill children at high risk of acute kidney injury and renal replacement therapy. PLoS One 2020; 15:e0240360. [PMID: 33119655 PMCID: PMC7595286 DOI: 10.1371/journal.pone.0240360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI), a common complication in paediatric intensive care units (PICU), is associated with increased morbidity and mortality. In this single centre, prospective, observational cohort study, neutrophil gelatinase-associated lipocalin in urine (uNGAL) and plasma (pNGAL) and renal angina index (RAI), and combinations of these markers, were assessed for their ability to predict severe (stage 2 or 3) AKI in children and young people admitted to PICU. In PICU children and young people had initial and serial uNGAL and pNGAL measurements, RAI calculation on day 1, and collection of clinical data, including serum creatinine measurements. Primary outcomes were severe AKI and renal replacement therapy (RRT). Secondary outcomes were length of stay, hospital acquired infection and mortality. The area under the Receiver Operating Characteristic (ROC) curves and Youden index was used to determine biomarker performance and identify optimum cut-off values. Of 657 children recruited, 104 met criteria for severe AKI (15∙8%) and 47 (7∙2%) required RRT. Severe AKI was associated with increased length of stay, hospital acquired infection, and mortality. The area under the curve (AUC) for severe AKI prediction for Day 1 uNGAL, Day 1 pNGAL and RAI were 0.75 (95% Confidence Interval [CI] 0∙69, 0∙81), 0∙64 (95% CI 0∙56, 0∙72), and 0.73 (95% CI 0∙65, 0∙80) respectively. The optimal combination of measures was RAI and day 1 uNGAL, giving an AUC of 0∙80 for severe AKI prediction (95% CI 0∙71, 0∙88). In this heterogenous PICU cohort, urine or plasma NGAL in isolation had poorer prediction accuracy for severe AKI than in previously reported homogeneous populations. However, when combined together with RAI, they produced good prediction for severe AKI.
Collapse
Affiliation(s)
- Rachel J. McGalliard
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen J. McWilliam
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Department of Women’s and Children’s Health, Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- MRC Centre for Drug Safety Science, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, First Floor Liverpool Science Park, Liverpool, United Kingdom
- * E-mail:
| | - Samuel Maguire
- Medical School, University of Liverpool, Liverpool, United Kingdom
| | - Caroline A. Jones
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Sarah Siner
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Paul Newland
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthew Peak
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Graham Jeffers
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Caroline Broughton
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Steven Lane
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephane Paulus
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nigel A. Cunliffe
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, First Floor Liverpool Science Park, Liverpool, United Kingdom
| | - Paul Baines
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Enitan D. Carrol
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, First Floor Liverpool Science Park, Liverpool, United Kingdom
| |
Collapse
|
9
|
Choi YH, Lee DH, Lee JH. The title: serum neutrophil Gelatinase-associated Lipocalin at 3 hours after return of spontaneous circulation in patients with cardiac arrest and therapeutic hypothermia: early predictor of acute kidney injury. BMC Nephrol 2020; 21:389. [PMID: 32894077 PMCID: PMC7487645 DOI: 10.1186/s12882-020-02054-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 03/20/2023] Open
Abstract
Background Serum neutrophil gelatinase-associated lipocalin (NGAL) could be used as a predictive marker of acute kidney injury (AKI) in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) who are managed with targeted temperature management (TTM). However, the NGAL measurement timepoints vary from immediately after ROSC to several days later. The primary objective of this study was to determine an association between AKI and NGAL, both immediately (ROSC-NGAL) and 3 h after ROSC (3 h-NGAL), in OHCA patients with TTM. The secondary objective was to ascertain the association between NGAL levels in the early post-ROSC phase and the neurologic outcomes at discharge. Methods This prospective observational study was conducted between January 2016 and December 2018 and enrolled adult OHCA patients (≥18 years) with TTM after ROSC. The serum NGAL level was measured both immediately and 3 h after ROSC. Univariate and multivariate analyses were performed to identify the associations between AKI, poor neurologic outcome, and NGAL. Results Among 861 OHCA patients, 89 patients were enrolled. AKI occurred in 48 (55.1%) patients. On multivariate logistic regression analysis, 3 h-NGAL was significantly associated with AKI (odds ratio [OR] 1.022; 95% confidence interval [CI] 1.009–1.035; p = 0.001). The area under the receiver operating characteristic curve of 3 h-NGAL for AKI was 0.910 (95% CI 0.830–0.960), and a cut-off value of 178 ng/mL was identified. Both ROSC-NGAL and 3 h-NGAL were not significantly associated with poor neurologic outcome on multivariate logistic regression analysis (ROSC-NGAL; OR 1.017; 95% CI 0.998–1.036; p = 0.084, 3 h-NGAL; OR 0.997; 95% CI 0.992–1.001; p = 0.113). Conclusions The serum NGAL concentration measured 3 h after ROSC is an excellent early predictive marker for AKI in OHCA patients treated with TTM. Future research is needed to identify the optimal measurement timepoint to establish NGAL as a predictor of neurologic outcome and to validate the findings of this research.
Collapse
Affiliation(s)
- Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Jae Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
| |
Collapse
|
10
|
Griffin BR, Gist KM, Faubel S. Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective. J Intensive Care Med 2020; 35:415-424. [PMID: 30654681 PMCID: PMC7333543 DOI: 10.1177/0885066618824531] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, and cost of care. Because of the high incidence and poor outcomes associated with AKI, there has been significant interest in the development of new therapies for the prevention and treatment of the disease. A lack of efficacy in drug trials led to the concern that AKI was not being diagnosed early enough for an effective intervention and that a rise in serum creatinine itself is not a sensitive-enough marker. Researchers have been searching for novel biomarkers that can not only assess a decline in kidney function but also demonstrate structural damage to the kidney and at time points earlier than increases in serum creatinine measurements allow. Over the past 10 years, there have been 3300 new publications and hundreds of new biomarkers investigated, yet concern still remains regarding AKI biomarker performance. The AKI biomarkers are yet to be widely utilized in clinical practice, leading some to question whether AKI biomarkers will ever reach their initial promise. However, we believe that biomarkers are an important part of current and future AKI research and clinical management. In this review, we compare the historical contexts of acute myocardial ischemia and AKI biomarker development to illustrate the progress that has been made within AKI biomarker research in a relatively short period of time and also to point out key differences between the disease processes that have been barriers to widespread AKI biomarker adoption. Finally, we discuss potential paths by which biomarkers can lead to appropriate AKI treatment responses that lower morbidity and mortality.
Collapse
Affiliation(s)
- Benjamin R. Griffin
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katja M. Gist
- Department of Pediatrics, The Heart Institute, University of Colorado, Aurora, CO, USA
| | - Sarah Faubel
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Renal Section, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| |
Collapse
|
11
|
Nezamoleslami S, Sheibani M, Jahanshahi F, Mumtaz F, Abbasi A, Dehpour AR. Protective effect of dapsone against renal ischemia-reperfusion injury in rat. Immunopharmacol Immunotoxicol 2020; 42:272-279. [PMID: 32321337 DOI: 10.1080/08923973.2020.1755308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Ischemia/reperfusion can cause injury to tissues and compromise functionality of organs due to inflammatory processes. Significantly, development of these effects in kidney tissue has been a challenging issue that leads to acute renal injury. In this study, anti-inflammatory, anti-oxidative, and protective features of dapsone on kidney ischemia/reperfusion injury were investigated.Material and methods: Renal ischemia was induced in rats by bilateral renal arteries clamping for 45 min followed by 24 h reperfusion phase. The effects of different doses of dapsone (1, 3, 10 mg/kg) on ischemia/reperfusion injury in kidney tissue were investigated by targeting BUN, Creatinine, LDH, MDA, MPO, IL-1β, TNF-α, and NFκB. In addition histopathological examination was performed by H&E staining method.Results and discussion: Comparing the findings of this study showed significant reduction in BUN and LDH in 10 mg/kg dapsone received groups, and Cr, MDA, and MPO in 3 mg/kg dapsone received groups. The serum level of TNF-α was significantly decreased with both doses of 3 and 10 mg/kg dapsone. The same results were observed in the serum level of IL-1β and NFκB. Besides, remarkable improvement in histological damages was also observed with dapsone treatment.Conclusion: These results support the hypothesis that the positive effects of dapsone on the renal ischemia/reperfusion injury are mediated by modulating inflammatory cascades.
Collapse
Affiliation(s)
- Sadaf Nezamoleslami
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sheibani
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jahanshahi
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faiza Mumtaz
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Abbasi
- Department of Pathology, Urmia University of Medical sciences (UMSU), Urmia, Iran
| | - Ahmad Reza Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Andrianova NV, Buyan MI, Zorova LD, Pevzner IB, Popkov VA, Babenko VA, Silachev DN, Plotnikov EY, Zorov DB. Kidney Cells Regeneration: Dedifferentiation of Tubular Epithelium, Resident Stem Cells and Possible Niches for Renal Progenitors. Int J Mol Sci 2019; 20:ijms20246326. [PMID: 31847447 PMCID: PMC6941132 DOI: 10.3390/ijms20246326] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022] Open
Abstract
A kidney is an organ with relatively low basal cellular regenerative potential. However, renal cells have a pronounced ability to proliferate after injury, which undermines that the kidney cells are able to regenerate under induced conditions. The majority of studies explain yielded regeneration either by the dedifferentiation of the mature tubular epithelium or by the presence of a resident pool of progenitor cells in the kidney tissue. Whether cells responsible for the regeneration of the kidney initially have progenitor properties or if they obtain a “progenitor phenotype” during dedifferentiation after an injury, still stays the open question. The major stumbling block in resolving the issue is the lack of specific methods for distinguishing between dedifferentiated cells and resident progenitor cells. Transgenic animals, single-cell transcriptomics, and other recent approaches could be powerful tools to solve this problem. This review examines the main mechanisms of kidney regeneration: dedifferentiation of epithelial cells and activation of progenitor cells with special attention to potential niches of kidney progenitor cells. We attempted to give a detailed description of the most controversial topics in this field and ways to resolve these issues.
Collapse
Affiliation(s)
- Nadezda V. Andrianova
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119992 Moscow, Russia
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Marina I. Buyan
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Ljubava D. Zorova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Irina B. Pevzner
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Vasily A. Popkov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Valentina A. Babenko
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Denis N. Silachev
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Egor Y. Plotnikov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
- Sechenov First Moscow State Medical University, Institute of Molecular Medicine, 119991 Moscow, Russia
- Correspondence: (E.Y.P.); (D.B.Z.); Tel.: +7-495-939-5944 (E.Y.P.)
| | - Dmitry B. Zorov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
- Correspondence: (E.Y.P.); (D.B.Z.); Tel.: +7-495-939-5944 (E.Y.P.)
| |
Collapse
|
13
|
Honda T, Manjourides J, Suh H. Daily ambient temperature is associated with biomarkers of kidney injury in older Americans. ENVIRONMENTAL RESEARCH 2019; 179:108790. [PMID: 31605868 PMCID: PMC6893879 DOI: 10.1016/j.envres.2019.108790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Increases in ambient temperature have recently been associated with increased emergency department visits and hospital admissions for acute renal failure. However, potential biological mechanisms through which short-term ambient temperature affects kidney function are not known. METHODS We used multiple regression models to evaluate the association between 1- and 3-day average, ambient temperature levels and two biomarkers of kidney injury (neutrophil gelatinase-associated lipocalin (NGAL) and adiponectin), among 3377 individuals over 57 years of age enrolled in the National Social Life, Health, and Aging Project. Ambient temperature was estimated on a 6-km grid covering the conterminous United States using ambient temperature measurements obtained from the National Climatic Data Center (NCDC). NGAL and adiponectin levels were measured from whole blood collected for each participant. All health effect models were adjusted for a number of demographics, socioeconomic, health behavior, medical history variables, with non-linear exposure-response relationships examined using natural cubic splines. RESULTS The relationship between 1- and 3-day average temperature and both NGAL and adiponectin levels was significant and non-linear, with largely null associations below 10 °C, and positive association for temperatures >10 °C. In fully adjusted, linear multiple regression models restricted to >10 °C, NGAL and adiponectin levels increased by 1.89% (95% CI: 0.77, 3.91) and 2.51% (95% CI: 1.34, 3.69), respectively, for a 1 °C increase in daily average temperature. Additionally, every 1 °C increase in temperature over 10 °C was associated with a 1.83% increased odds of having plasma NGAL levels consistent with acute kidney injury (>150 μg/L). CONCLUSIONS In a cohort of older men and women in the United States, our study is the first to observe that short-term ambient temperature exposures were significantly associated with biomarkers of kidney injury. These associations suggest that ambient temperature exposures could be an important risk factor for renal pathology.
Collapse
Affiliation(s)
- Trenton Honda
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, USA.
| | | | - Helen Suh
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| |
Collapse
|
14
|
Malyszko J, Bachorzewska-Gajewska H, Malyszko JS, Koc-Zorawska E, Matuszkiewicz-Rowinska J, Dobrzycki S. Hepcidin - Potential biomarker of contrast-induced acute kidney injury in patients undergoing percutaneous coronary interventions. Adv Med Sci 2019; 64:211-215. [PMID: 30818219 DOI: 10.1016/j.advms.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/10/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary interventions (PCI). In this study, we tested the hypothesis whether serum and urinary hepcidin could represent early biomarkers of CI-AKI in patients with normal serum creatinine undergoing PCI. In addition, we assessed serum and urinary neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, eGFR and serum creatinine in these patients. METHODS Serum and urinary hepcidin and NGAL, serum cystatin C, were evaluated before, and after 2, 4, 8, 24 and 48 h after PCI using commercially available kits. Serum creatinine was assessed before, 24 and 48 h after PCI. RESULTS We found a significant rise in serum hepcidin as early as after 4 and 8 h when compared to the baseline values. Serum NGAL increased after 2, 4 and 8 h, and in urinary NGAL after 4, 8 and 24 h after PCI. We found a significant fall in urinary hepcidin after 8 and 24 h after PCI. Serum cystatin C increased significantly 8 h after PCI, reaching peak 24 h after PCI and then decreased after 48 h. The prevalence of CI-AKI was 8%. Urine hepcidin was significantly lower 8 and 24 h after PCI in patients with CI-AKI, while serum and urine NGAL were significantly higher in patients with CI-AKI. CONCLUSIONS Our findings suggest that serum hepcidin might be an early predictive biomarker of ruling out CI-AKI after PCI, thereby contributing to early patient risk stratification. However, our data needs to be validated in large cohorts with various stages of CKD.
Collapse
|
15
|
Schlossbauer MH, Hubauer U, Stadler S, Hupf J, Sag S, Birner C, Zimmermann M, Orso E, Fischer M, Luchner A, Maier LS, Jungbauer CG. The role of the tubular biomarkers NAG, kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in patients with chest pain before contrast media exposition. Biomark Med 2019; 13:379-392. [PMID: 30920848 DOI: 10.2217/bmm-2018-0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: We evaluated the role of the tubular biomarkers N-acetyl-ß-D-glucosaminidase (NAG), kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with chest pain. Methods: Serum and urine samples were collected of 223 patients and 47 healthy controls. None of them was exposed to contrast media. Results: NAG showed among others significant correlation with N-terminal pro brain natriuretic peptide (NTproBNP), troponin I and creatinine. KIM-1 and NGAL showed weaker correlations. NAG was significantly elevated in all subgroups of acute coronary syndrome (ACS) compared with chest wall syndrome and controls. NAG was an independent predictor for the diagnosis of myocardial infarction. Conclusion: NAG may demonstrate the presence of acute tubular injury due to cardiac impairment already in the emergency department. NAG should be evaluated as marker of acute cardiorenal syndrome in patients with chest pain.
Collapse
Affiliation(s)
- Michael H Schlossbauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Julian Hupf
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Sabine Sag
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christoph Birner
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Interdisziplinäre Notaufnahme Universitätsklinikum Regensburg, Regensburg, Germany
| | - Evelyn Orso
- Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Marcus Fischer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lars S Maier
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| |
Collapse
|
16
|
Diagnostic Utility of Serum Neutrophil Gelatinase-Associated Lipocalin in Polytraumatized Patients Suffering Acute Kidney Injury: A Prospective Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2687584. [PMID: 30533430 PMCID: PMC6247699 DOI: 10.1155/2018/2687584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/27/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022]
Abstract
Introduction The incidence of acute kidney injury (AKI) considerably increases the mortality rate in polytrauma victims. Undoubtedly, early identification of patients at risk is crucial for timely implementation of preventive strategies in order to improve their prognosis. Therefore, we aimed to investigate if serum neutrophil gelatinase-associated lipocalin (sNGAL) may serve as a diagnostic biomarker of early AKI in polytrauma victims, especially considering patients needing renal replacement theory (RRT). Material and Methods Forty consecutive polytrauma victims (ISS ≥ 16, AISThorax ≥ 1, age ≥ 18 years, survival time ≥ 48 hours), directly admitted to our level I trauma center within one posttraumatic hour, were enrolled in our prospective study. sNGAL-levels were assessed at admission (initial) and on day 2 after trauma. AKI was diagnosed by an increase of serum creatinine (sCr) level of at least 0.3 mg/dl within 48 hours. Results Out of 30 men and 10 women (mean age, 43 years; mean ISS, 29), seven patients developed AKI, four of them needing RRT. AKI was diagnosed in 86% of the affected individuals until day 2. Day2-sNGAL-levels were higher in the AKI-group, compared to the no-AKI-group (p=0.049), and in patients treated with RRT than in individuals not needing RRT (p=0.037). Noteworthy, in patients not needing RRT sNGAL-levels significantly decreased from initial to day2-measurement (p=0.040). Furthermore, at any time point during our observation period polytraumatized patients with AKI and day2-sNGAL-levels of at least 181.0 ng/mL presented with higher sCr-levels compared to polytraumatized patients without AKI and day2-sNGAL-levels lower than 181.0 ng/mL (p≤0.029). Conclusion In polytrauma victims suffering AKI an increase in sNGAL-level from initial to day2-assessment may signalize deterioration in kidney function and thus indicate AKI progression. Unlike initial sNGAL-levels day2-sNGAL-levels might be an appropriate tool to define AKI and to signify the need of RRT in polytraumatized patients.
Collapse
|
17
|
Abstract
Aims: This study aimed to assess whether neutrophil gelatinase-associated lipocalin (NGAL) and fibroblast growth factor 23 (FGF23) could be reliable biomarkers for early diagnosis of contrast-induced nephropathy (CIN). Methods: 202 patients who underwent percutaneous coronary intervention (PCI) were included in the research. All subjects were divided into CIN group and non-CIN group. Serum NGAL and FGF23 were evaluated before and 0, 1, and 2 days after PCI. Serum levels of these two markers were compared intra-group and among groups. Receiver-operating characteristic (ROC) analysis and logistic regression models were conducted to assess the diagnostic performance of NGAL and FGF23 in detecting CIN. Results: When compared with baseline values, serum levels of both NGAL and FGF23 in all subjects increased after PCI, and the values peaked 1 day after PCI, but the changing was greater in CIN group. There were obvious differences between two groups in serum NGAL after 1, 2 days, and similar differences present in serum FGF23 after 1 day. ROC analysis showed that the area under the curve (AUC) of relative values (percent change from the baseline) in NGAL after 1 day was 0.899 (95% CI: 0.834–0.964, p = .000), the optimum cutoff was 49% (sensitivity = 80%, specificity = 92.4%). And the AUC in FGF23 was 0.814 (95% CI: 0.733–0.894, p = .000), the optimum cutoff was 20% (sensitivity = 73.3%, specificity = 87.6%). Both serum NGAL and serum FGF23 could improve the clinical models in identifying CIN. Conclusions: NGAL and FGF23 may have certain value in early diagnosis of CIN.
Collapse
Affiliation(s)
- Huihui Li
- a Department of Nephropathy , Xiangya Hospital Central-South University , Changsha , Hunan 410008 , China
| | - Zaixin Yu
- b Department of Cardiology , Xiangya Hospital Central-South University , Changsha , Hunan 410008 , China
| | - Lu Gan
- a Department of Nephropathy , Xiangya Hospital Central-South University , Changsha , Hunan 410008 , China
| | - Ling Peng
- a Department of Nephropathy , Xiangya Hospital Central-South University , Changsha , Hunan 410008 , China
| | - Qiaoling Zhou
- a Department of Nephropathy , Xiangya Hospital Central-South University , Changsha , Hunan 410008 , China
| |
Collapse
|
18
|
Gaião SM, Paiva JAODC. Biomarkers of renal recovery after acute kidney injury. Rev Bras Ter Intensiva 2018; 29:373-381. [PMID: 29044306 PMCID: PMC5632981 DOI: 10.5935/0103-507x.20170051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/28/2017] [Indexed: 01/21/2023] Open
Abstract
Novel biomarkers can be suitable for early acute kidney injury diagnosis and the
prediction of the need for dialysis. It remains unclear whether such biomarkers
may also play a role in the prediction of recovery after established acute
kidney injury or in aiding the decision of when to stop renal support therapy.
PubMed, Web of Science and Google Scholar were searched for studies that
reported on the epidemiology of renal recovery after acute kidney injury, the
risk factors of recovery versus non-recovery after acute kidney injury, and
potential biomarkers of acute kidney injury recovery. The reference lists of
these articles and relevant review articles were also reviewed. Final references
were selected for inclusion in the review based on their relevance. New
biomarkers exhibited a potential role in the early diagnosis of acute kidney
injury recovery. Urine HGF, IGFBP-7, TIMP-2 and NGAL may improve our ability to
predict the odds and timing of recovery and eventually renal support withdrawal.
Acute kidney injury recovery requires more study, and its definition needs to be
standardized to allow for better and more powerful research on biomarkers
because some of them show potential for the prediction of acute kidney injury
recovery.
Collapse
Affiliation(s)
- Sérgio Mina Gaião
- Department of Emergency and Intensive Care, Centro Hospitalar São João, Faculdade de Medicina, Universidade do Porto - Porto, Portugal.,Infection and Sepsis Group - Centro Hospitalar São João, Faculdade de Medicina, Universidade do Porto - Porto, Portugal
| | - José Artur Osório de Carvalho Paiva
- Department of Emergency and Intensive Care, Centro Hospitalar São João, Faculdade de Medicina, Universidade do Porto - Porto, Portugal.,Infection and Sepsis Group - Centro Hospitalar São João, Faculdade de Medicina, Universidade do Porto - Porto, Portugal
| |
Collapse
|
19
|
Moledina DG, Hall IE, Thiessen-Philbrook H, Reese PP, Weng FL, Schröppel B, Doshi MD, Wilson FP, Coca SG, Parikh CR. Performance of Serum Creatinine and Kidney Injury Biomarkers for Diagnosing Histologic Acute Tubular Injury. Am J Kidney Dis 2017; 70:807-816. [PMID: 28844586 DOI: 10.1053/j.ajkd.2017.06.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The diagnosis of acute kidney injury (AKI), which is currently defined as an increase in serum creatinine (Scr) concentration, provides little information on the condition's actual cause. To improve phenotyping of AKI, many urinary biomarkers of tubular injury are being investigated. Because AKI cases are not frequently biopsied, the diagnostic accuracy of concentrations of Scr and urinary biomarkers for histologic acute tubular injury is unknown. STUDY DESIGN Cross-sectional analysis from multicenter prospective cohort. SETTINGS & PARTICIPANTS Hospitalized deceased kidney donors on whom kidney biopsies were performed at the time of organ procurement for histologic evaluation. PREDICTORS (1) AKI diagnosed by change in Scr concentration during donor hospitalization and (2) concentrations of urinary biomarkers (neutrophil gelatinase-associated lipocalin [NGAL], liver-type fatty acid-binding protein [L-FABP], interleukin 18 [IL-18], and kidney injury molecule 1 [KIM-1]) measured at organ procurement. OUTCOME Histologic acute tubular injury. RESULTS Of 581 donors, 98 (17%) had mild acute tubular injury and 57 (10%) had severe acute tubular injury. Overall, Scr-based AKI had poor diagnostic performance for identifying histologic acute tubular injury and 49% of donors with severe acute tubular injury did not have AKI. The area under the receiver operating characteristic curve (AUROC) of change in Scr concentration for diagnosing severe acute tubular injury was 0.58 (95% CI, 0.49-0.67) and for any acute tubular injury was 0.52 (95% CI, 0.45-0.58). Compared with Scr concentration, NGAL concentration demonstrated higher AUROC for diagnosing both severe acute tubular injury (0.67; 95% CI, 0.60-0.74; P=0.03) and any acute tubular injury (0.60; 95% CI, 0.55-0.66; P=0.005). In donors who did not have Scr-based AKI, NGAL concentrations were higher with increasing severities of acute tubular injury (subclinical AKI). However, compared with Scr concentration, AUROCs for acute tubular injury diagnosis were not significantly higher for urinary L-FABP, IL-18, or KIM-1. LIMITATIONS The spectrum of AKI cause in deceased donors may be different from that of a general hospitalized population. CONCLUSIONS Concentrations of Scr and kidney injury biomarkers (L-FABP, IL-18, and KIM-1) lack accuracy for diagnosing acute tubular injury in hospitalized deceased donors. Although urinary NGAL concentration had slightly higher discrimination for acute tubular injury than did Scr concentration, its overall AUROC was still modest.
Collapse
Affiliation(s)
- Dennis G Moledina
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Isaac E Hall
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Heather Thiessen-Philbrook
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, Philadelphia, PA
| | | | | | | | - F Perry Wilson
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, New Haven, CT
| | - Steven G Coca
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chirag R Parikh
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, New Haven, CT.
| |
Collapse
|
20
|
Sallustio F, Curci C, Aloisi A, Toma CC, Marulli E, Serino G, Cox SN, De Palma G, Stasi A, Divella C, Rinaldi R, Schena FP. Inhibin-A and Decorin Secreted by Human Adult Renal Stem/Progenitor Cells Through the TLR2 Engagement Induce Renal Tubular Cell Regeneration. Sci Rep 2017; 7:8225. [PMID: 28811645 PMCID: PMC5557965 DOI: 10.1038/s41598-017-08474-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023] Open
Abstract
Acute kidney injury (AKI) is a public health problem worldwide. Several therapeutic strategies have been made to accelerate recovery and improve renal survival. Recent studies have shown that human adult renal progenitor cells (ARPCs) participate in kidney repair processes, and may be used as a possible treatment to promote regeneration in acute kidney injury. Here, we show that human tubular ARPCs (tARPCs) protect physically injured or chemically damaged renal proximal tubular epithelial cells (RPTECs) by preventing cisplatin-induced apoptosis and enhancing proliferation of survived cells. tARPCs without toll-like receptor 2 (TLR2) expression or TLR2 blocking completely abrogated this regenerative effect. Only tARPCs, and not glomerular ARPCs, were able to induce tubular cell regeneration process and it occurred only after damage detection. Moreover, we have found that ARPCs secreted inhibin-A and decorin following the RPTEC damage and that these secreted factors were directly involved in cell regeneration process. Polysaccharide synthetic vesicles containing these molecules were constructed and co-cultured with cisplatin damaged RPTECs. These synthetic vesicles were not only incorporated into the cells, but they were also able to induce a substantial increase in cell number and viability. The findings of this study increase the knowledge of renal repair processes and may be the first step in the development of new specific therapeutic strategies for renal repair.
Collapse
Affiliation(s)
- Fabio Sallustio
- University of Bari, Department of Emergency and Organ Transplantation, Piazza G. Cesare 11, 70124, Bari, Italy.,C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy
| | - Claudia Curci
- University of Bari, Department of Emergency and Organ Transplantation, Piazza G. Cesare 11, 70124, Bari, Italy.,C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy.,Schena Foundation, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy
| | - Alessandra Aloisi
- Consiglio Nazionale delle Ricerche (CNR), Institute of Nanoscience, Via Arnesano 16, 73100, Lecce, Italy.,Institute of Microelectronics and Microsystems (C.N.R.- I.M.M.), via Monteroni, Campus Ecotekne, 73100, Lecce, Italy
| | - Chiara Cristina Toma
- Consiglio Nazionale delle Ricerche (CNR), Institute of Nanoscience, Via Arnesano 16, 73100, Lecce, Italy.,University of Salento, Mathematics and Physics "E. De Giorgi" Department, University of Salento, 73100, Lecce, Italy
| | - Elisabetta Marulli
- Consiglio Nazionale delle Ricerche (CNR), Institute of Nanoscience, Via Arnesano 16, 73100, Lecce, Italy.,University of Salento, Mathematics and Physics "E. De Giorgi" Department, University of Salento, 73100, Lecce, Italy
| | - Grazia Serino
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Bari, 70013, Italy
| | - Sharon Natasha Cox
- C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy.,Schena Foundation, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy
| | - Giuseppe De Palma
- University of Bari, Department of Emergency and Organ Transplantation, Piazza G. Cesare 11, 70124, Bari, Italy.,C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy.,Schena Foundation, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy
| | - Alessandra Stasi
- University of Bari, Department of Emergency and Organ Transplantation, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Chiara Divella
- University of Bari, Department of Emergency and Organ Transplantation, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Rosaria Rinaldi
- Consiglio Nazionale delle Ricerche (CNR), Institute of Nanoscience, Via Arnesano 16, 73100, Lecce, Italy.,University of Salento, Mathematics and Physics "E. De Giorgi" Department, University of Salento, 73100, Lecce, Italy
| | - Francesco Paolo Schena
- University of Bari, Department of Emergency and Organ Transplantation, Piazza G. Cesare 11, 70124, Bari, Italy. .,C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy. .,Schena Foundation, Strada Prov. le Valenzano-Casamassima Km 3, 70100, Valenzano (Ba), Italy.
| |
Collapse
|
21
|
Lipocalin-2 and iron trafficking in the tumor microenvironment. Pharmacol Res 2017; 120:146-156. [PMID: 28342790 DOI: 10.1016/j.phrs.2017.03.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 02/07/2023]
Abstract
Iron is an essential element for virtually all organisms. It facilitates cell proliferation and growth but also contributes to major hallmarks of cancer such as tumor initiation, growth, and metastasis. Often, iron handling of tumor cells is disturbed, with altered iron acquisition, efflux, and storage. Targeting perturbed iron metabolic pathways might open opportunities towards novel approaches in cancer treatment. It is becoming clear that cells of the tumor microenvironment such as macrophages contribute to tumor progression. Since macrophages evolved a multitude of mechanisms to sequester, transport, store, and release iron it can be speculated that tumor cells educate them to supply iron to support tumor growth. Recent evidence supports the existence of transferrin-independent iron transport mechanisms in the tumor microenvironment, which points to local iron transport proteins such as lipocalin-2 and/or low molecular weight iron-trafficking substances such as siderophores. We hypothesize that tumor cells educate immune cells, i.e. macrophages in their neighborhood to make them delivering iron for the benefit of cancer progression. In particular, we pay attention to recent developments, pointing to lipocalin-2 and siderophores as alternative iron transport molecules in the tumor microenvironment.
Collapse
|
22
|
Fähling M, Mathia S, Scheidl J, Abramovitch R, Milman Z, Paliege A, Peters H, Persson PB, Heyman SN, Rosenberger C. Cyclosporin a induces renal episodic hypoxia. Acta Physiol (Oxf) 2017; 219:625-639. [PMID: 27690155 DOI: 10.1111/apha.12811] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/29/2016] [Accepted: 09/21/2016] [Indexed: 01/20/2023]
Abstract
AIM Cyclosporin A (CsA) causes renal toxicity. The underlying mechanisms are incompletely understood, but may involve renal hypoxia and hypoxia-inducible factors (Hifs). We sought for hypoxia and Hif in mouse kidneys with CsA-induced toxicity, assessed their time course, Hif-mediated responses and the impact of interventional Hif upregulation. METHODS Mice received CsA or its solvent cremophore for up to 6 weeks. Low salt diet (Na+ ↓) was given in combination with CsA to enhance toxicity. We assessed fine morphology, renal function, blood oxygen level-dependent magnetic resonance imaging under room air and following changes in breathing gas composition which correlate with vascular reactivity, pimonidazole adducts (which indicate O2 tensions below 10 mmHg), Hif-α proteins, as well as expression of Hif target genes. Stable Hif upregulation was achieved by inducible, Pax8-rtTA-based knockout of von Hippel-Lindau protein (Vhl-KO), which is crucial for Hif-α degradation. RESULTS Cyclosporin A transiently increased renal deoxyhaemoglobin (R2*). Augmented vascular reactivity was observed at 2 h, but decreased at 24 h after CsA treatment. Na+ ↓/CsA provoked chronic renal failure with tubular degeneration and interstitial fibrosis. Nephron segments at risk for injury accumulated pimonidazole adducts, as well as Hif-α proteins. Remarkably, Hif target gene expression remained unchanged, while factor-inhibiting Hif (Fih) was enhanced. Na+ ↓/CsA/Vhl-KO aggravated morpho-functional outcome of chronic renal CsA toxicity. CONCLUSIONS Cyclosporin A provokes episodic hypoxia in nephron segments most susceptible to chronic CsA toxicity. Fih is upregulated and likely blocks further Hif activity. Continuous tubular Hif upregulation via Vhl-KO worsens the outcome of chronic CsA-induced renal toxicity.
Collapse
Affiliation(s)
- M. Fähling
- Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Mathia
- Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin Germany
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Scheidl
- Gastroenterology; Krankenhaus Westend; Berlin Germany
| | - R. Abramovitch
- The Goldyne Savad Institute of Gene Therapy; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Z. Milman
- The Goldyne Savad Institute of Gene Therapy; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - A. Paliege
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Peters
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. B. Persson
- Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. N. Heyman
- Medicine; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - C. Rosenberger
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
23
|
Kiseli M, Caglar GS, Yilmaz H, Gursoy AY, Candar T, Pabuccu EG, Bengisun ZK, Tuzuner F. Neutrophil Gelatinase-Associated Lipocalin Levels During Pneumoperitoneum. JSLS 2017; 21:JSLS.2016.00091. [PMID: 28144124 PMCID: PMC5266513 DOI: 10.4293/jsls.2016.00091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and Objectives: A temporary deterioration in renal function during pneumoperitoneum has been reported, but the extent is not known. A new marker for the early detection of renal injury, neutrophil gelatinase-associated lipocalin (NGAL), has been shown to increase in various conditions that affect renal function. This study was conducted to explore detrimental effects of pneumoperitoneum in laparoscopic surgery on renal function by studying levels of urinary NGAL (uNGAL). Methods: Thirty-two women scheduled to undergo laparoscopic surgery in a gynecology clinic were recruited. NGAL was measured in urine collected at the beginning (0 h) and at 2 and 24 hours after the initiation of surgery. Hemodynamic parameters were analyzed immediately after intubation and before desufflation. Results: Levels of uNGAL increased from 5.45 ng/mL at 0 hours to 6.35 ng/mL at 2 hours and to 6.05 ng/mL at 24 h; however, there was no significant change in uNGAL levels at the collection time points. Intraoperative oliguria was observed in all cases, and the severity increased with the duration of surgery. uNGAL levels did not correlate with the duration of surgery or pneumoperitoneum. Conclusion: In patients with normal renal functions, pneumoperitoneum results in transient oliguria without any early renal damage, as indicated by nonsignificant changes in uNGAL levels.
Collapse
Affiliation(s)
- Mine Kiseli
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Gamze Sinem Caglar
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Hakan Yilmaz
- Department of Anesthesiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Asli Yarci Gursoy
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Tuba Candar
- Department of Biochemistry, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Emre Goksan Pabuccu
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | | | - Filiz Tuzuner
- Department of Anesthesiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
24
|
|
25
|
Shyam R, Patel ML, Sachan R, Kumar S, Pushkar DK. Role of Urinary Neutrophil Gelatinase-associated Lipocalin as a Biomarker of Acute Kidney Injury in Patients with Circulatory Shock. Indian J Crit Care Med 2017; 21:740-745. [PMID: 29279634 PMCID: PMC5699001 DOI: 10.4103/ijccm.ijccm_315_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The early prediction of acute kidney injury (AKI) by the current clinical and laboratory methods remains inadequate. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising noninvasive biomarker of kidney injury in shock. The aim of this study was to assess the ability of urinary NGAL (uNGAL) to predict AKI in adult Intensive Care Unit (ICU) patients. Materials and Methods We prospectively studied 70 patients with circulatory shock admitted to the ICU over a period of 1 year. uNGAL was analyzed at ICU admission and after 24 h. Risk, injury, failure, loss, and end-stage kidney criteria were calculated at admission and for consecutive 4 days. The primary outcome was AKI defined as an increase in creatinine of at least 50% from baseline or a reduction in urine output to <0.5 ml/kg/h for 6 h. Results uNGAL was a good diagnostic marker for AKI development; at day 1, the cutoff value 48.54 ng/mL had a sensitivity and specificity of 79.49 and 73.14, respectively, and the area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.75-0.87) for predicting AKI. At day 2, the cutoff value 190.92 ng/mL had a sensitivity and specificity of 90.0 and 64.66, respectively, and the AUC of 0.76 (95% CI, 0.70-0.88) for predicting AKI. Conclusion uNGAL could be a good early predictor biomarker of AKI following circulatory shock.
Collapse
Affiliation(s)
- Radhey Shyam
- Department of Anaesthesiology, Intensive Care Unit, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Munna Lal Patel
- Department of Medicine, Nephrology Unit, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rekha Sachan
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Satish Kumar
- Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Durgesh Kumar Pushkar
- Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
26
|
Neutrophil gelatinase-associated lipocalin production negatively correlates with HK-2 cell impairment: Evaluation of NGAL as a marker of toxicity in HK-2 cells. Toxicol In Vitro 2016; 39:52-57. [PMID: 27888128 DOI: 10.1016/j.tiv.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/19/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023]
Abstract
Neutrophil gelatinase-associated lipocalin is an extracellular protein produced mostly in kidney. Recently, it has become a promising biomarker of renal damage in vivo. On the other hand, the validation of NGAL as a biomarker for nephrotoxicity estimation in vitro has not been characterized in detail yet. Since the HK-2 cells are frequently used human kidney cell line, we aimed to characterize the production of NGAL in these cells and to evaluate NGAL as a possible marker of cell impairment. We used heavy metals (mercury, cadmium), peroxide, drugs (acetaminophen, gentamicin) and cisplatin to mimic nephrotoxicity. HK-2 cells were incubated with selected compounds for 1-24h and cell viability was measured together with extracellular NGAL production. We proved that HK-2 cells possess a capacity to produce NGAL in amount of 2pg/ml/h. We found a change in cell viability after 24h incubation with all tested toxic compounds. The largest decrease of the viability was detected in mercury, acetaminophen, cisplatin and gentamicin. Unexpectedly, we found also a significant decrease in NGAL production in HK-2 cells treated with these toxins for 24h: to 11±5%, 54±5%, 57±6% and 76±9% respectively, compared with controls (=100%). Our results were followed with qPCR analysis when we found no significant increase in LCN2 gene expression after 24h incubation. We conclude that extracellular NGAL production negatively correlates with HK-2 cell impairment.
Collapse
|
27
|
Cooper DS, Basu RK, Price JF, Goldstein SL, Krawczeski CD. The Kidney in Critical Cardiac Disease: Proceedings From the 10th International Conference of the Pediatric Cardiac Intensive Care Society. World J Pediatr Congenit Heart Surg 2016; 7:152-63. [PMID: 26957397 DOI: 10.1177/2150135115623289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. The focus of intensive care unit care has now shifted to that of morbidity reduction and eventual elimination. Acute kidney injury (AKI) after cardiac surgery is associated with adverse outcomes, including prolonged intensive care and hospital stays, diminished quality of life, and increased long-term mortality. Acute kidney injury occurs frequently, complicating the care of both postoperative patients and those with heart failure. Patients who become fluid overloaded and/or require dialysis are at high risk of mortality, but even minor degrees of AKI portend a significant increase in mortality and morbidity. Clinicians continue to seek methods of early diagnosis and risk stratification of AKI to prevent its adverse sequelae. Previous conventional wisdom that survivors of AKI fully recover renal function without subsequent consequences may be flawed.
Collapse
Affiliation(s)
- David S Cooper
- The Heart Institute and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rajit K Basu
- Division of Critical Care and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jack F Price
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Stuart L Goldstein
- The Heart Institute and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine D Krawczeski
- Dvision of Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
28
|
Abstract
Over a decade ago, it was proposed that the regulation of tubular repair in the kidney might involve the recapitulation of developmental pathways. Although the kidney cannot generate new nephrons after birth, suggesting a low level of regenerative competence, the tubular epithelial cells of the nephrons can proliferate to repair the damage after AKI. However, the debate continues over whether this repair involves a persistent progenitor population or any mature epithelial cell remaining after injury. Recent reports have highlighted the expression of Sox9, a transcription factor critical for normal kidney development, during postnatal epithelial repair in the kidney. Indeed, the proliferative response of the epithelium involves expression of several pathways previously described as being involved in kidney development. In some instances, these pathways are also apparently involved in the maladaptive responses observed after repeated injury. Whether development and repair in the kidney are the same processes or we are misinterpreting the similar expression of genes under different circumstances remains unknown. Here, we review the evidence for this link, concluding that such parallels in expression may more correctly represent the use of the same pathways in a distinct context, likely triggered by similar stressors.
Collapse
Affiliation(s)
- Melissa Helen Little
- Murdoch Children's Research Institute, Melbourne, Australia; and .,Department of Pediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Pamela Kairath
- Murdoch Children's Research Institute, Melbourne, Australia; and.,Department of Pediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
29
|
Prognostic Value of Levels of Urine Neutrophil Gelatinase-associated Lipocalin and Interleukin-18 in Patients With Delayed Graft Function After Kidney Transplantation. Transplant Proc 2016; 47:2846-51. [PMID: 26707300 DOI: 10.1016/j.transproceed.2015.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/02/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of our study was to examine how serial urine neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin (IL)-18 concentrations change over time after kidney transplantation and whether we can use them to predict delayed graft function (DGF). METHODS Spot urine samples for the NGAL and IL-18 tests were taken at 4, 12, 24, 48, and 72 hours after transplantation from every patient at hospital presentation. Urine samples were tested for NGAL by a chemiluminescence assay kit on the ARCHITECT I2000 immunology analyzer. IL-18 were measured by a quantitative immunoenzymatic assay kit. Serum samples for the creatinine measurement were taken at 24, 48, and 72 hours after kidney transplantation. Serum samples were tested for creatinine on the Olympus analyzer 5821 by alkaline picric acid method. The patients were divided into 2 groups: DGF group and non-DGF group. RESULTS The urine NGAL levels were increased in DGF group at all points over the follow-up period. There are differences (P < .05) in NGAL concentrations between DGF (n = 21) and non-DGF groups (n = 102). However, urine samples from the DGF group (n = 21) had increased IL-18 concentrations at 4, 12, 24, and 48 hours postoperatively compared with non-DGF group samples (n = 102) (P < .05). There were obvious distinctions (P < .05) of serum creatinine (SCr) levels in 24 hours between the DGF (n = 21) and non-DGF groups (n = 102). The specificity and positive predictive value of NGAL in the DGF diagnosis increased with time, but the sensitivity and negative predictive value do not change. The specificity, sensitivity, positive predictive, value and negative predictive value of IL-18 in the DGF diagnosis changed irregularly at multiple time points after transplant. The positive predictive value and negative predictive value of 24-hour SCr were 47.4% and 95.7%, respectively. The positive predictive value and negative predictive value of combination of NGAL, IL-18, and SCr (area under the receiver-operating characteristic curve = 0.984; 95% CI, 0.887-0.994) were 90.9% and 100%, respectively. Overall, the combination of NGAL, IL-18, and SCr was found to have a significantly better positive predictive value than all the other combination assays (P < .05). In addition, there were obvious distinction of the negative predictive value of NGAL and IL-18 combination compared with those of other combinations (P < .05). CONCLUSIONS The combination of NGAL, IL-18, and SCr measurements after initiation of treatment may be highly effective for risk stratification in patients with DGF. The combination may be useful to cover the complete diagnostic window of patients presenting with DGF.
Collapse
|
30
|
Abstract
OBJECTIVES The objectives of this review are to discuss the definition, diagnosis, and pathophysiology of acute kidney injury and its impact on immediate, short-, and long-term outcomes. In addition, the spectrum of cardiorenal syndromes will be reviewed including the pathophysiology on this interaction and its impact on outcomes. DATA SOURCE MEDLINE and PubMed. CONCLUSION The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. As mortality has become a rare occurrence, the focus of cardiac intensive care has shifted to that of morbidity reduction. Acute kidney injury adversely impact outcomes of patients following surgery for congenital heart disease as well as in those with heart failure (cardiorenal syndrome). Patients who become fluid overloaded and/or require dialysis are at a higher risk of mortality, but even minor degrees of acute kidney injury portend a significant increase in mortality and morbidity. Clinicians continue to seek methods of early diagnosis and risk stratification of acute kidney injury to prevent its adverse sequelae.
Collapse
|
31
|
Abstract
The incidence of chronic kidney disease (CKD) in children and adults is increasing. Cardiologists have become indispensable members of the care provider team for children with CKD. This is partly due to the high incidence of CKD in children and adults with congenital heart disease, with current estimates of 30-50%. In addition, the high incidence of acute kidney injury (AKI) due to cardiac dysfunction or following pediatric cardiac surgery that may progress to CKD is also well documented. It is now apparent that AKI and CKD are uniquely intertwined as interconnected syndromes. Furthermore, the well-known long-term cardiovascular morbidity and mortality associated with CKD require the joint attention of both nephrologists and cardiologists. Children with both congenital heart disease and CKD are increasingly surviving to adulthood, with synergistically negative medical, financial, and quality of life impact. An improved understanding of the epidemiology, mechanisms, early diagnosis, and preventive measures is of importance to cardiologists, nephrologists, scientists, economists, and policy makers alike. Herein, we report the current definitions, epidemiology, and complications of CKD in children, with an emphasis on children with congenital heart disease. We then focus on the clinical and experimental evidence for the progression of CKD after episodes of AKI commonly encountered in children with heart disease, and explore the role of novel biomarkers for the prediction of CKD progression.
Collapse
|
32
|
Abstract
Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy.
Collapse
Affiliation(s)
- John Lynn Jefferies
- The Heart Institute, Cincinnati Children's Hospital Medical Center, United States
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, United States
| |
Collapse
|
33
|
Pezeshgi A, Abedi Azar S, Ghasemi H, Kamali K, Esmaeilzadeh A, Hajsalimi B, Pour-Asghar S, Behmanesh MR, Kiafar M. Role of plasma neutrophil gelatinase-associated lipocalin as an emerging biomarker of acute renal failure following kidney transplantation and its correlation with plasma creatinine. J Renal Inj Prev 2016; 5:98-103. [PMID: 27471743 PMCID: PMC4962678 DOI: 10.15171/jrip.2016.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/03/2016] [Indexed: 01/22/2023] Open
Abstract
Introduction: Graft function early after kidney transplantation is an important parameter in
determining the outcome of operation. Urinary and plasma neutrophil gelatinase-associated
lipocalin (NGAL), a member of the lipocalin protein family, has been advocated as a sensitive,
early biomarker for predicting early renal graft after transplantation. The functions of NGAL
appears to be expressed in stress conditions and in tissues undergoing involution. It rapidly
accumulates in the kidney tubules and urine after nephrotoxic and ischemic insults. Objectives: This study aimed to examine the prognostic role of NGAL early after renal
transplantation.
Patients and Methods: A total of 37 kidney recipients were enrolled from a teaching centre
in Tabriz within a 6-month period of time. Plasma NGAL was measured immediately before
and at 6 and 12 hours post-transplantation. Changes of serum creatinine were documented
daily within the first week post-operation. Acute kidney injury (AKI)/graft rejection during
the first week after transplantation was the outcome variable.
Results: There were 22 males (59.5%) and 15 females (40.5%) with the mean age of 34.93 ± 14.97
years (range: 12-59) in the study group. AKI/graft rejection developed in 12 patients (32.4%).
The mean post-transplantation plasma NGAL levels and serum creatinine at all time
points were significantly higher in patients with AKI/graft rejection. The best prognostic
role was found for plasma NGAL at 12 hours (sensitivity = 100%, specificity = 92%; cut-off
value = 309 ng/ml), far better than the prognostic accuracy of corresponding serum creatinine
(sensitivity = 66.7%, specificity = 61.9%).
Conclusion: Plasma NGAL, particularly 12 hours after transplantation, is a very sensitive and
specific biomarker for predicting acute renal injury.
Collapse
Affiliation(s)
- Aiyoub Pezeshgi
- Department of Internal Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran ; Metaolic Diseases Research Center, Zanjan University of Medical Sciences, Iran
| | - Sima Abedi Azar
- Chronic Kidney Disease Research Center, Tabriz University Of medical Sciences, Tabriz, Iran
| | - Hussein Ghasemi
- Department of Internal Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Koorosh Kamali
- Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Bahare Hajsalimi
- Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Sajad Pour-Asghar
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Mina Kiafar
- Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
34
|
Gwinner W, Metzger J, Husi H, Marx D. Proteomics for rejection diagnosis in renal transplant patients: Where are we now? World J Transplant 2016; 6:28-41. [PMID: 27011903 PMCID: PMC4801803 DOI: 10.5500/wjt.v6.i1.28] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/14/2015] [Accepted: 01/05/2016] [Indexed: 02/05/2023] Open
Abstract
Rejection is one of the key factors that determine the long-term allograft function and survival in renal transplant patients. Reliable and timely diagnosis is important to treat rejection as early as possible. Allograft biopsies are not suitable for continuous monitoring of rejection. Thus, there is an unmet need for non-invasive methods to diagnose acute and chronic rejection. Proteomics in urine and blood samples has been explored for this purpose in 29 studies conducted since 2003. This review describes the different proteomic approaches and summarizes the results from the studies that examined proteomics for the rejection diagnoses. The potential limitations and open questions in establishing proteomic markers for rejection are discussed, including ongoing trials and future challenges to this topic.
Collapse
|
35
|
Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation? J Transl Med 2016; 14:20. [PMID: 26791565 PMCID: PMC4721068 DOI: 10.1186/s12967-016-0767-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/20/2015] [Indexed: 01/03/2023] Open
Abstract
Kidney transplantation is the treatment of choice in patients with end stage renal disease. During kidney transplantation ischemia reperfusion injury (IRI) occurs, which is a risk factor for acute kidney injury, delayed graft function and acute and chronic rejection. Kidneys from living donors show a superior short- and long-term graft survival compared with deceased donors. However, the shortage of donor kidneys has resulted in expansion of the donor pool by using not only living- and brain death donors but also kidneys from donation after circulatory death and from extended criteria donors. These grafts are associated with an increased sensitivity to IRI and decreased graft outcome due to prolonged ischemia and donor comorbidity. Therefore, preventing or ameliorating IRI may improve graft survival. Animal experiments focus on understanding the mechanism behind IRI and try to find methods to minimize IRI either before, during or after ischemia. This review evaluates the different experimental strategies that have been investigated to prevent or ameliorate renal IRI. In addition, we review the current state of translation to the clinical setting. Experimental research has contributed to the development of strategies to prevent or ameliorate IRI, but promising results in animal studies have not yet been successfully translated to clinical use.
Collapse
|
36
|
|
37
|
Daggülli M, Utangaç MM, Dede O, Bodakci MN, Hatipoglu NK, Penbegül N, Sancaktutar AA, Bozkurt Y, Söylemez H. Potential biomarkers for the early detection of acute kidney injury after percutaneous nephrolithotripsy. Ren Fail 2015; 38:151-6. [DOI: 10.3109/0886022x.2015.1073494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
38
|
Fang YG, Chen NN, Cheng YB, Sun SJ, Li HX, Sun F, Xiang Y. Urinary neutrophil gelatinase-associated lipocalin for diagnosis and estimating activity in lupus nephritis: a meta-analysis. Lupus 2015; 24:1529-39. [PMID: 26314302 DOI: 10.1177/0961203315600244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022]
Abstract
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is relatively specific in lupus nephritis (LN) patients. However, its diagnostic value has not been evaluated. The aim of this review was to determine the value of uNGAL for diagnosis and estimating activity in LN. A comprehensive search was performed on PubMed, EMBASE, Web of Knowledge, Cochrane electronic databases through December 2014. Meta-analysis of sensitivity and specificity was performed with a random-effects model. Additionally, summary receiver operating characteristic (SROC) curves and area under the curve (AUC) values were calculated. Fourteen studies were selected for this review. With respect to diagnosing LN, the pooled sensitivity and specificity were 73.6% (95% confidence interval (CI), 61.9–83.3) and 78.1% (95% CI, 69.0–85.6), respectively. The SROC-AUC value was 0.8632. Regarding estimating LN activity, the pooled sensitivity and specificity were 66.2% (95% CI, 60.4–71.7) and 62.1% (95% CI, 57.9–66.3), respectively. The SROC-AUC value was 0.7583. In predicting renal flares, the pooled sensitivity and specificity were 77.5% (95% CI, 68.1–85.1) and 65.3% (95% CI, 60.0–70.3), respectively. The SROC-AUC value was 0.7756. In conclusion, this meta-analysis indicates that uNGAL has relatively fair sensitivity and specificity in diagnosing LN, estimating LN activity and predicting renal flares, suggesting that uNGAL is a potential biomarker in diagnosing LN and monitoring LN activity.
Collapse
Affiliation(s)
- Y G Fang
- Medical College of Chinese PLA, General Hospital of Chinese PLA, Beijing, China
| | - N N Chen
- Department of TCM and Hematology, PLA 210 Hospital, Dalian, China
| | - Y B Cheng
- Department of TCM and Hematology, PLA 210 Hospital, Dalian, China
| | - S J Sun
- Department of TCM and Hematology, PLA 210 Hospital, Dalian, China
| | - H X Li
- Department of TCM and Hematology, PLA 210 Hospital, Dalian, China
| | - F Sun
- Department of TCM and Hematology, PLA 210 Hospital, Dalian, China
| | - Y Xiang
- Department of TCM and Hematology, PLA 210 Hospital, Dalian, China
| |
Collapse
|
39
|
Sallustio F, Serino G, Schena FP. Potential Reparative Role of Resident Adult Renal Stem/Progenitor Cells in Acute Kidney Injury. Biores Open Access 2015; 4:326-33. [PMID: 26309808 PMCID: PMC4509615 DOI: 10.1089/biores.2015.0011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human kidney is particularly susceptible to ischemia and toxins with consequential tubular necrosis and activation of inflammatory processes. This process can lead to the acute renal injury, and even if the kidney has a great capacity for regeneration after tubular damage, in several circumstances, the normal renal repair program may not be sufficient to achieve a successful regeneration. Resident adult renal stem/progenitor cells could participate in this repair process and have the potentiality to enhance the renal regenerative mechanism. This could be achieved both directly, by means of their capacity to differentiate and integrate into the renal tissues, and by means of paracrine factors able to induce or improve the renal repair or regeneration. Recent genetic fate-tracing studies indicated that tubular damage is instead repaired by proliferative duplication of epithelial cells, acquiring a transient progenitor phenotype and by fate-restricted clonal cell progeny emerging from different nephron segments. In this review, we discuss about the properties and the reparative characteristics of high regenerative CD133(+)/CD24(+) cells, with a view to a future application of these cells for the treatment of acute renal injury.
Collapse
Affiliation(s)
- Fabio Sallustio
- Department of Emergency and Organ Transplantation, University of Bari , Bari, Italy . ; C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3 , Valenzano, Italy . ; Dipartimento di Scienze e Tecnologie Biologiche ed Ambientali (DiSTeBA), Università del Salento , Lecce-Monteroni, Lecce, Italy
| | - Grazia Serino
- Department of Emergency and Organ Transplantation, University of Bari , Bari, Italy
| | - Francesco Paolo Schena
- C.A.R.S.O. Consortium, Strada Prov. le Valenzano-Casamassima Km 3 , Valenzano, Italy . ; Schena Foundation, Research Center of Renal Diseases , Bari, Italy
| |
Collapse
|
40
|
Moledina DG, Parikh CR, Garg AX, Thiessen-Philbrook H, Koyner JL, Patel UD, Devarajan P, Shlipak MG, Coca SG. Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study. PLoS One 2015; 10:e0129619. [PMID: 26053382 PMCID: PMC4460181 DOI: 10.1371/journal.pone.0129619] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/11/2015] [Indexed: 01/15/2023] Open
Abstract
Background Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown. Methods In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality. Results During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Pre-operative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04–2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0–1.7 and adjusted HR 1.78, 95% CI 1.2–2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79–1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87–1.61 for peak pNGAL). Conclusions Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.
Collapse
Affiliation(s)
- Dennis G. Moledina
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Jay L. Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Uptal D. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Michael G. Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, California, United States of America
| | - Steven G. Coca
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | | |
Collapse
|
41
|
Basu RK, Kaddourah A, Terrell T, Mottes T, Arnold P, Jacobs J, Andringa J, Armor M, Hayden L, Goldstein SL. Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in Critically Ill Children (AWARE): A Prospective Study to Improve Diagnostic Precision. ACTA ACUST UNITED AC 2015; 5. [PMID: 26719818 DOI: 10.4172/2167-0870.1000222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with poor outcomes in critically ill children. Recent international consensus panels recommend standardized classification systems to improve the precision of AKI diagnosis, but there is a paucity of data to enable this refinement, particularly in pediatric critical care. METHODS/DESIGN This is a prospective observational study. We anticipate collecting data from more than 5500 critically ill children admitted to 32 pediatric intensive care units (PICUs) across the world, during the calendar year of 2014. Data will be collected continuously for three months at each center on all children older than 90 days and younger than 25 years admitted to the ICU. Demographic, resuscitative, and daily physiological and lab data will be captured at individual centers using MediData Rave™, a commercial system designed to manage and report clinical research data. Kidney specific measured variables include changes in serum creatinine and urine output, cumulative fluid overload (%), serum creatinine corrected for fluid balance, and KDIGO AKI stage. Urinary AKI biomarkers to be measured include: urinary neutrophil gelatinase lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (l-FABP), and interleukin-18 (IL-18). Biomarker combinations will be created from different pairs and triplets of urinary biomarkers. The primary analysis will compare the discrimination of these panels versus changes in creatinine for prediction of severe AKI by Day 7 of ICU admission. Secondary analysis will investigate the prediction of biomarkers for injury 'time based phenotypes': duration (>2 days), severity (KDIGO stage, use of renal replacement therapy), reversibility (time to return of serum creatinine to baseline), association with fluid overload > 10%, and disease association (sepsis, hypovolemia, hypoxemia, or nephrotoxic). DISCUSSION The Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology (AWARE) study will be the largest ever prospective study of any disease process in pediatric critical care. Data from AWARE will enable refinement of AKI classification. AWARE creates the largest ever all-cause pediatric AKI data warehouse and biologic sample repository, providing a broad and invaluable resource for critical care nephrologists seeking to study risk factors, prediction, identification, and treatment options for a disease syndrome with high associated morbidity affecting a significant proportion of hospitalized children. Improving the precision of AKI diagnosis using biomarker combinations provides a foundation for targeted, personalized therapy for different injury phenotypes. TRIAL REGISTRATION NUMBER NCT01987921.
Collapse
Affiliation(s)
- Rajit K Basu
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Ahmad Kaddourah
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Tara Terrell
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Theresa Mottes
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Patricia Arnold
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Judd Jacobs
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Jennifer Andringa
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Melissa Armor
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Lauren Hayden
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, USA
| |
Collapse
|
42
|
Yoon YE, Lee KS, Choi KH, Kim KH, Yang SC, Han WK. Preconditioning strategies for kidney ischemia reperfusion injury: implications of the "time-window" in remote ischemic preconditioning. PLoS One 2015; 10:e0124130. [PMID: 25879855 PMCID: PMC4400007 DOI: 10.1371/journal.pone.0124130] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/10/2015] [Indexed: 12/13/2022] Open
Abstract
Remote ischemic preconditioning (IP) is a potential renoprotective strategy. However, there has been no demonstrated result in large animals and the role of time window in remote IP remains to be defined. Using a single-kidney porcine model, we evaluated organ protective function of remote IP in renal ischemia reperfusion injury. Fifteen Yorkshire pigs, 20 weeks old and weighing 35-38 kg were used. One week after left nephrectomy, we performed remote IP (clamping right external iliac artery, 2 cycles of 10 minutes) and right renal artery clamping (warm ischemia; 90 minutes). The animals were randomly divided into three groups: control group, warm ischemia without IP; group 1 (remote IP with early window [IP-E]), IP followed by warm ischemia with a 10-minute time window; and group 2 (remote IP with late window [IP-L]), IP followed by warm ischemia after a 24-hour time window. There were no differences in serum creatinine changes between groups. The IP-L group had lower urinary neutrophil gelatinase-associated lipocalin than control and IP-E at 72 hours post-ischemia. At 72 hours post-ischemia, the urinary kidney injury molecule-1 (KIM-1) was lower in the IP-L group than in the control and IP-E groups, and the IP-L group KIM-1 was near pre-ischemic levels, whereas the control and IP-E group KIM-1 levels were rising. Microalbumin also tended to be lower in the IP-L group. Taken together, remote IP showed a significant reduction in renal injury biomarkers from ischemia reperfusion injury. To effectively provide kidney protection, remote IP might require a considerable, rather than short, time window of ischemia.
Collapse
Affiliation(s)
- Young Eun Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Suk Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwa Choi
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Kwang Hyun Kim
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
43
|
Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE): study protocol for a prospective observational study. BMC Nephrol 2015; 16:24. [PMID: 25882434 PMCID: PMC4355130 DOI: 10.1186/s12882-015-0016-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 02/10/2015] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is associated with poor outcome in critically ill children. While data extracted from retrospective study of pediatric populations demonstrate a high incidence of AKI, the literature lacks focused and comprehensive multicenter studies describing AKI risk factors, epidemiology, and outcome. Additionally, very few pediatric studies have examined novel urinary biomarkers outside of the cardiopulmonary bypass population. Methods/Design This is a prospective observational study. We anticipate collecting data on over 5000 critically ill children admitted to 31 pediatric intensive care units (PICUs) across the world during the calendar year of 2014. Data will be collected for seven days on all children older than 90 days and younger than 25 years without baseline stage 5 chronic kidney disease, chronic renal replacement therapy, and outside of 90 days of a kidney transplant or from surgical correction of congenital heart disease. Data to be collected includes demographic information, admission diagnoses and co-morbidities, and details on fluid and vasoactive resuscitation used. The renal angina index will be calculated integrating risk factors and early changes in serum creatinine and fluid overload. On days 2–7, all hemodynamic and pertinent laboratory values will be captured focusing on AKI pertinent values. Daily calculated values will include % fluid overload, fluid corrected creatinine, and KDIGO AKI stage. Urine will be captured twice daily for biomarker analysis on Days 0–3 of admission. Biomarkers to be measured include neutrophil gelatinase lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (l-FABP), and interleukin-18 (IL-18). The primary outcome to be quantified is incidence rate of severe AKI on Day 3 (Day 3 – AKI). Prediction of Day 3 – AKI by the RAI and after incorporation of biomarkers with RAI will be analyzed. Discussion The Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology (AWARE) study, creates the first prospective international pediatric all cause AKI data warehouse and biologic sample repository, providing a broad and invaluable resource for critical care nephrologists seeking to study risk factors, prediction, identification, and treatment options for a disease syndrome with high associated morbidity affecting a significant proportion of hospitalized children. Trial registration ClinicalTrials.gov: NCT01987921 Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0016-6) contains supplementary material, which is available to authorized users.
Collapse
|
44
|
Matata BM, Scawn N, Morgan M, Shirley S, Kemp I, Richards S, Lane S, Wilson K, Stables R, Jackson M, Haycox A, Mediratta N. A Single-Center Randomized Trial of Intraoperative Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass for Patients With Impaired Kidney Function Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:1236-47. [PMID: 26119403 DOI: 10.1053/j.jvca.2015.02.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The authors investigated whether zero-balance ultrafiltration (Z-BUF) during bypass significantly improves clinical and cost outcomes or biomarkers of kidney injury for patients with preoperative kidney impairment (estimated glomerular filtration rate [eGFR]<60 mL/minute) undergoing cardiac surgery. DESIGN A single-center randomized controlled trial recruited, patients between 2010 and 2013, with a 12-months follow-up. SETTING Hospital. PARTICIPANTS One hundred ninety-nine patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). INTERVENTIONS Patients were assigned randomly to receive zero-balance ultrafiltration (Z-BUF) or not, with stratification for degree of kidney dysfunction and diabetes. MEASUREMENTS AND MAIN RESULTS The authors assessed clinical efficacy and kidney function biomarkers. Cumulative probability of discharge from the intensive care unit (ICU) was assessed by Kaplan-Meier plots and was found not to be significantly different between the two trial arms (p = 0.61). After adjusting for EuroSCORE, diabetes, eGFR, cardioplegia types and type of surgery in a Cox proportional hazard model, hazard ratios (HR) for ICU length of stay between the Z-BUF and no-Z-BUF groups was not significantly different: HR (95% CI): 0.89 (0.66, 1.20; p = 0.44). In contrast, significant reductions in postoperative chest infections and the composite of clinical endpoints (death, strokes, and myocardial infarctions) in the Z-BUF group were observed. In addition, Z-BUF significantly abrogated the rise in the kidney damage markers urinary NGAL/creatinine ratio, urea, creatinine and eGFR during CPB and adverse events risks. CONCLUSIONS Z-BUF during bypass surgery is associated with significant reductions in morbidity and biomarkers of CPB-induced acute kidney injury soon after CPB, which are indicative of clearance of inflammatory/immune mediators from the circulation.
Collapse
Affiliation(s)
| | - Nigel Scawn
- Liverpool Heart and Chest Hospital NHS Foundation Trust
| | | | - Sarah Shirley
- Liverpool Heart and Chest Hospital NHS Foundation Trust
| | - Ian Kemp
- Liverpool Heart and Chest Hospital NHS Foundation Trust
| | | | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Keith Wilson
- Liverpool Heart and Chest Hospital NHS Foundation Trust
| | | | - Mark Jackson
- Liverpool Heart and Chest Hospital NHS Foundation Trust
| | | | | |
Collapse
|
45
|
Investigation of apoptosis-related gene expression levels in preimplantation biopsies as predictors of delayed kidney graft function. Transplantation 2014; 97:1260-5. [PMID: 24503763 DOI: 10.1097/01.tp.0000442579.12285.e8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the expression of the gene coding for the antiapoptotic molecule Bcl-2, the proapoptotic molecule Bax, and the apoptosis executor enzyme caspase-3 in preimplantation renal biopsies (PIB) as markers for delayed graft function. METHODS In this prospective single-center study, gene expression levels were evaluated using real-time TaqMan polymerase chain reaction in PIB of kidneys from 72 deceased donors (DDs) and 18 living donors (LDs). RESULTS CASP3 and BAX expression levels were higher, whereas those of BCL2 were lower, in DD than in LD PIB. In biopsies from DD, BCL2 levels were lower in cases with DGF, whereas no differences were observed concerning CASP3 and BAX. The BAX/BCL2 gene expression ratio greater than 2.29 associated with DGF with an odds ratio of 2.00. A multiple regression analysis including data of TLR4 expression in the first day posttransplant PB from a previous study of our group conducted in the same patients revealed a very strong association of the combination of BAX/BCL2 greater than 2.3 in PIB and TLR4 of 0.95 uRE or lesser in PB with the occurrence of DGF, with OR of 120 and positive and negative predictive values of 91% and 92%, respectively. CONCLUSIONS The power to predict DGF of the combination of high BAX/BCL2 expression in PIB and low TLR4 expression in the first day posttransplant peripheral blood observed in the present study is extremely high, in comparison to any other marker or combinations of markers so far published in the literature.
Collapse
|
46
|
Zang X, Zheng F, Hong HJ, Jiang Y, Song Y, Xia Y. Neutrophil gelatinase-associated lipocalin protects renal tubular epithelial cells in hypoxia–reperfusion by reducing apoptosis. Int Urol Nephrol 2014; 46:1673-9. [DOI: 10.1007/s11255-014-0749-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
|
47
|
Abstract
The mammalian kidney has an intrinsic ability to repair after significant injury. However, this process is inefficient: patients are at high risk for the loss of kidney function in later life. No therapy exists to treat established acute kidney injury (AKI) per se: strategies to promote endogenous repair processes and retard associated fibrosis are a high priority. Whole-organ gene expression profiling has been used to identify repair responses initiated with AKI, and factors that may promote the transition from AKI to chronic kidney disease. Transcriptional profiling has shown molecular markers and potential regulatory pathways of renal repair. Activation of a few key developmental pathways has been reported during repair. Whether these are comparable networks with similar target genes with those in earlier nephrogenesis remains unclear. Altered microRNA profiles, persistent tubular injury responses, and distinct late inflammatory responses highlight continuing kidney pathology. Additional insights into injury and repair processes will be gained by study of the repair transcriptome and cell-specific translatome using high-resolution technologies such as RNA sequencing and translational profiling tailored to specific cellular compartments within the kidney. An enhanced understanding holds promise for both the identification of novel therapeutic targets and biomarker-based evaluation of the damage-repair process.
Collapse
Affiliation(s)
- Sanjeev Kumar
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad-California Institute of Regenerative Medicine (CIRM) Center for Regenerative Medicine and Stem Cell Research, The Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jing Liu
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad-California Institute of Regenerative Medicine (CIRM) Center for Regenerative Medicine and Stem Cell Research, The Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Andrew P McMahon
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad-California Institute of Regenerative Medicine (CIRM) Center for Regenerative Medicine and Stem Cell Research, The Keck School of Medicine of the University of Southern California, Los Angeles, CA.
| |
Collapse
|
48
|
Mussap M, Noto A, Fanos V, Van Den Anker JN. Emerging biomarkers and metabolomics for assessing toxic nephropathy and acute kidney injury (AKI) in neonatology. BIOMED RESEARCH INTERNATIONAL 2014; 2014:602526. [PMID: 25013791 PMCID: PMC4071811 DOI: 10.1155/2014/602526] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/25/2014] [Indexed: 01/07/2023]
Abstract
Identification of novel drug-induced toxic nephropathy and acute kidney injury (AKI) biomarkers has been designated as a top priority by the American Society of Nephrology. Increasing knowledge in the science of biology and medicine is leading to the discovery of still more new biomarkers and of their roles in molecular pathways triggered by physiological and pathological conditions. Concomitantly, the development of the so-called "omics" allows the progressive clinical utilization of a multitude of information, from those related to the human genome (genomics) and proteome (proteomics), including the emerging epigenomics, to those related to metabolites (metabolomics). In preterm newborns, one of the most important factors causing the pathogenesis and the progression of AKI is the interaction between the individual genetic code, the environment, the gestational age, and the disease. By analyzing a small urine sample, metabolomics allows to identify instantly any change in phenotype, including changes due to genetic modifications. The role of liquid chromatography-mass spectrometry (LC-MS), proton nuclear magnetic resonance (1H NMR), and other emerging technologies is strategic, contributing basically to the sudden development of new biochemical and molecular tests. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are closely correlated with the severity of kidney injury, representing noninvasive sensitive surrogate biomarkers for diagnosing, monitoring, and quantifying kidney damage. To become routine tests, uNGAL and KIM-1 should be carefully tested in multicenter clinical trials and should be measured in biological fluids by robust, standardized analytical methods.
Collapse
Affiliation(s)
- M. Mussap
- Department of Laboratory Medicine, IRCCS San Martino-IST, University Hospital, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - A. Noto
- Department of Pediatrics and Clinical Medicine, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, 09042 Cagliari, Italy
| | - V. Fanos
- Department of Pediatrics and Clinical Medicine, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, 09042 Cagliari, Italy
| | - J. N. Van Den Anker
- Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC 20010, USA
| |
Collapse
|
49
|
Grgic I, Krautzberger AM, Hofmeister A, Lalli M, DiRocco DP, Fleig SV, Liu J, Duffield JS, McMahon AP, Aronow B, Humphreys BD. Translational profiles of medullary myofibroblasts during kidney fibrosis. J Am Soc Nephrol 2014; 25:1979-90. [PMID: 24652793 DOI: 10.1681/asn.2013101143] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myofibroblasts secrete matrix during chronic injury, and their ablation ameliorates fibrosis. Development of new biomarkers and therapies for CKD will be aided by a detailed analysis of myofibroblast gene expression during the early stages of fibrosis. However, dissociating myofibroblasts from fibrotic kidney is challenging. We therefore adapted translational ribosome affinity purification (TRAP) to isolate and profile mRNA from myofibroblasts and their precursors during kidney fibrosis. We generated and characterized a transgenic mouse expressing an enhanced green fluorescent protein (eGFP)-tagged L10a ribosomal subunit protein under control of the collagen1α1 promoter. We developed a one-step procedure for isolation of polysomal RNA from collagen1α1-eGFPL10a mice subject to unilateral ureteral obstruction and analyzed and validated the resulting transcriptional profiles. Pathway analysis revealed strong gene signatures for cell proliferation, migration, and shape change. Numerous novel genes and candidate biomarkers were upregulated during fibrosis, specifically in myofibroblasts, and we validated these results by quantitative PCR, in situ, and Western blot analysis. This study provides a comprehensive analysis of early myofibroblast gene expression during kidney fibrosis and introduces a new technique for cell-specific polysomal mRNA isolation in kidney injury models that is suited for RNA-sequencing technologies.
Collapse
Affiliation(s)
- Ivica Grgic
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine and Nephrology, Philipps-University, Marburg, Germany
| | - A Michaela Krautzberger
- Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine of the University of Southern California, Los Angeles, California; Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Los Angeles, California
| | - Andreas Hofmeister
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine and Nephrology, Philipps-University, Marburg, Germany
| | - Matthew Lalli
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Derek P DiRocco
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susanne V Fleig
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Hannover Medical School, Hannover, Germany
| | - Jing Liu
- Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jeremy S Duffield
- Division of Nephrology and Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Andrew P McMahon
- Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine of the University of Southern California, Los Angeles, California; Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Los Angeles, California
| | - Bruce Aronow
- University of Cincinnati Department of Pediatrics, Cincinnati, Ohio; and
| | - Benjamin D Humphreys
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Kidney Group, Harvard Stem Cell Institute, Cambridge, Massachusetts
| |
Collapse
|
50
|
Kaucsár T, Révész C, Godó M, Krenács T, Albert M, Szalay CI, Rosivall L, Benyó Z, Bátkai S, Thum T, Szénási G, Hamar P. Activation of the miR-17 family and miR-21 during murine kidney ischemia-reperfusion injury. Nucleic Acid Ther 2014; 23:344-54. [PMID: 23988020 DOI: 10.1089/nat.2013.0438] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ischemia-reperfusion (I/R) is the main cause of acute kidney injury (AKI) in patients. We investigated renal microRNA (miRNA) expression profiles and the time course of changes in selected miRNA expressions after renal I/R to characterize the miRNA network activated during development and recovery from AKI. METHODS AND RESULTS One day after lethal (30 minutes) and sublethal (20 minutes) renal ischemia, AKI was verified by renal histology (tubular necrosis, regeneration), blood urea nitrogen (BUN) level, renal mRNA expression, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) in C57BL/6J mice. On the first day after 30-minute, lethal I/R miR-21, miR-17-5p, and miR-106a were elevated out of the 21 miRNAs successfully profiled on the Luminex multiplex assay. After 20-minute, sublethal I/R, renal miR-17-5p and miR-106a expressions were elevated on the first and second days of reperfusion, while miR-21 expression increased later and lasted longer. Renal miR-17-5p and miR-21 expressions correlated with each other. Renal function returned to normal on the fourth day after sublethal I/R. CONCLUSIONS Our results demonstrate that besides miR-21, miR-17-5p, and miR-106a are additionally activated during the maintenance and recovery phases of renal I/R injury. Furthermore, a correlation between renal miR-17-5p and miR-21 expressions warrants further investigation of how they may influence each other and the outcome of renal ischemia-reperfusion injury.
Collapse
Affiliation(s)
- Tamás Kaucsár
- Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|