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Silva Barbosa JD, Meneses GC, Castelo LR, da Silva Júnior GB, Costa Martins AM, Francesco Daher ED, Sampaio TL, Oliveira Gomes AD, Carvalho Dantas SM, Silva Rebouças AD, de Lima PR, Lopes NC, da Silva ME, Rodrigues da Costa MD, Reis Jereissati AA, Ramos VQ, Gonçalves Machado RP, Gonçalves Lemes RP. Urinary cystatin-C and urinary NGAL associated with sepsis predicts longer hospital stay in premature newborns. Biomark Med 2024; 18:649-658. [PMID: 39263780 PMCID: PMC11404570 DOI: 10.1080/17520363.2024.2377532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 07/04/2024] [Indexed: 09/13/2024] Open
Abstract
Aim: To evaluate the urinary biomarkers related to sepsis in preterm newborns (NBs) and to investigate the predictive capacity of these biomarkers for a longer hospital stay.Methods: Serum and urine were collected from 27 healthy NBs, 24 NBs with neonatal infection without sepsis and 11 NBs with sepsis for the measurement of sindecan-1, lipocalin associated with urinary neutrophil gelatinase (uNGAL), urinary cystatin-C (uCysC) and urinary kidney injury molecule-1.Results: Levels of uNGAL and urinary cystatin-C were elevated in NBs with sepsis and neonatal infection, and uNGAL was significant predictor of hospital stay longer than 30 days (odds ratio: 1.052; 95% CI: 1.012-1.093; p = 0.01).Conclusion: uNGAL was associated with sepsis in preterm NBs and was useful to predict extended hospital stay.
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Affiliation(s)
| | | | - Luan Rebouças Castelo
- Postgraduate Program in Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Alice Maria Costa Martins
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Tiago Lima Sampaio
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Arthur da Silva Rebouças
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Paula Roberta de Lima
- Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Nicole Coelho Lopes
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Mateus Edson da Silva
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Mac Dionys Rodrigues da Costa
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Pons S, Trouillet-Assant S, Subtil F, Abbas-Chorfa F, Cornaton E, Berthiot A, Galletti S, Plat A, Rapin S, Trapes L, Generenaz L, Brengel-Pesce K, Callies A, Plaisant F, Claris O, Portefaix A, Flamant C, Butin M. Performance of 11 Host Biomarkers Alone or in Combination in the Diagnosis of Late-Onset Sepsis in Hospitalized Neonates: The Prospective EMERAUDE Study. Biomedicines 2023; 11:1703. [PMID: 37371798 DOI: 10.3390/biomedicines11061703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the high prevalence of late-onset sepsis (LOS) in neonatal intensive care units, a reliable diagnosis remains difficult. This prospective, multicenter cohort study aimed to identify biomarkers early to rule out the diagnosis of LOS in 230 neonates ≥7 days of life with signs of suspected LOS. Blood levels of eleven protein biomarkers (PCT, IL-10, IL-6, NGAL, IP-10, PTX3, CD14, LBP, IL-27, gelsolin, and calprotectin) were measured. Patients received standard of care blinded to biomarker results, and an independent adjudication committee blinded to biomarker results assigned each patient to either infected, not infected, or unclassified groups. Performances of biomarkers were assessed considering a sensitivity of at least 0.898. The adjudication committee classified 22% of patients as infected and all of these received antibiotics. A total of 27% of the not infected group also received antibiotics. The best biomarkers alone were IL-6, IL-10, and NGAL with an area under the curve (95% confidence interval) of 0.864 (0.798-0.929), 0.845 (0.777-0.914), and 0.829 (0.760-0.898), respectively. The best combinations of up to four biomarkers were PCT/IL-10, PTX3/NGAL, and PTX3/NGAL/gelsolin. The best models of biomarkers could have identified not infected patients early on and avoided up to 64% of unjustified antibiotics. At the onset of clinical suspicion of LOS, additional biomarkers could help the clinician in identifying non-infected patients.
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Affiliation(s)
- Sylvie Pons
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Sophie Trouillet-Assant
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
- Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, INSERM U1111, CNRS UMR5308, ENS Lyon, 69364 Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Fatima Abbas-Chorfa
- Service de Biostatistique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Elise Cornaton
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Amélie Berthiot
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Sonia Galletti
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Aurélie Plat
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Stephanie Rapin
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Laurene Trapes
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Laurence Generenaz
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Karen Brengel-Pesce
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Arnaud Callies
- Department of Neonatology, Hôpital Mère-Enfant, University Hospital of Nantes, 44093 Nantes, France
| | - Franck Plaisant
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Croix Rousse, 69002 Lyon, France
- Research Unit EA 4129, University Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Aurelie Portefaix
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Cyril Flamant
- Department of Neonatology, Hôpital Mère-Enfant, University Hospital of Nantes, 44093 Nantes, France
| | - Marine Butin
- Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, INSERM U1111, CNRS UMR5308, ENS Lyon, 69364 Lyon, France
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
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Correa LP, Marzano ACS, Silva Filha R, Magalhães RC, Simoes-E-Silva AC. Biomarkers of renal function in preterm neonates at 72h and 3weeks of life. J Pediatr (Rio J) 2021; 97:508-513. [PMID: 33358961 PMCID: PMC9432259 DOI: 10.1016/j.jped.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Serum levels of creatinine in neonates are quite variable and suffer interference from the immature kidney and maternal creatinine concentration. The aim of this study was to measure novel biomarkers of glomerular and tubular function in healthy preterm neonates at 72h and 3 weeks of life. METHODS Urine samples were collected in 40 preterm neonates with 28-34 incomplete weeks of gestational age. None of the participants had comorbidities, malformations and infections. The samples were collected at 72h of life and at 3 weeks after birth. Measurements of Calbindin, Collagen IV, FABP1, αGST, IP-10, KIM-1, Osteoactivin, Renin, TFF-3, TIMP-1, α-1-Microglobulin, Albumin, Clusterin, Cystatin C, EGF, Lipocalin-2/NGAL and Osteopontin were performed using panels 1 and 2 of multiplex kits of kidney injury. Data were analyzed using the software GraphPad Prism version 6.0. RESULTS The preterm neonates included 55% of males with gestational age of 30±1 weeks. The most frequent maternal condition associated with preterm birth was preeclampsia (80%). Molecules related to glomerular function showed a significant increase in the concentrations obtained at 3 weeks of life compared to 72h of life. Markers related to tubular injury (KIM-1 and NGAL) also showed an increase. On the other hand, cystatin C did not change. CONCLUSION The elevation of molecules related to glomerular function indicates an increase of glomerular filtration rate from 72h up until 3 weeks of life, which was not clearly detected with the measurement of cystatin C.
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Affiliation(s)
- Luisa Petri Correa
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Unidade de Nefrologia Pediátrica, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil
| | - Alessandra Cristina Santos Marzano
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Unidade de Nefrologia Pediátrica, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil
| | - Roberta Silva Filha
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Unidade de Nefrologia Pediátrica, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil
| | - Rafael Coelho Magalhães
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Unidade de Nefrologia Pediátrica, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simoes-E-Silva
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Unidade de Nefrologia Pediátrica, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil.
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Capelli I, Vitali F, Zappulo F, Martini S, Donadei C, Cappuccilli M, Leonardi L, Girardi A, Aiello V, Galletti S, Faldella G, Poluzzi E, DE Ponti F, Gaetano LAM. Biomarkers of Kidney Injury in Very-low-birth-weight Preterm Infants: Influence of Maternal and Neonatal Factors. In Vivo 2021; 34:1333-1339. [PMID: 32354927 DOI: 10.21873/invivo.11910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM Acute kidney injury is an important cause of mortality in very-low-birth-weight (VLBW) preterm infants. As in the general population, the detection of renal damage cannot rely on the measurement of serum creatinine, since it has been demonstrated to be a weak predictor and a delayed indicator of kidney function deterioration. However, several candidate biomarkers have failed to prove sufficient specificity and sensitivity for a routine clinical use because of the poor awareness of their biological role. This study was aimed to investigate the impact of different maternal and neonatal conditions on several renal biomarkers in VLBW preterm infants during the first week of life. PATIENTS AND METHODS Preterm infants<32 weeks' gestation and <1500g were enrolled. We measured urinary biomarkers kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, epidermal growth factor (EGF) and osteopontin (OPN) on the 1st, 3rd, and 7th day after birth. RESULTS Thirty-tree infants were included. The multivariate analysis showed a significant association between gestational age, the presence of patent ductus arteriosus, antenatal maternal hypertension and the levels of urinary biomarkers. CONCLUSION There is a possible relation between early biomarkers of renal injury and antenatal, perinatal and post-natal characteristics in VLBW preterm infants during the first week of life.
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Affiliation(s)
- Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesca Vitali
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Martini
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Chiara Donadei
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Luca Leonardi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Anna Girardi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Galletti
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Fabrizio DE Ponti
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - LA Manna Gaetano
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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5
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Hidayati EL, Utami MD, Rohsiswatmo R, Tridjaja B. Cystatin C compared to serum creatinine as a marker of acute kidney injury in critically ill neonates. Pediatr Nephrol 2021; 36:181-186. [PMID: 32594242 DOI: 10.1007/s00467-020-04668-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is one of the most common causes of neonatal morbidity and mortality. Diagnosing AKI in neonates is challenging as it lacks specific signs, symptoms, and biomarkers. However, detecting AKI in critically ill neonates is crucial to determine appropriate management and prevent complications. Cystatin C (CysC) has been recognized as a superior kidney biomarker reflecting kidney function in neonates. The objective of this study is to evaluate the diagnostic value of CysC as an AKI biomarker in critically ill neonates. METHODS We performed a diagnostic test between cystatin C-based estimated glomerular filtration rate (eGFR-CysC) and serum creatinine-based estimated glomerular filtration rate (eGFR-SCr) as the gold standard to diagnose AKI in 135 critically ill neonates treated in Cipto Mangunkusumo National Hospital from July 2017 to January 2018. RESULTS Prevalence of AKI was 23.7% predominantly in neonates with a very preterm gestational age, low birthweight, probable sepsis, and those receiving invasive oxygen therapy or nephrotoxic drugs. The proportion of AKI based on neonate RIFLE criteria was 72.7% risk, 18.9% injury, and 9% failure. eGFR-CysC had the following parameters: sensitivity, 84.8%; specificity, 61.8%; PPV, 41.8%; NPV, 89.7%; LR(+), 2.2; LR(-), 0.24; and accuracy, 67.4%. The AUROC for CysC was 84.9%. The optimal cut-off value for CysC was 1.605 mg/l. CONCLUSIONS CysC may be used as a screening biomarker of AKI in critically ill neonates; yet, it was not superior to serum creatinine. Graphical abstract.
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Affiliation(s)
- Eka Laksmi Hidayati
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Meita Dwi Utami
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rinawati Rohsiswatmo
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bambang Tridjaja
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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6
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Yum SK, Seo YM, Youn YA, Sung IK. Preoperative metabolic acidosis and acute kidney injury after open laparotomy in the neonatal intensive care unit. Pediatr Int 2019; 61:994-1000. [PMID: 31267596 DOI: 10.1111/ped.13929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/25/2019] [Accepted: 06/14/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study evaluated potential risk factors associated with acute kidney injury (AKI) in infants undergoing bedside open laparotomy in the neonatal intensive care unit (NICU), and analyzed the association between postoperative AKI and outcomes. METHODS Retrospective data, including neonatal characteristics, perioperative findings (i.e. vital signs and fluid status), postoperative AKI incidence, and postoperative mortality rate of infants who underwent bedside open laparotomy in the NICU between May 2013 and May 2018 were collected and analyzed. RESULTS A total of 53 cases (26 in AKI group vs 27 in non-AKI group) were analyzed. On univariable analysis, transfusion, pre- and postoperative blood gas analysis and number of inotropic agents, cumulative postoperative percentage fluid overload (48 h), and preoperative hourly urine output were associated with the development of postoperative AKI. On multivariable logistic regression analysis, preoperative acidosis (pH <7.15 or base deficit >10; P = 0.002; OR, 11.067; 95%CI: 2.499-49.017) and preoperative urine output (P = 0.035; OR, 0.548; 95%CI: 0.314-0.959) were significant factors associated with postoperative AKI. Postoperative mortality rate 30 days after surgery was higher in the AKI group, but the difference was not significant. CONCLUSIONS Preoperative metabolic acidosis and urine output are important factors potentially associated with the development of postoperative AKI in neonates undergoing bedside open laparotomy. Strategies such as alkali therapy, which protect the kidney from further injury, should be validated in future studies. A decreasing urine output may suggest deteriorating kidney function prior to surgery, potentially amplifying the risk of postoperative AKI.
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Affiliation(s)
- Sook Kyung Yum
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Yu Mi Seo
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Young-Ah Youn
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - In Kyung Sung
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
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7
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Yuan L, Zhu L, Zhang Y, Chen H, Kang H, Li J, Zhao X, Wan M, Miao Y, Tang W. Effect of Da-Cheng-Qi decoction for treatment of acute kidney injury in rats with severe acute pancreatitis. Chin Med 2018; 13:38. [PMID: 30013616 PMCID: PMC6045888 DOI: 10.1186/s13020-018-0195-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/09/2018] [Indexed: 02/05/2023] Open
Abstract
Background The traditional Chinese formula Da-Cheng-Qi-decoction (DCQD) has been used to treat acute pancreatitis for decades. DCQD could ameliorate the disease severity and the complications of organ injuries, including those of the liver and lungs. However, the pharmacological effects in the kidney, a target organ, are still unclear. This study aimed to investigate the herbal tissue pharmacology of DCQD for acute kidney injury (AKI) in rats with severe acute pancreatitis (SAP). Methods Rats were randomly divided into the sham-operation group (SG), the model group (MG) and the low-, medium- and high-dose treatment groups (LDG, MDG, and HDG, respectively). Sodium taurocholate (3.5%) was retrogradely perfused into the biliopancreatic duct to establish the model of SAP in rats. Different doses of DCQD were administered to the treatment groups 2 h after the induction of SAP. The major components of DCQD in kidney tissues were detected by HPLC–MS/MS. Inflammatory mediators in the kidney tissues, as well as serum creatinine (Scr), blood urea nitrogen (BUN) and pathologic scores, were also evaluated. Results Ten components of DCQD were detected in the kidneys of the treatment groups, and their concentrations increased dose-dependently. Compared with the SG, the levels of inflammatory mediators, Scr, BUN and pathological scores in the MG were obviously increased (p < 0.05). The high dose of DCQD showed a maximal effect in downregulating the pro-inflammatory mediators interleukin-6 (IL)-6 and tumour necrosis factor-α (TNF-α), upregulating anti-inflammatory mediators IL-4 and IL-10 in the kidney and alleviating the pathological damages. DCQD decreased the pancreas and kidney pathological scores of rats with SAP, especially in the HDG (p < 0.05). Compared with the MG, the level of Scr in the HDG was significantly decreased (p < 0.05). Conclusions DCQD ameliorated AKI in rats with SAP via regulating the inflammatory response, which might be closely related to the distribution of its components in the kidney. Electronic supplementary material The online version of this article (10.1186/s13020-018-0195-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ling Yuan
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Lv Zhu
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Yumei Zhang
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Huan Chen
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Hongxin Kang
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Juan Li
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Xianlin Zhao
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Meihua Wan
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Yifan Miao
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Wenfu Tang
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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9
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Sweetman DU. Neonatal acute kidney injury - Severity and recovery prediction and the role of serum and urinary biomarkers. Early Hum Dev 2017; 105:57-61. [PMID: 28089174 DOI: 10.1016/j.earlhumdev.2016.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neonatal acute kidney injury is common, in part due to incomplete renal maturation and also due to frequent exposure to risk factors for acute kidney injury such as perinatal asphyxia, extracorporeal-membrane-oxygenation, cardiac surgery, sepsis, prematurity and nephrotoxicity. However the current method by which acute kidney injury is diagnosed is sub-optimal and not universally accepted which impairs the accurate estimation of the true incidence of neonatal acute kidney injury. Serum Cystatin-C, urinary NGAL, KIM-1 and IL-18 are promising neonatal acute kidney injury biomarkers however the diagnosis of acute kidney injury remains serum creatinine/urine output-based in many studies. Emerging biomarkers which require further study in the neonatal population include netrin-1 and EGF. Increased awareness amongst clinicians of nephrotoxic medications being a modifiable risk factor for the development of neonatal acute kidney injury is imperative. The burden of chronic kidney failure following neonatal acute kidney injury is unclear and requires further study.
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Affiliation(s)
- Deirdre U Sweetman
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
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10
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STUDY OF ACUTE KIDNEY INJURY IN PREMATURE NEWBORNS AFFECTED BY PERINATAL HYPOXIA. WORLD OF MEDICINE AND BIOLOGY 2017. [DOI: 10.26724/2079-8334-2017-4-62-71-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Güneş A, Ece A, Aktar F, Tan İ, Söker M, Karabel D, Balık H, Uluca Ü, Şen V, Yolbaş İ. Urinary Kidney Injury Molecules in Children with Iron-Deficiency Anemia. Med Sci Monit 2015; 21:4023-9. [PMID: 26697893 PMCID: PMC4694706 DOI: 10.12659/msm.896794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/08/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the urine levels of human kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with iron-deficiency anemia (IDA). MATERIAL AND METHODS Thirty-five children with IDA and 32 matched healthy controls were recruited. We assessed complete blood count, serum iron, iron-binding capacity, ferritin, serum levels of urea, creatinine (Cr), sodium (Na), potassium (K), calcium (Ca), and glucose levels. Estimated glomerular filtration rate (eGFR) was calculated. Urinary NAG, NGAL, KIM-1, and L-FABP were measured and divided by urine creatinine for comparisons. RESULTS There were no significant differences in serum urea, Cr, or eGFR between the IDA group and the control group (p>0.05, for all). IDA patients had significantly higher urine NGAL/Cr, L-FABP/Cr, KIM-1/Cr, and NAG/Cr compared with the control group (p<0.05). There were significant negative correlations between hemoglobin, hematocrit, red blood cell count, and urine NGAL/Cr, NAG/Cr, L-FABP/Cr, KIM-1/Cr levels (p<0.05). CONCLUSIONS Higher urinary kidney injury molecule levels in IDA patients suggest a possible subclinical renal injury in pediatric IDA patients whose renal functions and serum electrolytes were normal.
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Affiliation(s)
- Ali Güneş
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Aydın Ece
- Department of Pediatric Nephrology, Medical School, Dicle University, Diyarbakir, Turkey
| | - Fesih Aktar
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - İlhan Tan
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Murat Söker
- Department of Pediatric Hematology, Medical School, Dicle University, Diyarbakir, Turkey
| | - Duran Karabel
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Hasan Balık
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Ünal Uluca
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Velat Şen
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - İlyas Yolbaş
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
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12
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Assadi F, Sharbaf FG. Practical considerations to drug dosing in children with acute kidney injury. J Clin Pharmacol 2015; 56:399-407. [PMID: 26363281 DOI: 10.1002/jcph.636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/04/2015] [Indexed: 01/12/2023]
Abstract
Medication dosing for children with acute kidney injury (AKI) needs to be individualized based on pharmacokinetic and pharmacodynamic principles of the prescribed drugswhenever possible to optimize therapeutic outcome and to minimize toxicity. The pediatric RIFLE criteria should be prospectively utilized to identify patients at highest risk of developing AKI. Serum creatinine and urine output along with volume status should be utilized to guide drug dosing when urinary biomarkers including kidney injury molecule 1, interleukin-18, or neutrophil gelatinase-associated lipocalin are not readily available. Because of the presence of a positive fluid balance in early stages of AKI, the dosing regimen for many drugs, especially antimicrobial agents, should be initiated at a larger loading dose based on the expected volume of distribution to achieve target serum concentrations.When possible, therapeutic drug monitoring should be utilized for those medications where serum drug concentrations can be obtained in a clinically relevant time frame. For these medications, close monitoring of serum drug concentrations is highly recommended. This review addresses drug-dosing strategies in pediatric patients with AKI including the roles of therapeutic drug monitoring and newer kidney injury biomarkers.
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Affiliation(s)
- Farahnak Assadi
- Department of Pediatrics, Section of Nephrology, Rush University Medical Center, Chicago, IL, USA
| | - Fatemeh Ghane Sharbaf
- Department of Pediatrics, Section of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran
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13
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Umbilical neutrophil gelatinase-associated lipocalin level as an early predictor of acute kidney injury in neonates with hypoplastic left heart syndrome. BIOMED RESEARCH INTERNATIONAL 2015; 2015:360209. [PMID: 25699275 PMCID: PMC4324892 DOI: 10.1155/2015/360209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/12/2014] [Accepted: 11/18/2014] [Indexed: 12/27/2022]
Abstract
Acute kidney injury (AKI) is a primarily described complication after unbalanced systemic perfusion in neonates with congenital heart defects, including hypoplastic left heart syndrome (HLHS). The aim of the study was to compare the umbilical NGAL concentrations between neonates born with HLHS and healthy infants, as well as to analyze whether the determination of NGAL level could predict AKI in neonates with prenatally diagnosed HLHS. Twenty-one neonates with prenatally diagnosed HLHS were enrolled as study group and 30 healthy neonates served as controls. Perinatal characteristics and postnatal parameters were extracted from the hospital neonatal database. In umbilical cord blood, we determined plasma NGAL concentrations, acid base balance, and lactate and creatinine levels. In neonates with HLHS, complications (respiratory insufficiency, circulatory failure, NEC, IVH, and AKI) were recorded until the day of cardiosurgery. We observed in neonates with HLHS higher umbilical NGAL levels compared to controls. Among 8 neonates with HLHS and diagnosed AKI stage 1, we observed elevated NGAL levels in comparison to those newborns without AKI. Umbilical NGAL could predict, with high sensitivity and specificity, AKI development in study neonates. We suggest that the umbilical blood NGAL concentration may be an early marker to predict AKI in neonates with HLHS.
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14
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Hsu WL, Lin YS, Hu YY, Wong ML, Lin FY, Lee YJ. Neutrophil gelatinase-associated lipocalin in dogs with naturally occurring renal diseases. J Vet Intern Med 2014; 28:437-42. [PMID: 24417186 PMCID: PMC4858015 DOI: 10.1111/jvim.12288] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 11/07/2013] [Accepted: 11/21/2013] [Indexed: 01/04/2023] Open
Abstract
Background Neutrophil gelatinase–associated lipocalin (NGAL) is released from renal tubular cells after injury and serves in humans as a real‐time indicator of active kidney damage, including acute kidney injury (AKI) and chronic kidney disease (CKD). However, NGAL concentrations in dogs with naturally occurring AKI or CKD rarely have been explored in detail. Hypothesis/Objectives The goal of this study was to evaluate whether NGAL can serve as a useful biomarker in dogs with naturally occurring renal disease. Animals Client‐owned dogs with renal disease (57) and control dogs without any disease (12) were examined. Methods Serum NGAL (sNGAL) and urine NGAL (uNGAL) concentrations were measured in each animal by a newly developed ELISA system. Demographic, hematologic, and serum biochemical data were recorded. Survival attributable to AKI and CKD was evaluated at 30 days and 90 days, respectively. Results Serum and urine NGAL concentrations in azotemic dogs were significantly higher than in nonazotemic dogs and were highly correlated with serum creatinine concentration (P < .05). Among CKD dogs, death was associated with significantly higher sNGAL and uNGAL concentrations compared with survivors. Receiver‐operating characteristic curve (ROC) analysis showed that sNGAL was better than serum creatinine concentration when predicting clinical outcomes for CKD dogs (P < .05). The best cutoff point for sNGAL was 50.6 ng/mL, which gave a sensitivity and a specificity of 76.9 and 100%, respectively. Furthermore, dogs that had higher concentrations of sNGAL survived for a significantly shorter time. Conclusion sNGAL is a useful prognostic marker when evaluating dogs with CKD.
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Affiliation(s)
- W-L Hsu
- Graduate Institute of Veterinary Microbiology and Public Health, National Chung Hsing University, Taichung, Taiwan
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15
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Bezerra CTDM, Vaz Cunha LC, Libório AB. Defining reduced urine output in neonatal ICU: importance for mortality and acute kidney injury classification. Nephrol Dial Transplant 2013; 28:901-9. [PMID: 23348885 DOI: 10.1093/ndt/gfs604] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is an independent risk factor for mortality in adults and children. Generally, urine output (UO) < 1 mL/kg/h is accepted as oliguria in neonates, although it has not been systematically studied. pRIFLE criteria suggest UO cut-offs similar to those of the adult population (0.3 and 0.5 mL/kg/h). The aim of the present study was to investigate UO in correlation with mortality in critically ill neonates and suggest changes in the pRIFLE definition of reduced diuresis. METHODS A retrospective cohort study was performed in an eight-bed neonatal intensive care unit (NICU). UO was systematically measured by diaper weight each 3 h. Discriminatory capacity to predict mortality of UO was measured and patients were divided according to UO ranges: G1 > 1.5 mL/kg/h; G2 1.0-1.5 mL/kg/h; G3 0.7-1.0 mL/kg/h and G4 < 0.7 mL/kg/h. These ranges were incorporated to pRIFLEGFR criteria and its performance was evaluated. RESULTS Of 384 patients admitted at the NICU during the study period, 72 were excluded and overall mortality was 12.8%. UO showed good performance for mortality prediction (area under the curve 0.789, P < 0.001). There was a stepwise increase in hospital mortality according to UO groups after controlling for SNAPPE-II and diuretic use. Using these UO ranges with pRIFLE improves its discriminatory capacity (area under the receiver operating characteristic curve 0.882 versus 0.693, P < 0.05). CONCLUSIONS UO is a predictor of mortality in NICU. An association between a UO threshold < 1.5 mL/kg/h and mortality was observed, which is higher than the previously published pRIFLE thresholds. Adopting higher values of UO in pRIFLE criteria can improve its capacity to detect AKI severity in neonates.
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