1
|
Sun Y, Zhang X, Zhang M, Guo Y, Sun T, Liu M, Gao X, Liu Y, Gao Z, Chen L, Du X, Wang Y. Preliminary investigation of the effect of non-cardiac surgery on intraoperative islet and renal function: a single-center prospective cohort study. Front Med (Lausanne) 2024; 11:1235335. [PMID: 38414619 PMCID: PMC10897010 DOI: 10.3389/fmed.2024.1235335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
Background The effect of different non-cardiac surgical methods on islet and renal function remains unclear. We conducted a preliminary investigation to determine whether different surgical methods affect islet function or cause further damage to renal function. Methods In this prospective cohort study, the clinical data of 63 adult patients who underwent non-cardiac surgery under general anesthesia were evaluated from February 2019 to January 2020. Patients were divided into the abdominal surgery group, the laparoscopic surgery group, and the breast cancer surgery group. The primary outcome was the difference between the effects of different surgical methods on renal function. Results Islet and renal function were not significantly different between the groups. The correlation analysis showed that hematocrit (HCT) and hemoglobin (HB) were negatively correlated with fasting plasma glucose (FPG) (p < 0.05), MAP was positively correlated with C-peptide (p < 0.05), and HCT and Hb were positively correlated with serum creatinine (SCr) (p < 0.05). Fasting insulin (FINS) and C-peptide were negatively correlated with SCr (p < 0.05), and the homeostatic model assessment of insulin resistance (HOMA-IR) was positively correlated with SCr (p < 0.05). FINS, C-peptide, HOMA-IR, and the homeostatic model assessment of β-cell function (HOMA-β) were positively correlated with cystatin C (Cys C) (p < 0.05). Conclusion FINS, C-peptide, and HOMA-IR had positive effects on beta-2-microglobulin (β2-MG). FINS, C-peptide, and HOMA-IR were positively correlated with Cys C and β2-Mg. While FINS and C-peptide were negatively correlated with SCr, HOMA-IR was positively correlated with SCr.
Collapse
Affiliation(s)
- Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mengjie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Zhongquan Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaoyan Du
- Yidu Cloud (Beijing) Technology Co. Ltd., Beijing, China
| | - Yuelan Wang
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| |
Collapse
|
2
|
Asrani SK, Shankar N, da Graca B, Nadim MK, Cardenas A. Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation. Liver Transpl 2022; 28:466-482. [PMID: 34714972 DOI: 10.1002/lt.26344] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 01/13/2023]
Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) are important drivers of morbidity and mortality in patients with cirrhosis before and after liver transplantation (LT). In this review, we examine the role of novel kidney biomarkers for early recognition of kidney injury. Studies are limited by lack of reference standards, heterogeneous definitions of outcomes and biomarker cutoffs, and inconsistent diagnostic performance. Overall, a change in biomarker is more relevant than an absolute cutoff. Cystatin C and urinary neutrophil gelatinase-associated lipocalin (uNGAL) are the most studied candidate biomarkers and identify AKI or progression of AKI earlier than serum creatinine (sCr). Kidney injury molecule 1 and liver-type fatty acid-binding protein (L-FABP) also show potential. NGAL and interleukin 18 may play a role in differentiating acute tubular necrosis from other forms of AKI. Combining novel biomarkers with the Model for End-Stage Liver Disease score may assist prognosis. Persistent elevations in select markers (eg, NGAL) can portend irreversible injury. Several pretransplantation markers (including sCr) predict posttransplantation kidney dysfunction. Pretransplantation assessment of clinical factors (eg, age, diabetes) and novel markers (osteopontin and tissue inhibitor of metalloproteinases 1 [TIMP-1]) may predict renal kidney recovery after LT. Intraoperative changes in biomarkers predict early post-LT AKI. Prediction of CKD remains difficult, although a combination of biomarkers (eg, beta-2 microglobulin, CD40) is promising. Novel biomarkers have yet to replace sCr in guideline-based evaluation and management of kidney dysfunction in patients with cirrhosis. We propose a theoretical framework for practical incorporation of these biomarkers that considers patient characteristics (risk for irreversible injury), markers of functional and structural change, and assessment of the AKI-CKD continuum to identify patients at the highest risk for progressive kidney disease before and after LT.
Collapse
Affiliation(s)
| | | | | | - Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Andres Cardenas
- GI/Liver Transplant Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| |
Collapse
|
3
|
Wang R, Hu H, Hu S, He H, Shui H. β2-microglobulin is an independent indicator of acute kidney injury and outcomes in patients with intracerebral hemorrhage. Medicine (Baltimore) 2020; 99:e19212. [PMID: 32080111 PMCID: PMC7034650 DOI: 10.1097/md.0000000000019212] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI), a serious complication in critically ill patients, is associated with poor clinical outcomes. We explored the hypothesis that β2-microglobulin (β2-MG) is an independent indicator of AKI development and outcomes in patients with intracerebral hemorrhage (ICH) in the neurosurgical intensive care unit (NICU).Patients with ICH (n = 403) admitted to the NICU of Zhongnan Hospital, Wuhan University, between January 1, 2015 and December 31, 2016 were prospectively enrolled in this single-center, observational study. The primary outcome was the incidence of AKI, secondary outcomes were in-hospital mortality and 1-year mortality (from time of admission).The overall AKI incidence, in hospital, was 35.2%; patients were diagnosed with stage 1 (22.1%), 2 (5.7%), and 3 (7.4%) AKI. β2-MG levels predicted AKI with an area under the curve of 0.712 (95% confidence interval [CI], 0.652-0.772) and a cut-off of 2026.85 μg/L (sensitivity, 57.5%; specificity, 79.4%). Compared with the group having lower β2-MG values, the group with higher values (β2-MG >2123.50 μg/L) had significantly higher risks of AKI (odds ratio, 2.606; 95% CI, 1.315-5.166), in-hospital mortality (hazard ratio [HR], 2.548; 95% CI, 1.318-4.924), and 1-year mortality (HR, 3.161; 95% CI, 1.781-5.611) in adjusted analyses.β2-MG levels predict AKI development and outcomes in patients with ICH in the NICU.
Collapse
Affiliation(s)
| | - Hongtao Hu
- Department of Intensive Care Unit, Zhongnan Hospital, Wuhan University, Wuhan, China
| | | | | | | |
Collapse
|
4
|
Lu HY, Ning XY, Chen YQ, Han SJ, Chi P, Zhu SN, Yue Y. Predictive Value of Serum Creatinine, Blood Urea Nitrogen, Uric Acid, and β 2-Microglobulin in the Evaluation of Acute Kidney Injury after Orthotopic Liver Transplantation. Chin Med J (Engl) 2018; 131:1059-1066. [PMID: 29692377 PMCID: PMC5937314 DOI: 10.4103/0366-6999.230726] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background As a major complication after orthotopic liver transplantation (OLT), the occurrence of acute kidney injury (AKI) is frequently defined by serum creatinine (Cr); however, the accuracy of commonly used blood urea nitrogen (BUN), uric acid (UA), and β2-microglobulin (β2-MG) remains to be explored. This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation. Methods Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled. The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes (KDIGO) criteria and classified by stage. Measurement data were analyzed using the t-test or Wilcoxon rank-sum test; enumerated data were analyzed using the Chi-square test or Fisher's exact test. Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic (ROC) curve analysis. Results This study excluded 976 cases and analyzed 697 patients (578 men and 119 women); the post-OLT AKI incidence was 0.409. Compared with the no-AKI group, the AKI group showed very significant differences in Model for End-stage Liver Disease score (14.74 ± 9.91 vs. 11.07 ± 9.54, Z = 5.404; P < 0.001), hepatic encephalopathy (45 [15.8%] vs. 30 [7.3%], χ2 = 12.699; P < 0.001), hemofiltration (28 [9.8%] vs. 0 [0.0%], χ2 = 42.171; P < 0.001), and 28-day mortality (23 [8.1%] vs. 9 [2.2%], χ2 = 13.323; P <0.001). Moreover, mean values of Cr, BUN, UA, and β2-MG in the AKI group differed significantly at postoperative days 1, 3, and 7 (all P < 0.001). ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 (sensitivity 80.1%, specificity 75.7%, cutoff value 88.23 μmol/L), 0.916 for Stage 2 (sensitivity 87.6%, specificity 82.6%, cutoff value 99.9 μmol/L), and 0.972 for Stage 3 (sensitivity 94.1%, specificity 88.2%, cutoff value 122.90 μmol/L). Conclusion The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.
Collapse
Affiliation(s)
- Hai-Yang Lu
- Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020; Department of Anaesthesiology, Beijing You An Hospital, Capital Medical University, Beijing 100069; Department of Anaesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xin-Yu Ning
- Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020; Department of Anaesthesiology, The General Hospital of the Chinese People's Armed Police Forces, Beijing 100039, China
| | - Ying-Qi Chen
- Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Shu-Jun Han
- Department of Anaesthesiology, The General Hospital of the Chinese People's Armed Police Forces, Beijing 100039, China
| | - Ping Chi
- Department of Anaesthesiology, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Sai-Nan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing 100034, China
| | - Yun Yue
- Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| |
Collapse
|
5
|
Dexmedetomidine Pretreatment Attenuates Kidney Injury and Oxidative Stress during Orthotopic Autologous Liver Transplantation in Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2016:4675817. [PMID: 26682005 PMCID: PMC4670681 DOI: 10.1155/2016/4675817] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 12/18/2022]
Abstract
This paper aims to explore whether pretreatment with dexmedetomidine (Dex) has antioxidative and renal protective effects during orthotopic autologous liver transplantation (OALT) and its impact on nuclear factor erythroid 2-related factor 2 (Nrf2) activation. Sprague-Dawley rats were randomized into groups that include sham-operated (group S), model (group M), low dose Dex (group D1),
high dose Dex (group D2), atipamezole (a nonspecific α2 receptor blocker) + high dose Dex (group B1), ARC239 (a specific α2B/c receptor blocker) + high dose Dex (group B2), and BRL-44408 (a specific α2A receptor blocker) + high dose Dex (group B3). Then histopathologic examination of the kidneys and measurement of renal function, the renal Nrf2 protein expression, and oxidants and antioxidants were performed 8 hours after OALT. We found that pretreatment with Dex activated Nrf2 in glomerular cells and upregulated antioxidants but reduced oxidants (all P < 0.01, group D2 versus group M). Atipamezole and BRL-44408, but not ARC239, reversed these protective effects. In conclusion, pretreatment with Dex activates Nrf2 through α2A receptor, increases the antioxidant levels, and attenuates renal injury during OALT.
Collapse
|
6
|
Dexmedetomidine Inhibits TLR4/NF-κB Activation and Reduces Acute Kidney Injury after Orthotopic Autologous Liver Transplantation in Rats. Sci Rep 2015; 5:16849. [PMID: 26585410 PMCID: PMC4653646 DOI: 10.1038/srep16849] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/21/2015] [Indexed: 12/24/2022] Open
Abstract
Patients who undergo orthotopic liver transplantation often sustain acute kidney injury(AKI). The toll-like receptor 4(TLR4)/Nuclear factor-кB(NF-кB) pathway plays a role in AKI. Dexmedetomidine(Dex) has been shown to attenuate AKI. The current study aimed to determine whether liver transplantation-induced AKI is associated with inflammatory response, and to assess the effects of dexmedetomidine pretreatment on kidneys in rats following orthotopic autologous liver transplantation(OALT). Seventy-seven adult male rats were randomized into 11 groups. Kidney tissue histopathology and levels of blood urea nitrogen(BUN) and serum creatinine(SCr) were evaluated. Levels of TLR4, NF-κB, tumor necrosis factor-α, and interleukin-1β levels were measured in kidney tissues. OALT resulted in significant kidney functional impairment and tissue injury. Pre-treatment with dexmedetomidine decreased BUN and SCr levels and reduced kidney pathological injury, TLR4 expression, translocation of NF-κB, and cytokine production. The effects of dexmedetomidine were reversed by pre-treatment with atipamezole and BRL44408, but not ARC239. These results were confirmed by using α2A-adrenergic receptor siRNA which reversed the protective effect of dexmedetomidine on attenuating NRK-52E cells injury induced by hypoxia reoxygenation. In conclusion, Dexmedetomidine-pretreatment attenuates OALT-induced AKI in rats which may be contributable to its inhibition of TLR4/MyD88/NF-κB pathway activation. The renoprotective effects are related to α2A-adrenergic receptor subtypes.
Collapse
|
7
|
Jun L, Tong G, Xu F, Renjie Z. Effect of salvianolic acid A and C compatibility on inflammatory cytokines in rats with unilateral ureteral obstruction. J TRADIT CHIN MED 2015; 35:564-70. [DOI: 10.1016/s0254-6272(15)30140-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
8
|
Chen S, Shi JS, Yibulayin X, Wu TS, Yang XW, Zhang J, Baiheti P. Cystatin C is a moderate predictor of acute kidney injury in the early stage of traumatic hemorrhagic shock. Exp Ther Med 2015; 10:237-240. [PMID: 26170941 DOI: 10.3892/etm.2015.2446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 04/01/2015] [Indexed: 01/20/2023] Open
Abstract
Patients with traumatic hemorrhagic shock are highly susceptible to the development of acute kidney injury (AKI), but little data are available regarding the changes in cystatin C (CysC) in patients with traumatic hemorrhagic shock. The aim of the present study, therefore, was to investigate whether CysC has a higher value than serum creatinine (SCr) and urea for use in monitoring glomerular function in traumatic hemorrhagic shock. Data from a cohort of patients with traumatic hemorrhagic shock, who had been admitted to a trauma center, were collected. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of serum CysC, SCr and urea for the identification of renal dysfunction, and the data were expressed as the area under the curve (AUC). CysC was not significantly affected by gender, age, mechanism of injury or time between injury and arrival at the center in the patients with traumatic hemorrhagic shock. The CysC level of the patients was significantly higher than that of the normal subjects (1.10±0.36 vs. 0.91±0.34 mg/l); the SCr and urea levels of the patients were also significantly increased compared with those of the normal subjects. Nonparametric ROC plots of the sensitivity and specificity of SCr, CysC and urea for the detection of AKI revealed AUC values of 0.901 [95% confidence interval (CI), 0.791-1.000], 0.728 (95% CI, 0.570-0.886) and 0.709 (95% CI, 0.552-0.865) for SCr, CysC and urea, respectively. No significant correlation between mortality and CysC, SCr or urea was found. These data indicate that the level of CysC is significantly increased in the early stage of traumatic hemorrhagic shock and that CysC can be used as a marker to predict AKI; however, the diagnostic utility of CysC remains lower than that of SCr in the early stage of the condition.
Collapse
Affiliation(s)
- Shu Chen
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| | - Jing-Song Shi
- Emergency Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| | - Xiaokaiti Yibulayin
- Emergency Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| | - Tian-Shan Wu
- Emergency Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| | - Xin-Wen Yang
- Emergency Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| | - Jie Zhang
- Emergency Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| | - Paerhati Baiheti
- Emergency Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830000, P.R. China
| |
Collapse
|
9
|
Is Urinary γ-Glutamyl Transpeptidase Superior to Urinary Neutrophil Gelatinase–Associated Lipocalin for Early Prediction of Acute Kidney Injury After Liver Transplantation? Transplant Proc 2014; 46:1812-8. [DOI: 10.1016/j.transproceed.2014.05.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Dedeoglu B, de Geus HRH, Fortrie G, Betjes MGH. Novel biomarkers for the prediction of acute kidney injury in patients undergoing liver transplantation. Biomark Med 2014; 7:947-57. [PMID: 24266830 DOI: 10.2217/bmm.13.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM Because of the delayed rise of serum creatinine concentrations, novel biomarkers such as NGAL, GST and KIM-1 are proposed to detect acute kidney injury (AKI). In this study we evaluated these biomarkers. MATERIALS & METHODS Twenty-six consecutive adult liver transplantations were evaluated. Markers were measured at four different time points during an intensive care unit admission. RESULTS Plasma NGAL detected AKI with an optimal area under the curve at 8 h after admission (0.86; p = 0.004) and at 4 h after admission for urinary NGAL (0.80; p = 0.012). The other markers failed to detect AKI. CONCLUSION NGAL is a promising biomarker for detecting AKI in patients after liver transplantation.
Collapse
Affiliation(s)
- Burç Dedeoglu
- Department of Nephrology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
11
|
Oxidative stress-mediated reperfusion injury: mechanism and therapies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:373081. [PMID: 24803980 PMCID: PMC3997101 DOI: 10.1155/2014/373081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
|
12
|
Vanmassenhove J, Vanholder R, Nagler E, Van Biesen W. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2012; 28:254-73. [PMID: 23115326 DOI: 10.1093/ndt/gfs380] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) remains associated with high morbidity and mortality, despite progress in medical care. Although the RIFLE (Risk, Injury, Failure, Loss, End-Stage Kidney Disease) and AKIN (Acute Kidney Injury Network) criteria, based on serum creatinine and urine output, were a step forward in diagnosing AKI, a reliable tool to differentiate between true parenchymal and pre-renal azotaemia in clinical practice is still lacking. In the last decade, many papers on the use of new urinary and serum biomarkers for the diagnosis and prognostication of AKI have been published. Thus, the question arises which biomarker is a reliable differential diagnostic tool under which circumstances. METHODS We searched Medline from inception to April 2012 using medical subject heading and text words for AKI and biomarkers [neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), Cystatin C, interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-18 (IL-18), N-acetyl-glucosaminidase (NAG), glutathione transferases (GST) and liver fatty acid binding protein (LFABP)] to identify relevant papers in five different settings (paediatrics, cardiac surgery, emergency department, critically ill and contrast-induced nephropathy). RESULTS We included 87 relevant papers, reporting on 74 studies. Depending upon the setting, 7-27 different definitions of AKI were used. Reported diagnostic performance of the different biomarkers was variable from poor to excellent, and no consistent generalizable conclusions can be drawn on their diagnostic value. CONCLUSIONS Early diagnosing of AKI in clinical conditions by using new serum and urinary biomarkers remains cumbersome, especially in those settings where timing and aetiology of AKI are not well defined. Putting too much emphasis on markers that have not convincingly proven reliability might lead to incorrect interpretation of clinical trials. Further research in this field is warranted before biomarkers can be introduced in clinical practice.
Collapse
|
13
|
Wang Y, Zhu Q, Luo C, Zhang A, Hei Z, Su G, Xia Z, Irwin MG. Dual Effects of Bilirubin on the Proliferation of Rat Renal NRK52E Cells and ITS Association with Gap Junctions. Dose Response 2012; 11:220-37. [PMID: 23930103 PMCID: PMC3682199 DOI: 10.2203/dose-response.12-003.hei] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The effect of bilirubin on renal pathophysiology is controversial. This study aimed to observe the effects of bilirubin on the proliferation of normal rat renal tubular epithelial cell line (NRK52E) and its potential interplay with gap junction function. METHODS Cultured NRK52E cells, seeded respectively at high- or low- densities, were treated with varying concentrations of bilirubin for 24 hours. Cell injury was assessed by measuring cell viability and proliferation, and gap junction function was assessed by Parachute dye-coupling assay. Connexin 43 protein was assessed by Western blotting. RESULTS At doses from 17.1 to 513μmol/L, bilirubin dose-dependently enhanced cell viability and colony-formation rates when cells were seeded at either high- or low- densities (all p<0.05 vs. solvent group) accompanied with enhanced intercellular fluorescence transmission and increased Cx43 protein expression in high-density cells. However, the above effects of BR were gradually reversed when its concentration increased from 684 to 1026μmol/L. In high-density cells, gap junction inhibitor 12-O-tetradecanoylphorbol 13-acetate attenuated bilirubin-induced enhancement of colony-formation and fluorescence transmission. However, in the presence of high concentration bilirubin (1026μmol/L), activation of gap junction with retinoid acid decreased colony-formation rates. CONCLUSION Bilirubin can confer biphasic effects on renal NRK52E cell proliferation potentially by differentially affecting gap junction functions.
Collapse
Affiliation(s)
- Yanling Wang
- Department of anesthesiology, the third affiliated hospital of Sun Yat-sen university. NO.600 Tianhe Road, Tianhe district, Guangzhou, China, 510630
| | - Qiongfang Zhu
- Department of Anesthesiology, the first affiliated hospital of Sun Yat-sen university. NO.58, Zhongshan Road II, Yuexiu district, Guangzhou, China
| | - Chenfang Luo
- Department of anesthesiology, the third affiliated hospital of Sun Yat-sen university. NO.600 Tianhe Road, Tianhe district, Guangzhou, China, 510630
| | - Ailan Zhang
- Department of anesthesiology, the third affiliated hospital of Sun Yat-sen university. NO.600 Tianhe Road, Tianhe district, Guangzhou, China, 510630
| | - Ziqing Hei
- Department of anesthesiology, the third affiliated hospital of Sun Yat-sen university. NO.600 Tianhe Road, Tianhe district, Guangzhou, China, 510630
| | - Guangjie Su
- Department of anesthesiology, the third affiliated hospital of Sun Yat-sen university. NO.600 Tianhe Road, Tianhe district, Guangzhou, China, 510630
| | - Zhengyuan Xia
- Department of Anesthesiology, University of Hong Kong. Room 424, 4th Floor, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Michael G. Irwin
- Department of Anesthesiology, University of Hong Kong. Room 424, 4th Floor, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| |
Collapse
|
14
|
|
15
|
Lin Z, Zhou Z, Liu Y, Gong Q, Yan X, Xiao J, Wang X, Lin S, Feng W, Li X. Circulating FGF21 levels are progressively increased from the early to end stages of chronic kidney diseases and are associated with renal function in Chinese. PLoS One 2011; 6:e18398. [PMID: 21525989 PMCID: PMC3078122 DOI: 10.1371/journal.pone.0018398] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 03/06/2011] [Indexed: 01/13/2023] Open
Abstract
Background Fibroblast growth factor 21 (FGF21) is a hepatic hormone involved in the regulation of lipid and carbohydrate metabolism. This study aims to test the hypothesis that elevated FGF21 concentrations are associated with the change of renal function and the presence of left ventricular hypertrophy (LVH) in the different stages of chronic kidney disease (CKD) progression. Methodology/Principal Findings 240 subjects including 200 CKD patients (146 outpatients and 54 long-term hemodialytic patients) and 40 healthy control subjects were recruited. All CKD subjects underwent echocardiograms to assess left ventricular mass index. Plasma FGF21 levels and other clinical and biochemical parameters in all subjects were obtained based on standard clinical examination methods. Plasma FGF21 levels were significantly increased with the development of CKD from early- and end-stage (P<0.001 for trend), and significantly higher in CKD subjects than those in healthy subjects (P<0.001). Plasma FGF21 levels in CKD patients with LVH were higher than those in patients without LVH (P = 0.001). Furthermore, plasma FGF21 level correlated positively with creatinine, blood urea nitrogen (BUN), β2 microglobulin, systolic pressure, adiponectin, phosphate, proteinuria, CRP and triglyceride, but negatively with creatinine clearance rate (CCR), estimated glomerular filtrate rate (eGFR), HDL-c, LDL-c, albumin and LVH after adjusting for BMI, gender, age and the presence of diabetes mellitus. Multiple stepwise regression analyses indicated that FGF21 was independently associated with BUN, Phosphate, LVMI and β2 microglobulin (all P<0.05). Conclusion Plasma FGF21 levels are significantly increased with the development of early- to end-stage CKD and are independently associated with renal function and adverse lipid profiles in Chinese population. Understanding whether increased FGF21 is associated with myocardial hypertrophy in CKD requires further study.
Collapse
Affiliation(s)
- Zhuofeng Lin
- School of Pharmacy, Wenzhou Medical College, Zhejiang, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Can a Cutoff Value for Cystatin C in the Operative Setting Be Determined to Predict Kidney Function After Liver Transplantation? Transplant Proc 2010; 42:2323-6. [DOI: 10.1016/j.transproceed.2010.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|