Urinary cytokines: clinically useful markers of chronic renal disease progression?

Influence of the Plant-citrate Complex on Indicators of Systemic Inflammation in Patients with Urolithiasis

Treatment of urolithiasis is a complex task of modern medicine. The search for non-invasive methods of treatment, prevention of relapses and complications, slowing down the development of renal failure is an urgent issue of our time. The study demonstrated a comprehensive analysis of indicators of systemic inflammation in patients with urolithiasis and the effectiveness of using the plant-citrate complex. The objective: to conduct a clinical assessment of systemic inflammation in patients with urolithiasis, to determine the effectiveness of the use of the plant-citrate complex of the drug Uriklar on the indicators of systemic inflammation. Materials and methods. There were examined 52 (55.6 %) patients with urolithiasis, which were divided into two groups: Group I (main group) – 32 patients with urolithiasis who received the herbal citrate complex and Group II (comparison group) – 20 patients with urolithiasis. The control group included 20 almost healthy individuals. All patients underwent clinical and laboratory tests: general and biochemical blood tests to determine the parameters of iron metabolism, lipid profile, CRP, determination of the levels of cytokines in the blood, blood pressure, body mass index. Results. The results of this study demonstrate the development of systemic inflammation in patients with urolithiasis, determined by a decrease in GFR. Against the background of the treatment with Uriklar, a decrease in the levels of pro-inflammatory cytokines, CRP and ferritin is observed, which indicates the anti-inflammatory properties of the drug. Conclusion. Such properties of the plant-citrate complex are pathogenetically substantiated and can be recommended for urolithiasis, which, along with the therapeutic properties, allows to obtain the provision of metaphylaxis of urolithiasis and to slow down the rate of development of chronic kidney disease.

Effect of Chinese herbs on immunoglobulin A nephropathy: a randomized controlled trial

OBJECTIVE

The accumulation of extracellular matrix (ECM) is one of the main causes of renal fibrosis. Emerging evidence suggests that the metabolic enzyme of ECM is associated with renal fibrosis. In this study, we applied randomly controlled trial to check the curative effect of Chinese herbs on patients with immunoglobulin A nephropathy (IgAN).

METHODS

Twenty-six patients were randomly divided into group A (control group) treated with Western Medicine and group B (treatment group) treated with combination of Traditional Chinese Medicine (TCM) and Western Medicine. Blood and urine tests were done before treatment and after 8-week treatment.

RESULTS

The levels of the main composition of extracellular matrix (MC-ECM), the metabolic enzyme of ECM (ME-ECM) and some cytokines in group B decreased more obviously than those in group A after 8-week treatment. So did the level of 24-hour urine protein. However, Metal matrix protease (MMP)-2 and vascular endothelial growth factor in group B increased more obviously than those in group A after 8-week treatment. No effects on the renal function were found in both groups.

CONCLUSION

Our study provided important information on using the combination of TCM with Western Medicine to inhibit the progression of renal fibrosis in patients with IgAN.

Association of urinary inflammatory markers and renal decline in microalbuminuric type 1 diabetics

Progressive renal function decline begins in one third of patients with microalbuminuria and type 1 diabetes. This study examined whether this decline is associated with elevated excretion of inflammatory markers in urine. Five inflammatory markers (IL-6, IL-8, monocyte chemoattractant protein-1, interferon-gamma-inducible protein (IP-10), and macrophage inflammatory protein-1delta) were measured in urine samples from the First Joslin Study of the Natural History of Microalbuminuria in Type 1 Diabetes, a cohort recruited in 1991. Samples were obtained from 43 participants with microalbuminuria and stable renal function (nondecliners), from 28 with microalbuminuria and early progressive renal function decline (decliners), and from 74 with normoalbuminuria and stable renal function (reference). Urinary concentrations of all five inflammatory markers were significantly higher in decliners than in nondecliners, who were similar to the reference group. Multivariate analysis revealed that those with more than two markers elevated were more than five times as likely to have early progressive decline of renal function. In contrast, serum concentrations of C-reactive protein, IL-8, and macrophage inflammatory protein-1delta did not differ between decliners and nondecliners. These results support the hypothesis that inflammatory processes in the kidney contribute to the progression of nephropathy in patients with type 1 diabetes.

Application of antibody array technology in the analysis of urinary cytokine profiles in patients with chronic kidney disease

AIMS

Emerging evidence suggests that the urinary excretion of cytokines is associated with the progression of chronic kidney disease (CKD). However, detection of urinary cytokines in high throughput is still a problem in clinical practice. In this cross-sectional study, we applied a novel proteomic technology, antibody array, to analyze urinary cytokine profiles in patients with CKD.

METHODS

A total of 10 subjects including 7 CKD patients and 3 normal controls were studied. These patients with CKD were divided into two groups according to the levels of estimated glomerular filtration rate (eGFR): group A (eGFR >or=80 ml/min/1.73 m(2), n = 3) and group B (eGFR <or=40 ml/min/1.73 m(2), n = 4). Urine samples taken from age and gender-matched healthy volunteers (n = 3) served as control. Differential excretion of urinary cytokines was determined by human cytokine antibody array (Raybiotech, Norcross, Ga., USA). A 2-fold change in spot intensity compared to controls was considered as significant. In order to check the reliability of the data obtained by antibody array, urinary monocyte chemoattractant protein (MCP) 1 and tumor necrosis factor (TNF) alpha were determined by using enzyme-linked immunosorbent assay.

RESULTS

A total of 15 cytokines varied significantly in urinary samples obtained from patients with CKD compared with normal controls. It was shown that the levels of MCP-1, RANTES, tissue inhibitor of metalloproteinase (TIMP) 1, TNF-alpha, vascular endothelial growth factor (VEGF), E-selectin, Fas, intercellular adhesion molecule 1, interleukin 2, matrix metalloproteinase (MMP) 2 and transforming growth factor beta in patients with CKD at stage 1-2 (group A) were 2- to 5-fold higher than those in normal controls, while the excretion of MCP-1, RANTES, TIMP-1, TNF-alpha and VEGF was further increased in the patients with renal insufficiency (group B). However, a lower excretion of urinary vascular cell adhesion molecule 1 and platelet-derived growth factor was found in patients with CKD compared with normal controls. Impressively, the urinary MMP-9 excretion was 492-fold higher in group A and 198-fold higher in group B than that in normal controls. The levels of MCP-1 and TNF-alpha correlated well with the relative n-fold change seen in the antibody array experiments. The rank correlation coefficients (r values) were 0.976 (p < 0.001) and 0.939 (p < 0.001) for MCP-1and TNF-alpha, respectively.

CONCLUSION

Antibody array could serve as a fast, high-throughput and sensitive tool for detecting the excretion of urinary cytokines. Our study is the first to provide an important information regarding the utility of antibody array in evaluating the role of cytokines in the initiation and progression of CKD.

Serum C-reactive protein and leptin as predictors of kidney disease progression in the Modification of Diet in Renal Disease Study

BACKGROUND

In vitro and in vivo data suggest that markers of inflammation and nutritional status may be risk factors for the progression of chronic kidney disease.

METHODS

We investigated whether higher levels of C-reactive protein (CRP) and leptin were risk factors for progression of chronic kidney disease in the Modification of Diet in Renal Disease (MDRD) Study. Frozen samples were assayed for high sensitivity C-reactive protein (CRP) or leptin in 804 patients. CRP and leptin were then evaluated as risk factors for glomerular filtration rate (GFR) decline using univariate and multivariable analyses.

RESULTS

At baseline, the mean (median) CRP in Study A (GFR between 25 and 55 mL/min/1.73 m2) and Study B (GFR between 13 and 24 mL/min/1.73 m2) were 0.48 (0.25) and 0.46 (0.20) mg/dL, respectively, while the mean (median) leptin in Study A and Study B were 15.2 (9.80) and 15.1 (7.80) ng/mL, respectively. Mean follow-up time was 2.2 years. The mean GFR decline was -4.33 and -3.65 mL/min/year in Study A and B, respectively. There was no significant association between the rate of GFR decline with the level of CRP or leptin in multivariable analysis in Study A [0.08 (-0.14, 0.30) mL/min/year slower GFR decline per twofold increase in CRP level; and 0.14 (-0.13, 0.40) mL/min/year slower GFR decline per twofold increase in leptin level], or in multivariable analysis in Study B [-0.05 (-0.28, 0.18) mL/min/year faster GFR decline per twofold increase in CRP level; and -0.12 (-0.42, 0.19) mL/min/year faster GFR decline per twofold increase in leptin level].

CONCLUSIONS

Higher serum levels of CRP and leptin are not independent risk factors for progression of non-diabetic kidney disease.

New clinical practice guidelines for chronic kidney disease: a framework for K/DOQI

Chronic kidney disease affects millions of individuals in the United States, and millions more are at risk for the development of kidney disease. The National Kidney Foundation (NKF) has recently published 15 clinical practice guidelines (CPGs) for chronic kidney disease under the Kidney/Disease Outcomes Quality Initiative (K/DOQI). This initial set of guidelines creates a framework for additional interventional CPGs currently in development. Importantly, these guidelines define and classify CKD. In addition, recommendations for the clinical assessment of kidney disease are elaborated. In reviewing the guidelines, we find that they follow the basic principles of CPG development and incorporate the essential aspects of CPGs. The validity of the CPGs is limited in some areas because of the paucity of data. Despite their limitations, the current CPGs allow for the development of clinical performance measures and continuous quality improvement in the hopes of improving public health and reducing progression to end-stage renal disease (ESRD).