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Takagi A, Kusunoki Y, Ohigashi M, Osugi K, Inoue C, Inoue M, Tsunoda T, Kadoya M, Konishi K, Katsuno T, Koyama H. Association between continuous glucose monitoring-derived glycemic control indices and urinary biomarkers of diabetic kidney disease: Hyogo Diabetes Hypoglycemia Cognition Complications study. Acta Diabetol 2024; 61:413-423. [PMID: 38006524 DOI: 10.1007/s00592-023-02214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/08/2023] [Indexed: 11/27/2023]
Abstract
AIMS Glomerular damage and proximal tubular damage play an important role in the pathogenesis of diabetic kidney disease. This study aimed to investigate the relationship between the urinary markers of proximal tubular injury, including urinary liver-type fatty acid-binding protein-to-creatinine ratio (uL-FABP/Cr) and urinary N-acetyl-β-D-glucosaminidase-to-creatinine ratio (uNAG/Cr), and glycemic control status. METHODS This cross-sectional study included 245 and 39 patients with type 2 diabetes mellitus (T2DM) and non-T2DM (NDM), respectively. The participants of this study were fitted with retrospective CGM, and glycemic control indices, such as time in range (TIR) and glycemia risk index (GRI), were calculated. RESULTS The results were presented as medians (interquartile ranges). The uL-FABP/Cr was significantly higher in the microalbuminuria than in the normo-albuminuria group [4.2 (2.7-7.1) and 2.2 (1.4-3.4) μg/gCr, respectively, P < 0.001], while the uNAG/Cr in the normo-albuminuria group [6.3 (4.5-10.1) U/gCr] was significantly higher than that in the NDM group [5.3 (3.8-6.3) U/gCr, P = 0.048] but significantly lower than that in the microalbuminuria group [9.2 (6.4-11.1) U/gCr, P = 0.004]. The multivariate logistic regression analysis indicated that CGM-derived TIR was significantly associated with the urinary albumin-to-creatinine ratio [uAlb/Cr, odds ratio (OR) 0.985, 95% confidence interval (CI) 0.971-0.998, P = 0.029] and uNAG/Cr (OR 0.973, 95% CI 0.957-0.989, P = 0.001) independent of renal function. GRI was similarly associated with uAlb/Cr and uNAG/Cr. CONCLUSION The findings of this study indicated that uNAG/Cr was elevated before albuminuria development and was associated with CGM-derived TIR and GRI.
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Affiliation(s)
- Ayako Takagi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiki Kusunoki
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Mana Ohigashi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Keiko Osugi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Chikako Inoue
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Maki Inoue
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Taku Tsunoda
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Manabu Kadoya
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kosuke Konishi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomoyuki Katsuno
- Department of Occupational Therapy, School of Rehabilitation, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Campbell RE, Chen CH, Edelstein CL. Overview of Antibiotic-Induced Nephrotoxicity. Kidney Int Rep 2023; 8:2211-2225. [PMID: 38025228 PMCID: PMC10658282 DOI: 10.1016/j.ekir.2023.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
Drug-induced nephrotoxicity accounts for up to 60% of cases of acute kidney injury (AKI) in hospitalized patients and is associated with increased morbidity and mortality in both adults and children. Antibiotics are one of the most common causes of drug-induced nephrotoxicity. Mechanisms of antibiotic-induced nephrotoxicity include glomerular injury, tubular injury or dysfunction, distal tubular obstruction from casts, and acute interstitial nephritis (AIN) mediated by a type IV (delayed-type) hypersensitivity response. Clinical manifestations of antibiotic-induced nephrotoxicity include acute tubular necrosis (ATN), AIN, and Fanconi syndrome. Given the potential nephrotoxic effects of antibiotics on critically ill patients, the use of novel biomarkers can provide information to optimize dosing and duration of treatment and can help prevent nephrotoxicity when traditional markers, such as creatinine, are unreliable. Use of novel kidney specific biomarkers, such as cystatin C and urinary kidney injury molecule-1 (KIM-1), may result in earlier detection of AKI, dose adjustment, or discontinuation of antibiotic and development of nonnephrotoxic antibiotics.
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Affiliation(s)
- Ruth E. Campbell
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Chang Huei Chen
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles L. Edelstein
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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3
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Bae J, Lee BW. Significance of Diabetic Kidney Disease Biomarkers in Predicting Metabolic-Associated Fatty Liver Disease. Biomedicines 2023; 11:1928. [PMID: 37509567 PMCID: PMC10377561 DOI: 10.3390/biomedicines11071928] [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: 06/15/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Metabolic-associated fatty liver disease (MAFLD) and diabetic kidney disease (DKD) share various pathophysiological factors, and epidemiological evidence suggests that these two diseases are associated. Albuminuria and the estimated glomerular filtration rate, which are conventional biomarkers of DKD, are reportedly associated with the risk or severity of MAFLD. Recently, novel DKD biomarkers reflecting renal tubular injury have been introduced to complement conventional DKD markers. In this article, we looked at previous studies that showed an association between MAFLD and DKD, and also reviewed the significance of DKD biomarkers as predictive risk factors for MAFLD.
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Affiliation(s)
- Jaehyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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4
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Novak R, Salai G, Hrkac S, Vojtusek IK, Grgurevic L. Revisiting the Role of NAG across the Continuum of Kidney Disease. Bioengineering (Basel) 2023; 10:bioengineering10040444. [PMID: 37106631 PMCID: PMC10136202 DOI: 10.3390/bioengineering10040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Acute and chronic kidney diseases are an evolving continuum for which reliable biomarkers of early disease are lacking. The potential use of glycosidases, enzymes involved in carbohydrate metabolism, in kidney disease detection has been under investigation since the 1960s. N-acetyl-beta-D-glucosaminidase (NAG) is a glycosidase commonly found in proximal tubule epithelial cells (PTECs). Due to its large molecular weight, plasma-soluble NAG cannot pass the glomerular filtration barrier; thus, increased urinary concentration of NAG (uNAG) may suggest injury to the proximal tubule. As the PTECs are the workhorses of the kidney that perform much of the filtration and reabsorption, they are a common starting point in acute and chronic kidney disease. NAG has previously been researched, and it is widely used as a valuable biomarker in both acute and chronic kidney disease, as well as in patients suffering from diabetes mellitus, heart failure, and other chronic diseases leading to kidney failure. Here, we present an overview of the research pertaining to uNAG’s biomarker potential across the spectrum of kidney disease, with an additional emphasis on environmental nephrotoxic substance exposure. In spite of a large body of evidence strongly suggesting connections between uNAG levels and multiple kidney pathologies, focused clinical validation tests and knowledge on underlining molecular mechanisms are largely lacking.
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Affiliation(s)
- Ruder Novak
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Grgur Salai
- Department of Pulmonology, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Stela Hrkac
- Department of of Clinical Immunology, Allergology and Rheumatology, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Ivana Kovacevic Vojtusek
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Lovorka Grgurevic
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Anatomy, “Drago Perovic”, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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5
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Ye X, Gao D, Mu X, Wu Q, Ma P, Song D. Dual-Signal Triple-Mode Optical Sensing Platform for Assisting in the Diagnosis of Kidney Disorders. Anal Chem 2023; 95:4653-4661. [PMID: 36863867 DOI: 10.1021/acs.analchem.2c04958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
As known biomarkers of kidney diseases, N-acetyl-β-d-glucosaminidase (NAG) and β-galactosidase (β-GAL) are of great importance for the diagnosis and treatment of diseases. The feasibility of using multiplex sensing methods to simultaneously report the outcome of the two enzymes in the same sample is even more alluring. Herein, we establish a simple sensing platform for the concurrent detection of NAG and β-GAL using silicon nanoparticles (SiNPs) as a fluorescent indicator synthesized by a one-pot hydrothermal route. p-Nitrophenol (PNP), as a common enzymatic hydrolysis product of the two enzymes, led to the attenuation of fluorometric signal caused by the inner filter effect on SiNPs, the enhancement of colorimetric signal due to the increase of intensity of the characteristic absorption peak at around 400 nm with increasing reaction time, and the changes of RGB values of images obtained through a color recognition application on a smartphone. The fluorometric/colorimetric approach combined with the smartphone-assisted RGB mode was able to detect NAG and β-GAL with good linear response. Applying this optical sensing platform to clinical urine samples, we found that the two indicators in healthy individuals and patients (glomerulonephritis) with kidney diseases were significantly different. By expanding to other renal lesion-related specimens, this tool may show great potentials in clinical diagnosis and visual inspection.
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Affiliation(s)
- Xiwen Ye
- Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, College of Chemistry, Jilin University, Qianjin Street 2699, Changchun 130012, China
| | - Dejiang Gao
- Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, College of Chemistry, Jilin University, Qianjin Street 2699, Changchun 130012, China
| | - Xiaowei Mu
- Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, College of Chemistry, Jilin University, Qianjin Street 2699, Changchun 130012, China
| | - Qiong Wu
- Key Laboratory of Pathobiology, Ministry of Education, Nanomedicine and Translational Research Center, China-Japan Union Hospital of Jilin University, 126 Sendai Street, Changchun 130033, Jilin, China
| | - Pinyi Ma
- Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, College of Chemistry, Jilin University, Qianjin Street 2699, Changchun 130012, China
| | - Daqian Song
- Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, College of Chemistry, Jilin University, Qianjin Street 2699, Changchun 130012, China
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6
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Proficient Novel Biomarkers Guide Early Detection of Acute Kidney Injury: A Review. Diseases 2022; 11:diseases11010008. [PMID: 36648873 PMCID: PMC9844481 DOI: 10.3390/diseases11010008] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 01/03/2023] Open
Abstract
The definition of acute kidney injury (AKI), despite improvements in criteria, continues to be based on the level of serum creatinine and urinary output that do not specifically indicate tubular function or injury, or glomerular function or injury that is not significant enough to warrant acute hospitalization of the patient. Finding novel biomarkers of AKI has become a major focus nowadays in nephrology to overcome the further complications of end stage renal disease (ESRD). Many compounds, such as KIM 1, IL 18, NGAL, uromodulin, calprotectin, vanin 1, galactin 3, platelet-derived growth factor (PDGF), urinary Na+/H+ exchanger isoform 3 (NHE3), retinol binding protein (RBP) and Cystatin C, are released from the renal tubules and thus any alterations in tubular function can be detected by measuring these parameters in urine. Additionally, glomerular injury can be detected by measuring immunoglobulin G, nephrin, podocalyxin, podocin, transferrin, netrin-1, pyruvate kinase M2, etc. in urine. These novel biomarkers will be useful for timing the initial insult and assessing the duration of AKI. According to available research, these biomarkers could be applied to assess the onset of AKI, distinguishing between kidney injury and dysfunction, directing the management of AKI, and enhancing disease diagnosis. Therefore, we intend to present recent developments in our understanding of significant biomarkers implicated in various aspects of renal damage. Numerous biomarkers are implicated in various pathophysiological processes that follow renal injury, and can improve prognosis and risk classification.
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7
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Monson KR, Peters BA, Usyk M, Um CY, Oberstein PE, McCullough ML, Purdue MP, Freedman ND, Hayes RB, Ahn J. Elevated dietary carbohydrate and glycemic intake associate with an altered oral microbial ecosystem in two large U.S. cohorts. CANCER RESEARCH COMMUNICATIONS 2022; 2:1558-1568. [PMID: 36567732 PMCID: PMC9770587 DOI: 10.1158/2767-9764.crc-22-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/27/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
The human oral microbiome is associated with chronic diseases including cancer. However, our understanding of its relationship with diet is limited. We assessed the associations between carbohydrate and glycemic index (GI) with oral microbiome composition in 834 non-diabetic subjects from the NCI-PLCO and ACS-CPSII cohorts. The oral microbiome was characterized using 16Sv3-4 rRNA-sequencing from oral mouthwash samples. Daily carbohydrate and GI were assessed from food frequency questionnaires. We used linear regression, permutational MANOVA, and negative binomial Generalized Linear Models (GLM) to test associations of diet with α- and β-diversity and taxon abundance (adjusting for age, sex, cohort, BMI, smoking, caloric intake, and alcohol). A q-value (FDR-adjusted P-value) of <0.05 was considered significant. Oral bacterial α-diversity trended higher in participants in the highest quintiles of carbohydrate intake, with marginally increased richness and Shannon diversity (p-trend=0.06 and 0.07). Greater carbohydrate intake was associated with greater abundance of class Fusobacteriia (q=0.02) and genus Leptotrichia (q=0.01) and with lesser abundance of an Actinomyces OTU (q=4.7E-04). Higher GI was significantly related to greater abundance of genus Gemella (q=0.001). This large, nationwide study provides evidence that diets high in carbohydrates and GI may influence the oral microbiome.
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Affiliation(s)
- Kelsey R. Monson
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Brandilyn A. Peters
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mykhaylo Usyk
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Caroline Y. Um
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Paul E. Oberstein
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | | | - Mark P. Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Richard B. Hayes
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Jiyoung Ahn
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
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8
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Venkatesan A, Roy A, Kulandaivel S, Natesan V, Kim SJ. p-Coumaric Acid Nanoparticles Ameliorate Diabetic Nephropathy via Regulating mRNA Expression of KIM-1 and GLUT-2 in Streptozotocin-Induced Diabetic Rats. Metabolites 2022; 12:metabo12121166. [PMID: 36557204 PMCID: PMC9785963 DOI: 10.3390/metabo12121166] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Diabetic nephropathy (DN) has become a leading cause of end-stage renal failure worldwide. The goal of the current study was to examine the protective effects of chitosan-loaded p-Coumaric acid nanoparticles (PCNPs) in nephrotoxicity induced by streptozotocin (STZ). Because of the antidiabetic, anti-inflammatory, and antioxidant properties of PCNPs, the development of DN may be considerably decreased. In this study, the rats received a single intraperitoneal injection (i.p.) of STZ (45 mg/kg) to induce DN. PCNPs were given orally 80 mg/kg b.w to the rats for a duration of four weeks. Body weight, kidney weight, blood glucose, and insulin levels were measured at the end of the experiment. Serum and urine parameters were also examined, along with the histological, immunobiological, and tumor necrosis factor (TNF) and interleukin-6 (IL-6) expression of the nephrotic rats. To comprehend the impact of PCNPs, the expression patterns of the kidney injury molecule (KIM-1) and glucose transporter-2 (GLUT-2) were evaluated. Administration of PCNPs significantly increased body weight, decreased kidney weight and also ameliorated blood glucose levels in the nephropathic rats. The administration of PCNPs also reverted the levels of urea, serum creatinine, urinary NAG, β-glucuronidase and albumin to near-normal levels. The administration of PCNPs also caused the levels of serum and urine parameters to return to near-normal levels. Additionally, the PCNP-treated rats had markedly reduced TNF-α, IL-6, and KIM-1 expressions as well as enhanced GLUT-2 mRNA expression. Our findings clearly showed that PCNP administration prevents the onset of DN in rats by lowering hyperglycemia, decreasing inflammation, and improving the expression of GLUT-2 mRNA in nephropathic rats.
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Affiliation(s)
- Amalan Venkatesan
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar 608002, Tamil Nadu, India
| | - Anitha Roy
- Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, Tamil Nadu, India
- Department of Pharmacology, Saveetha College of Allied Health Sciences, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai 602105, Tamil Nadu, India
| | - Srinivasan Kulandaivel
- Department of Pharmaceutical Chemistry, Nandha College of Pharmacy, Erode 638052, Tamil Nadu, India
| | - Vijayakumar Natesan
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar 608002, Tamil Nadu, India
- Correspondence: (V.N.); (S.-J.K.)
| | - Sung-Jin Kim
- Department of Pharmacology and Toxicology, Metabolic Diseases Research Laboratory, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
- Correspondence: (V.N.); (S.-J.K.)
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9
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Schaefer HR, Flannery BM, Crosby L, Jones-Dominic OE, Punzalan C, Middleton K. A systematic review of adverse health effects associated with oral cadmium exposure. Regul Toxicol Pharmacol 2022; 134:105243. [PMID: 35981600 DOI: 10.1016/j.yrtph.2022.105243] [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: 03/09/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
Scientific data characterizing the adverse health effects associated with dietary cadmium (Cd) exposure were identified in order to make informed decisions about the most appropriate toxicological reference value (TRV) for use in assessing dietary Cd exposure. Several TRVs are available for Cd and regulatory organizations have used epidemiologic studies to derive these reference values; however, risk of bias (RoB) evaluations were not included in the assessments. We performed a systematic review by conducting a thorough literature search (through January 4, 2020). There were 1714 references identified by the search strings and 328 studies identified in regulatory assessments. After applying the specific inclusion and exclusion criteria, 208 studies (Human: 105, Animal: 103) were considered eligible for further review and data extraction. For the epidemiologic and animal studies, the critical effects identified for oral Cd exposure from the eligible studies were a decrease in bone mineral density (BMD) and renal tubular degeneration. A RoB analysis was completed for 49 studies (30 epidemiological and 19 animal) investigating these endpoints. The studies identified through the SR that were considered high quality and low RoB (2 human and 5 animal) can be used to characterize dose-response relationships and inform the derivation of a Cd TRV.
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Affiliation(s)
- Heather R Schaefer
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA.
| | - Brenna M Flannery
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Lynn Crosby
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Olivia E Jones-Dominic
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Cecile Punzalan
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Karlyn Middleton
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
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Khanijou V, Zafari N, Coughlan MT, MacIsaac RJ, Ekinci EI. Review of potential biomarkers of inflammation and kidney injury in diabetic kidney disease. Diabetes Metab Res Rev 2022; 38:e3556. [PMID: 35708187 PMCID: PMC9541229 DOI: 10.1002/dmrr.3556] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/18/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
Diabetic kidney disease is expected to increase rapidly over the coming decades with rising prevalence of diabetes worldwide. Current measures of kidney function based on albuminuria and estimated glomerular filtration rate do not accurately stratify and predict individuals at risk of declining kidney function in diabetes. As a result, recent attention has turned towards identifying and assessing the utility of biomarkers in diabetic kidney disease. This review explores the current literature on biomarkers of inflammation and kidney injury focussing on studies of single or multiple biomarkers between January 2014 and February 2020. Multiple serum and urine biomarkers of inflammation and kidney injury have demonstrated significant association with the development and progression of diabetic kidney disease. Of the inflammatory biomarkers, tumour necrosis factor receptor-1 and -2 were frequently studied and appear to hold most promise as markers of diabetic kidney disease. With regards to kidney injury biomarkers, studies have largely targeted markers of tubular injury of which kidney injury molecule-1, beta-2-microglobulin and neutrophil gelatinase-associated lipocalin emerged as potential candidates. Finally, the use of a small panel of selective biomarkers appears to perform just as well as a panel of multiple biomarkers for predicting kidney function decline.
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Affiliation(s)
- Vuthi Khanijou
- Melbourne Medical SchoolUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Neda Zafari
- Department of MedicineUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Melinda T. Coughlan
- Department of DiabetesCentral Clinical SchoolMonash UniversityAlfred Medical Research AllianceMelbourneVictoriaAustralia
- Baker Heart & Diabetes InstituteMelbourneVictoriaAustralia
| | - Richard J. MacIsaac
- Department of Endocrinology & DiabetesSt. Vincent's Hospital Melbourne and University of MelbourneMelbourneVictoriaAustralia
| | - Elif I. Ekinci
- Melbourne Medical SchoolUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
- Department of EndocrinologyAustin HealthMelbourneVictoriaAustralia
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11
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High Glycated Hemoglobin Instead of High Body Mass Index Might Increase the Urine N-Acetyl-β-D-glucosaminidase Con-Centration in Children and Adolescents with Diabetes Mellitus. LIFE (BASEL, SWITZERLAND) 2022; 12:life12060879. [PMID: 35743910 PMCID: PMC9225163 DOI: 10.3390/life12060879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
Children with diabetes, and particularly those with obesity, have poor glycemic control. They are thus at higher risk of early microvascular complications. Renal tubulointerstitial markers are integral to evaluating diabetic nephropathy. Various biomarkers have been proposed, but their role in the obese pediatric population is uncertain. We investigated renal injury markers in children with diabetes, according to obesity, and determined their role as early predictors of diabetic nephropathy. Fifty-three children and adolescents, diagnosed with either type 1 or 2 diabetes mellitus, and 43 control children, aged 7-18 years, were included. Clinical and laboratory characteristics, including six renal injury markers, were compared among subjects according to body mass index and presence of diabetes mellitus. Urine neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and N-acetyl-β-D-glucosaminidase (NAG) showed significant difference between controls and diabetic children, whereas urine NAG was the only biomarker that was significantly lower either in non-obese or obese controls as compared to diabetic children. Urine NGAL, KIM-1, and NAG showed significant correlations with both HbA1c and urine ACR, whereas only urine NAG was significantly correlated with HbA1c even when groups were subdivided based on the presence of either obesity or diabetes. After adjusting for age, sex, body mass index, duration of known diabetes, and urine albumin-to-creatinine ratio, HbA1c remained a significant risk factor for elevated urine NAG. Urine NAG could be a useful indicator of tubulointerstitial damage in children with diabetes in the pre-albuminuric state. Tighter glycemic control appears to be crucial for avoiding early progression to diabetic nephropathy.
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Morsby JJ, Smith BD. Advances in Optical Sensors of N-Acetyl-β-d-hexosaminidase ( N-Acetyl-β-d-glucosaminidase). Bioconjug Chem 2022; 33:544-554. [PMID: 35302753 PMCID: PMC9870670 DOI: 10.1021/acs.bioconjchem.2c00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
N-Acetyl-β-d-hexosaminidases (EC 3.2.1.52) are exo-acting glycosyl hydrolases that remove N-acetyl-β-d-glucosamine (Glc-NAc) or N-acetyl-β-d-galactosamine (Gal-NAc) from the nonreducing ends of various biomolecules including oligosaccharides, glycoproteins, and glycolipids. The same enzymes are sometimes called N-acetyl-β-d-glucosaminidases, and this review article employs the shorthand descriptor HEX(NAG) to indicate that the terms HEX or NAG are used interchangeably in the literature. The wide distribution of HEX(NAG) throughout the biosphere and its intracellular location in lysosomes combine to make it an important enzyme in food science, agriculture, cell biology, medical diagnostics, and chemotherapy. For more than 50 years, researchers have employed chromogenic derivatives of N-acetyl-β-d-glucosaminide in basic assays for biomedical research and clinical chemistry. Recent conceptual and synthetic innovations in molecular fluorescence sensors, along with concurrent technical improvements in instrumentation, have produced a growing number of new fluorescent imaging and diagnostics methods. A systematic summary of the recent advances in optical sensors for HEX(NAG) is provided under the following headings: assessing kidney health, detection and treatment of infectious disease, fluorescence imaging of cancer, treatment of lysosomal disorders, and reactive probes for chemical biology. The article concludes with some comments on likely future directions.
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Affiliation(s)
| | - Bradley D. Smith
- Corresponding Author: Bradley D. Smith - Department of Chemistry and Biochemistry, 251 Nieuwland Science Hall, University of Notre Dame, IN 46556, USA.
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13
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Lou W, Cheng Q, Liang Y, Xia D. Urinary N-Acetyl-β-d-Glucosaminidase (NAG) Levels and Risk of Cardiovascular Events in Diabetic Patients. Int J Gen Med 2022; 14:10495-10502. [PMID: 35002305 PMCID: PMC8722575 DOI: 10.2147/ijgm.s337874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) have a high incidence rate in population with diabetic patients. Studies on the association between urinary N-acetyl-β-d-glucosaminidase (NAG) levels, the biomarker of renal tubular damage, with cardiovascular (CV) events diabetic patients was still few. METHODS The relationship between urinary NAG levels and CV events was analyzed in a prospective cohort including 357 patients with type 2 diabetes mellitus at a follow-up of 5 years. RESULTS Twenty-six (7.3%) patients have CV events. Kaplan-Meier analysis suggested that diabetic patients with urine NAG levels ≥37.5 IU/L had a higher rate of CV events than those with urine NAG levels <37.5 IU/L (Log rank test, P = 0.021). Cox analysis revealed that elevated urine NAG levels significantly contributed to increased risk of CV events (HR = 1.43, 95% CI 1.23-1.93, P < 0.001) after adjusting for clinical confounding factors. Interestingly, we also found that "abnormal renal function" has an effect modification on the association between urine NAG levels and CV events. ROC-AUC analysis suggested that the urine NAG (AUC = 0.81, P < 0.001) had a better predictive value than eGFR (AUC = 0.74, P = 0.012). CONCLUSION Elevated urine NAG levels are associated with higher risk of CV events in patients with type 2 diabetes. These results might further suggested that urinary NAG is a value urinary biomarker for early detecting CV events among diabetic patients.
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Affiliation(s)
- Weiwei Lou
- Department of Rehabilitation, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Qun Cheng
- Department of Rehabilitation, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Yanqiu Liang
- Department of Rehabilitation, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Ding Xia
- Urology Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
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14
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Kim HK, Lee M, Lee YH, Kang ES, Cha BS, Lee BW. Renal Tubular Damage Marker, Urinary N-acetyl-β-D-Glucosaminidase, as a Predictive Marker of Hepatic Fibrosis in Type 2 Diabetes Mellitus. Diabetes Metab J 2022; 46:104-116. [PMID: 34253010 PMCID: PMC8831822 DOI: 10.4093/dmj.2020.0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Non-alcoholic steatohepatitis is closely associated with the progression of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM). We investigated whether urinary N-acetyl-β-D-glucosaminidase (u-NAG), an early renal tubular damage biomarker in DKD, could be related to the degree of hepatic fibrosis in patients with T2DM. METHODS A total of 300 patients with T2DM were enrolled in this study. Hepatic steatosis and fibrosis were determined using transient elastography. The levels of urinary biomarkers, including u-NAG, albumin, protein, and creatinine, and glucometabolic parameters were measured. RESULTS Based on the median value of the u-NAG to creatinine ratio (u-NCR), subjects were divided into low and high u-NCR groups. The high u-NCR group showed a significantly longer duration of diabetes, worsened hyperglycemia, and a more enhanced hepatic fibrosis index. A higher u-NCR was associated with a greater odds ratio for the risk of higher hepatic fibrosis stage (F2: odds ratio, 1.99; 95% confidence interval [CI], 1.04 to 3.82). Also, u-NCR was an independent predictive marker for more advanced hepatic fibrosis, even after adjusting for several confounding factors (β=1.58, P<0.01). CONCLUSION The elevation of u-NAG was independently associated with a higher degree of hepatic fibrosis in patients with T2DM. Considering the common metabolic milieu of renal and hepatic fibrosis in T2DM, the potential use of u-NAG as an effective urinary biomarker reflecting hepatic fibrosis in T2DM needs to be validated in the future.
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Affiliation(s)
- Hae Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
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15
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Tan J, Yin K, Ouyang Z, Wang R, Pan H, Wang Z, Zhao C, Guo W, Gu X. Real-Time Monitoring Renal Impairment Due to Drug-Induced AKI and Diabetes-Caused CKD Using an NAG-Activatable NIR-II Nanoprobe. Anal Chem 2021; 93:16158-16165. [PMID: 34813273 DOI: 10.1021/acs.analchem.1c03926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Real-time in vivo optical imaging of kidney function is important for the diagnosis of renal diseases, such as acute kidney injury (AKI) and chronic kidney disease (CKD), with high morbidity and mortality worldwide. However, the reported optical imaging agents still have limitations for identifying AKI or CKD in the early stage due to their low sensitivity, poor tissue penetration, and significant background interference. Herein, an N-acetyl-β-d-glucosaminidase (NAG)-activatable second near-infrared (NIR-II) fluorescent nanoprobe (BOD-II-NAG-NP) is developed for monitoring the progression of drug-induced AKI and in vivo imaging of diabetes-caused CKD. NAG, as a biomarker of renal diseases, is able to specifically activate BOD-II-NAG-NP to release NIR-II fluorescence signals, enabling in vivo imaging of kidney dysfunctions in living mice. Importantly, such an active imaging mechanism allows BOD-II-NAG-NP to noninvasively detect the onset of drug-induced AKI at least 32 h earlier than the most existing assays, which indicates that BOD-II-NAG-NP has the potential to be an optical imaging agent for the early diagnosis of AKI. Moreover, NIR-II fluorescence produced by BOD-II-NAG-NP could deeply penetrate into the relatively thick layers of fat in diabetic nephropathy mice and provide in vivo imaging with high resolution, indicating that BOD-II-NAG-NP has clinical potential for precision diagnosis of CKD.
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Affiliation(s)
- Jiahui Tan
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
| | - Kai Yin
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
| | - Zhirong Ouyang
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
| | - Rongchen Wang
- Key Laboratory for Advanced Materials and Feringa Nobel Prize Scientist Joint Research Center, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Hongming Pan
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
| | - Zhijun Wang
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
| | - Chuchang Zhao
- Key Laboratory for Advanced Materials and Feringa Nobel Prize Scientist Joint Research Center, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Wei Guo
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
| | - Xianfeng Gu
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai, 201203, P. R. China
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16
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Yang Z, Lou X, Zhang J, Nie R, Liu J, Tu P, Duan P. Association Between Early Markers of Renal Injury and Type 2 Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2021; 14:4391-4397. [PMID: 34744444 PMCID: PMC8565989 DOI: 10.2147/dmso.s335283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN) are both common chronic complications of type 2 diabetes mellitus (T2DM). The aim of this study was to examine whether some markers of early renal injury were associated with DPN. METHODS Retrospective hospitalization data from 471 patients with T2DM were analyzed. Subjects were divided into DPN group and non-DPN group according to clinical history, symptoms, signs and nerve conduction study. Markers of glomerular injury [urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)] and tubular injury [urinary N-acetyl-β-D-glucosaminidase/creatinine ratio (NAG/Cr) and urinary β2 microglobulin (β2-MG)] were innovatively combined to assess the association with DPN. Staging of chronic kidney disease (CKD) was classified as G1, G2, G3a, G3b, G4 based on eGFR categories of ≥90, 60-89, 45-59, 30-44, 15-29 mL/min/1.73m2. RESULTS DPN was detected in 71.1% of our population. Subjects in DPN group suffered from older age, longer duration of diabetes and worse blood glucose control compared with non-DPN group. The levels of UACR, NAG/Cr and β2-MG were significantly increased in DPN group than those in non-DPN group, while eGFR was decreased. The prevalence of DPN increased gradually in G1, G2 and G3-4 of CKD, which were 66.3%, 73.2% and 82.7% (P = 0.014). After adjusting for confounding factors, NAG/Cr >1.41 U/mmol (the highest tertile) was a consistently independent risk factor for DPN [odds ratio, OR (95% confidence interval, CI) = 1.86 (1.04-3.33)]. However, UACR, eGFR and β2-MG did not significantly affect the risk of DPN. CONCLUSION When T2DM patients suffer from CKD, DPN will be more likely to appear, accelerate or deteriorate. Some easily available urinary markers of glomerular and tubular damage can be used for early prediction of DPN, in which increased NAG/Cr is an independent risk factor for DPN.
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Affiliation(s)
- Zhi Yang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Xiaoyang Lou
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, People’s Republic of China
| | - Jie Zhang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China
| | - Ronghui Nie
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China
| | - Jiang Liu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Peng Duan
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
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17
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Jiang X, Sui W. Serum KIM-1, NGAL, and NAG Levels and Correlation with the Diagnostic Value in Patients with Fracture Traumatic Shock. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:3063229. [PMID: 34434244 PMCID: PMC8382536 DOI: 10.1155/2021/3063229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022]
Abstract
Traumatic shock is the most common cause of serious adverse outcomes in patients with severe traumatic diseases such as fractures, and some studies here have shown that the main cause of death from traumatic shock is the impairment of organ function that occurs after shock. In this study, we explored the role of serum kidney injury molecule-1 (KIM-1), neutrophil gelatin-related lipid transporter protein (NGAL), and N-acetyl-β-D-glucosidase (NAG) levels in evaluating and diagnosing the condition of patients with fracture traumatic shock based on the goal of contributing to the clinical diagnosis of the patient's condition as soon as possible and taking measures to alleviate its progress. 96 patients with fracture traumatic shock were included in the study as the observation group and 58 healthy examiners as the control group, and the observation group was divided into 69 cases in the mild-moderate group and 27 cases in the severe group according to the Acute Physiology and Chronic Health Status Scale (APACHE-II). In this study, we detected and analyzed the differences in serum KIM-1, NGAL, and NAG levels between the observation group and the control group and the observation group with different disease levels. We found that the observation group was significantly higher than the control group, and the severe patients were higher than the mild to moderate patients, and we observed that serum KIM-1, NGAL, and NAG are significantly correlated with the condition of patients with fracture traumatic shock after further analysis using the Pearson model. In addition, the diagnostic value of receiver operating characteristic curve analysis showed that the AUC of serum KIM-1 for the diagnosis of fracture traumatic shock was 0.755, the AUC of serum NGAL was 0.750, the AUC of serum NAG was 0.772, and the AUC of the combination of the three indicators was 0.915. The results of this study thus suggest the possibility of serum KIM-1, NGAL, and NAG as clinical indicators for evaluating the condition of patients with fracture traumatic shock and the possibility of a combined test of serum KIM-1, NGAL, and NAG for diagnosing the condition.
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Affiliation(s)
- Xiaoyan Jiang
- Department of Critical Care Medicine, Zhuji People's Hospital, Zhuji, Zhejiang 311800, China
| | - Wei Sui
- Department of Orthopedics, Xiangyang Central Hospital, Xiangyang, Hubei 441021, China
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18
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Gavini MP, Mahmood A, Belenchia AM, Beauparlant P, Kumar SA, Ardhanari S, DeMarco VG, Pulakat L. Suppression of Inflammatory Cardiac Cytokine Network in Rats with Untreated Obesity and Pre-Diabetes by AT2 Receptor Agonist NP-6A4. Front Pharmacol 2021; 12:693167. [PMID: 34220518 PMCID: PMC8253363 DOI: 10.3389/fphar.2021.693167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity affects over 42% of the United States population and exacerbates heart disease, the leading cause of death in men and women. Obesity also increases pro-inflammatory cytokines that cause chronic tissue damage to vital organs. The standard-of-care does not sufficiently attenuate these inflammatory sequelae. Angiotensin II receptor AT2R is an anti-inflammatory and cardiovascular protective molecule; however, AT2R agonists are not used in the clinic to treat heart disease. NP-6A4 is a new AT2R peptide agonist with an FDA orphan drug designation for pediatric cardiomyopathy. NP-6A4 increases AT2R expression (mRNA and protein) and nitric oxide generation in human cardiovascular cells. AT2R-antagonist PD123319 and AT2RSiRNA suppress NP-6A4-effects indicating that NP-6A4 acts through AT2R. To determine whether NP-6A4 would mitigate cardiac damage from chronic inflammation induced by untreated obesity, we investigated the effects of 2-weeks NP-6A4 treatment (1.8 mg/kg delivered subcutaneously) on cardiac pathology of male Zucker obese (ZO) rats that display obesity, pre-diabetes and cardiac dysfunction. NP-6A4 attenuated cardiac diastolic and systolic dysfunction, cardiac fibrosis and cardiomyocyte hypertrophy, but increased myocardial capillary density. NP-6A4 treatment suppressed tubulointerstitial injury marker urinary β-NAG, and liver injury marker alkaline phosphatase in serum. These protective effects of NP-6A4 occurred in the presence of obesity, hyperinsulinemia, hyperglycemia, and hyperlipidemia, and without modulating blood pressure. NP-6A4 increased expression of AT2R (consistent with human cells) and cardioprotective erythropoietin (EPO) and Notch1 in ZO rat heart, but suppressed nineteen inflammatory cytokines. Cardiac miRNA profiling and in silico analysis showed that NP-6A4 activated a unique miRNA network that may regulate expression of AT2R, EPO, Notch1 and inflammatory cytokines, and mitigate cardiac pathology. Seventeen pro-inflammatory and pro-fibrotic cytokines that increase during lethal cytokine storms caused by infections such as COVID-19 were among the cytokines suppressed by NP-6A4 treatment in ZO rat heart. Thus, NP-6A4 activates a novel anti-inflammatory network comprised of 21 proteins in the heart that was not reported previously. Since NP-6A4's unique mode of action suppresses pro-inflammatory cytokine network and attenuates myocardial damage, it can be an ideal adjuvant drug with other anti-glycemic, anti-hypertensive, standard-of-care drugs to protect the heart tissues from pro-inflammatory and pro-fibrotic cytokine attack induced by obesity.
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Affiliation(s)
| | - Abuzar Mahmood
- Dalton Cardiovascular Research Center, Columbia, MO, United States.,Department of Medicine, Boston, MA, United States.,Harry S. Truman Memorial VA Hospital, Columbia, MO, United States
| | - Anthony M Belenchia
- Dalton Cardiovascular Research Center, Columbia, MO, United States.,Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Paige Beauparlant
- Dalton Cardiovascular Research Center, Columbia, MO, United States.,Department of Medicine, Boston, MA, United States.,Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | | | | | - Vincent G DeMarco
- Dalton Cardiovascular Research Center, Columbia, MO, United States.,Department of Medicine, Boston, MA, United States.,Harry S. Truman Memorial VA Hospital, Columbia, MO, United States
| | - Lakshmi Pulakat
- Dalton Cardiovascular Research Center, Columbia, MO, United States.,Department of Medicine, Boston, MA, United States.,Harry S. Truman Memorial VA Hospital, Columbia, MO, United States.,Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States.,Tufts Medical Center and Department of Medicine, Molecular Cardiology Research Institute, Tufts University School of Medicine, Boston, MA, United States
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19
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Bae J, Won YJ, Lee BW. Non-Albumin Proteinuria (NAP) as a Complementary Marker for Diabetic Kidney Disease (DKD). Life (Basel) 2021; 11:life11030224. [PMID: 33802211 PMCID: PMC7998887 DOI: 10.3390/life11030224] [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: 02/16/2021] [Revised: 03/06/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetic kidney disease (DKD) is one of the most common forms of chronic kidney disease. Its pathogenic mechanism is complex, and it can affect entire structures of the kidney. However, conventional approaches to early stage DKD have focused on changes to the glomerulus. Current standard screening tools for DKD, albuminuria, and estimated glomerular filtration rate are insufficient to reflect early tubular injury. Therefore, many tubular biomarkers have been suggested. Non-albumin proteinuria (NAP) contains a wide range of tubular biomarkers and is convenient to measure. We reviewed the clinical meanings of NAP and its significance as a marker for early stage DKD.
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Affiliation(s)
- Jaehyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon KS006, Korea; (J.B.); (Y.J.W.)
| | - Young Jun Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon KS006, Korea; (J.B.); (Y.J.W.)
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul KS013, Korea
- Correspondence:
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20
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Yang Z, Lou X, Zhang J, Nie R, Liu J, Tu P, Duan P. Association Between Early Markers of Renal Injury and Type 2 Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2021. [PMID: 34744444 DOI: 10.2147/dmso.s335283:] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN) are both common chronic complications of type 2 diabetes mellitus (T2DM). The aim of this study was to examine whether some markers of early renal injury were associated with DPN. METHODS Retrospective hospitalization data from 471 patients with T2DM were analyzed. Subjects were divided into DPN group and non-DPN group according to clinical history, symptoms, signs and nerve conduction study. Markers of glomerular injury [urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)] and tubular injury [urinary N-acetyl-β-D-glucosaminidase/creatinine ratio (NAG/Cr) and urinary β2 microglobulin (β2-MG)] were innovatively combined to assess the association with DPN. Staging of chronic kidney disease (CKD) was classified as G1, G2, G3a, G3b, G4 based on eGFR categories of ≥90, 60-89, 45-59, 30-44, 15-29 mL/min/1.73m2. RESULTS DPN was detected in 71.1% of our population. Subjects in DPN group suffered from older age, longer duration of diabetes and worse blood glucose control compared with non-DPN group. The levels of UACR, NAG/Cr and β2-MG were significantly increased in DPN group than those in non-DPN group, while eGFR was decreased. The prevalence of DPN increased gradually in G1, G2 and G3-4 of CKD, which were 66.3%, 73.2% and 82.7% (P = 0.014). After adjusting for confounding factors, NAG/Cr >1.41 U/mmol (the highest tertile) was a consistently independent risk factor for DPN [odds ratio, OR (95% confidence interval, CI) = 1.86 (1.04-3.33)]. However, UACR, eGFR and β2-MG did not significantly affect the risk of DPN. CONCLUSION When T2DM patients suffer from CKD, DPN will be more likely to appear, accelerate or deteriorate. Some easily available urinary markers of glomerular and tubular damage can be used for early prediction of DPN, in which increased NAG/Cr is an independent risk factor for DPN.
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Affiliation(s)
- Zhi Yang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Xiaoyang Lou
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, People's Republic of China
| | - Jie Zhang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People's Republic of China
| | - Ronghui Nie
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People's Republic of China
| | - Jiang Liu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Peng Duan
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
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21
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Al-Hazmi SF, Gad HGM, Alamoudi AA, Eldakhakhny BM, Binmahfooz SK, Alhozali AM. Evaluation of early biomarkers of renal dysfunction in diabetic patients. Saudi Med J 2020; 41:690-697. [PMID: 32601635 PMCID: PMC7502923 DOI: 10.15537/smj.2020.7.25168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives: To evaluate 2 renal tubular enzymes; urinary neutrophil gelatinase-associated lipocalin (uNGAL), and urinary N-acetyl-beta-D-glucosaminidase (uNAG), and serum Cystatin C as candidate biomarkers for early diagnosis of early stage of diabetic nephropathy (DB) in patients with type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study was carried out at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia during the period between May 2017 and May 2018 and was conducted on 86 patients with T2DM. Patients were classified according to their albumin/creatinine ratio (ACR) into 3 groups; a normal albuminuria group with ACR <30 mg/g creatinine, a moderately increased albuminuria group with ACR: 30-299 mg/g creatinine, and a severely increased albuminuria group with ACR ≥300 mg/g. Healthy adults were recruited as a control group. Urine uNGAL, uNAG, and serum Cystatin C were measured in all patients. Results: Compared with healthy control, diabetic patients with normal albuminuria excreted significantly higher levels of uNGAL (p<0.001). In addition, significantly elevated uNGAL, uNAG and cystatin C levels were observed in moderately increased albuminuria and severely increased albuminuria groups when compared to the control and normoalbuminuric groups (p<0.001). urinary neutrophil gelatinase-associated lipocalin, urinary N-acetyl-beta-D-glucosaminidase and Cystatin C showed a positive correlation with fasting blood glucose (FBG), HbA1c, duration of diabetes, urea, creatinine, and ACR. Conclusion: Our results indicated that uNGAL could be a sensitive biomarker for early renal dysfunction in diabetic patients while uNAG and serum Cystatin C might have prognostic value.
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Affiliation(s)
- Shrouq F Al-Hazmi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Kim G, Lim S, Kwon H, Park IB, Ahn KJ, Park C, Kwon SK, Kim HS, Park SW, Kim SG, Moon MK, Kim ES, Chung CH, Park KS, Kim M, Chung DJ, Lee CB, Kim TH, Lee M. Efficacy and safety of evogliptin treatment in patients with type 2 diabetes: A multicentre, active-controlled, randomized, double-blind study with open-label extension (the EVERGREEN study). Diabetes Obes Metab 2020; 22:1527-1536. [PMID: 32319168 PMCID: PMC7496811 DOI: 10.1111/dom.14061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
AIM To investigate the efficacy and safety of evogliptin compared with linagliptin in patients with type 2 diabetes. MATERIALS AND METHODS In this 12-week, multicentre, randomized, double-blind, active-controlled, and 12-week open-label extension study, a total of 207 patients with type 2 diabetes who had HbA1c levels of 7.0%-10.0% were randomized 1:1 to receive evogliptin 5 mg (n = 102) or linagliptin 5 mg (n = 105) daily for 12 weeks. The primary efficacy endpoint was the change from baseline HbA1c at week 12. The secondary endpoint was the change in the mean amplitude of glycaemic excursion (MAGE) assessed by continuous glucose monitoring. In the extension study conducted during the following 12 weeks, evogliptin 5 mg daily was administered to both groups: evogliptin/evogliptin group (n = 95) and linagliptin/evogliptin group (n = 92). RESULTS After 12 weeks of treatment, the mean change in HbA1c in the evogliptin group and in the linagliptin group was -0.85% and -0.75%, respectively. The between-group difference was -0.10% (95% CI: -0.32 to 0.11), showing non-inferiority based on a non-inferiority margin of 0.4%. The change in MAGE was -24.6 mg/dL in the evogliptin group and -16.7 mg/dL in the linagliptin group. These values were significantly lower than the baseline values in both groups. However, they did not differ significantly between the two groups. In the evogliptin/evogliptin group at week 24, HbA1c decreased by -0.94%, with HbA1c values of <7.0% in 80.2% of the patients. The incidence and types of adverse events were comparable between the two groups for 24 weeks. CONCLUSION In this study, the glucose-lowering efficacy of evogliptin was non-inferior to linagliptin. It was maintained at week 24 with a 0.94% reduction in HbA1c. Evogliptin therapy improved glycaemic variability without causing any serious adverse events in patients with type 2 diabetes.
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Affiliation(s)
- Gyuri Kim
- Department of Medicine, Samsung Medical CenterSungkyunkwan UniversitySeoulKorea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Hyuk‐Sang Kwon
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
| | - Ie B. Park
- Department of Internal MedicineGachon University Gil Medical CenterIncheonKorea
| | - Kyu J. Ahn
- Department of Internal MedicineKangdong Kyung Hee University HospitalSeoulKorea
| | - Cheol‐Young Park
- Department of Internal MedicineKangbuk Samsung HospitalSeoulKorea
| | - Su K. Kwon
- Department of Internal MedicineKosin University Gospel HospitalBusanKorea
| | - Hye S. Kim
- Department of Internal MedicineKeimyung University Dongsan Medical CenterDaeguKorea
| | - Seok W. Park
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
| | - Sin G. Kim
- Department of Internal MedicineKorea University Anam HospitalSeoulKorea
| | - Min K. Moon
- Department of Internal MedicineSeoul National University Boramae Medical CenterSeoulKorea
| | - Eun S. Kim
- Department of Internal Medicine, Ulsan University HospitalCollege of Medicine University of UlsanUlsanKorea
| | - Choon H. Chung
- Department of Internal MedicineWonju Severance Christian HospitalWonjuKorea
| | - Kang S. Park
- Department of Internal MedicineEulji University HospitalDaejeonKorea
| | - Mikyung Kim
- Department of Internal MedicineInje University Haeundae Paik HospitalBusanKorea
| | - Dong J. Chung
- Department of Internal Medicine, Chonnam National University Medical SchoolChonnam National University HospitalGwangjuKorea
| | - Chang B. Lee
- Department of Internal MedicineHanyang University Guri HospitalGuriKorea
| | - Tae H. Kim
- Department of Internal MedicineSeoul Medical CenterSeoulKorea
| | - Moon‐Kyu Lee
- Department of Internal MedicineSoonchunhyang University Gumi HospitalGumiSouth Korea
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Barbosa J, Faria J, Garcez F, Leal S, Afonso LP, Nascimento AV, Moreira R, Queirós O, Carvalho F, Dinis-Oliveira RJ. Repeated Administration of Clinical Doses of Tramadol and Tapentadol Causes Hepato- and Nephrotoxic Effects in Wistar Rats. Pharmaceuticals (Basel) 2020; 13:ph13070149. [PMID: 32664348 PMCID: PMC7407499 DOI: 10.3390/ph13070149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/18/2022] Open
Abstract
Tramadol and tapentadol are fully synthetic and extensively used analgesic opioids, presenting enhanced therapeutic and safety profiles as compared with their peers. However, reports of adverse reactions, intoxications and fatalities have been increasing. Information regarding the molecular, biochemical, and histological alterations underlying their toxicological potential is missing, particularly for tapentadol, owing to its more recent market authorization. Considering the paramount importance of liver and kidney for the metabolism and excretion of both opioids, these organs are especially susceptible to toxicological damage. In the present study, we aimed to characterize the putative hepatic and renal deleterious effects of repeated exposure to therapeutic doses of tramadol and tapentadol, using an in vivo animal model. Male Wistar rats were randomly divided into six experimental groups, composed of six animals each, which received daily single intraperitoneal injections of 10, 25 or 50 mg/kg tramadol or tapentadol (a low, standard analgesic dose, an intermediate dose and the maximum recommended daily dose, respectively). An additional control group was injected with normal saline. Following 14 consecutive days of administration, serum, urine and liver and kidney tissue samples were processed for biochemical, metabolic and histological analysis. Repeated administration of therapeutic doses of both opioids led to: (i) increased lipid and protein oxidation in liver and kidney, as well as to decreased total liver antioxidant capacity; (ii) decreased serum albumin, urea, butyrylcholinesterase and complement C3 and C4 levels, denoting liver synthesis impairment; (iii) elevated serum activity of liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and γ-glutamyl transpeptidase, as well as lipid profile alterations, also reflecting hepatobiliary commitment; (iv) derangement of iron metabolism, as shown through increases in serum iron, ferritin, haptoglobin and heme oxygenase-1 levels. In turn, elevated serum cystatin C, decreased urine creatinine output and increased urine microalbumin levels were detected upon exposure to tapentadol only, while increased serum amylase and urine N-acetyl-β-D-glucosaminidase activities were observed for both opioids. Collectively, these results are compatible with kidney injury. Changes were also found in the expression levels of liver- and kidney-specific toxicity biomarker genes, upon exposure to tramadol and tapentadol, correlating well with alterations in lipid profile, iron metabolism and glomerular and tubular function. Histopathological analysis evidenced sinusoidal dilatation, microsteatosis, mononuclear cell infiltrates, glomerular and tubular disorganization, and increased Bowman's spaces. Although some findings are more pronounced upon tapentadol exposure, our study shows that, when compared with acute exposure, prolonged administration of both opioids smooths the differences between their toxicological effects, and that these occur at lower doses within the therapeutic range.
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Affiliation(s)
- Joana Barbosa
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: (J.B.); (R.J.D.-O.); Tel.: +351-224-157-216 (J.B.); +351-224-157-216 (R.J.D.-O.)
| | - Juliana Faria
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
| | - Fernanda Garcez
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Sandra Leal
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Luís Pedro Afonso
- Department of Pathology, Portuguese Institute of Oncology of Porto, 4200-072 Porto, Portugal;
| | - Ana Vanessa Nascimento
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Roxana Moreira
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Odília Queirós
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Félix Carvalho
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
| | - Ricardo Jorge Dinis-Oliveira
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: (J.B.); (R.J.D.-O.); Tel.: +351-224-157-216 (J.B.); +351-224-157-216 (R.J.D.-O.)
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Choi EY, Park SE, Lee SC, Koh HJ, Kim SS, Byeon SH, Kim M. Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus. Invest Ophthalmol Vis Sci 2020; 61:4. [PMID: 32150245 PMCID: PMC7401845 DOI: 10.1167/iovs.61.3.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the clinical significance of the changes in the macular microvasculature in patients with diabetes mellitus type 2 without diabetic retinopathy. Methods Fifty-five patients with diabetes mellitus type 2 without diabetic retinopathy and 48 healthy individuals were enrolled in a prospective cross-sectional study. We identified the changes of optical coherence tomography angiography parameters (foveal avascular zone [FAZ] area and circularity, vessel density, and perfusion index) of the 6 × 6-mm macular scan. Correlation and multiple regression analyses were performed between optical coherence tomography angiography parameters and previously known diabetes mellitus type 2-related demographic and systemic characteristics, and serum biochemical markers. Results FAZ parameters and perfusion index of the superficial and deep vascular plexus showed significant correlation with serum insulin level, and homeostasis model assessment indices. In multiple linear regression analysis, low insulin levels predicted increased FAZ areas in both the superficial (β = –0.007; P = 0.030) and deep layers (β = –0.010; P = 0.018) and a decreased perfusion index in the deep layer (β = 0.003; P = 0.001). Conclusions The expansion and loss of circularity of the FAZ and the decrease in the perfusion index may be affected by insulin resistance and secretory capacity in patients with diabetes mellitus type 2 with no diabetic retinopathy.
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Proteinuria is Associated with Carotid Artery Atherosclerosis in Non-Albuminuric Type 2 Diabetes: A Cross-Sectional Study. J Clin Med 2020; 9:jcm9010136. [PMID: 31947845 PMCID: PMC7019294 DOI: 10.3390/jcm9010136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022] Open
Abstract
The association of specific urinary proteins other than albumin with cardiovascular (CV) outcomes in patients with type 2 diabetes (T2D) has been shown. In this respect, CV outcomes may differ in non-albuminuric T2D patients who were considered as a low risk group, according to the presence of proteinuria. We investigated the association between proteinuria and atherosclerosis assessed by carotid artery intima-media thickness (CIMT) in non-albuminuric T2D patients. 2047 T2D patients whose urine albumin-to-creatinine ratio was below 30 mg/g were recruited and classified into a non-proteinuria (NP, uPCR < 150 mg/g, n = 1865) group and a non-albuminuric proteinuria (NAP, uPCR ≥ 150 mg/g, n = 182) group. CIMT was compared between the two groups and logistic regression analysis was conducted to verify whether proteinuria could predict deteriorated CIMT status. In this cross-sectional study, mean CIMT of the NAP group were significantly thicker than those of the NP group (0.73 ± 0.16 vs. 0.70 ± 0.14, p = 0.016). The presence of proteinuria is associated with deteriorated CIMT after the adjustment for conventional risk factors (odds ratio, 2.342; 95% confidence interval, 1.082-5.070, p = 0.030) in regression analysis. We postulated that the measurement of urinary protein in conjunction with albumin might be helpful for predicting atherosclerosis, especially for non-albuminuric patients.
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Wang L, Deng Y, Zhai Y, Xu F, Li J, Zhang D, Gao L, Hou Y, OuYang X, Hu L, Yuan J, Ye H, Chi R, Chen C. Impact of blood glucose levels on the accuracy of urinary N-acety-β-D-glucosaminidase for acute kidney injury detection in critically ill adults: a multicenter, prospective, observational study. BMC Nephrol 2019; 20:186. [PMID: 31126255 PMCID: PMC6534873 DOI: 10.1186/s12882-019-1381-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The performance of urinary N-acetyl-β-D-glucosaminidase (uNAG) for the detection of acute kidney injury (AKI) was controversial. uNAG is positively correlated with blood glucose levels. Hyperglycemia is common in the critically ill adults. The influence of blood glucose levels on the accuracy of uNAG in AKI detection has not yet been reported. The present study evaluated the effect of blood glucose levels on the diagnostic accuracy of uNAG to detect AKI. METHODS A total of 1585 critically ill adults in intensive care units at three university hospitals were recruited in this prospective observational study. uNAG, serum glucose, and glycosylated hemoglobin (HbA1c) were measured at ICU admission. Patients were categorized based on the history of diabetes and blood glucose levels. The performance of uNAG to detect AKI in different groups was assessed by the area under the receiver operator characteristic curve. RESULTS Four hundred and twelve patients developed AKI, of which 109 patients were severe AKI. uNAG was significantly correlated with the levels of serum glucose (P < 0.001) and HbA1c (P < 0.001). After stratification based on the serum glucose levels, no significant difference was observed in the AUC of uNAG in detecting AKI between any two groups (P > 0.05). Stratification for stress hyperglycemic demonstrated similar results.However, among non-diabetic patients, the optimal cut-off value of uNAG for detecting AKI was higher in stress hyperglycemic patients as compared to those without stress hyperglycemia. CONCLUSIONS The blood glucose levels did not significantly affect the performance of uNAG for AKI detection in critically ill adults. However, the optimal cut-off value of uNAG to detect AKIwas affected by stress hyperglycemia in non-diabetic patients.
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Affiliation(s)
- Lin Wang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Yujun Deng
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Yiling Zhai
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Feng Xu
- Department of Emergency Medicine, Shandong University Qilu Hospital, Jinan, 250012, Shandong Province, China
| | - Jinghua Li
- Department of Clinical Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Danqing Zhang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Lu Gao
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Yating Hou
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Xin OuYang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Linhui Hu
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Jie Yuan
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, China
| | - Heng Ye
- Department of Critical Care Medicine, Guangzhou Nansha Central Hospital, Guangzhou, 511400, Guangdong Province, China
| | - Ruibin Chi
- Department of Critical Care Medicine, Xiaolan Hospital of Southern Medical University, Zhongshan, 528415, Guangdong Province, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China.
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Yan F, Tian X, Luan Z, Feng L, Ma X, James TD. NAG-targeting fluorescence based probe for precision diagnosis of kidney injury. Chem Commun (Camb) 2019; 55:1955-1958. [DOI: 10.1039/c8cc10311a] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
NAG-targeting fluorescent probe for sensing proximal tubule cells in patient's crude urine and precision diagnosis for kidney injury unit.
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Affiliation(s)
- Fei Yan
- Academy of Integrative Medicine
- College of Pharmacy
- Advanced Institute for Medical Sciences
- Dalian Medical University
- Dalian 116044
| | - Xiangge Tian
- Academy of Integrative Medicine
- College of Pharmacy
- Advanced Institute for Medical Sciences
- Dalian Medical University
- Dalian 116044
| | - Zhilin Luan
- Academy of Integrative Medicine
- College of Pharmacy
- Advanced Institute for Medical Sciences
- Dalian Medical University
- Dalian 116044
| | - Lei Feng
- Academy of Integrative Medicine
- College of Pharmacy
- Advanced Institute for Medical Sciences
- Dalian Medical University
- Dalian 116044
| | - Xiaochi Ma
- Academy of Integrative Medicine
- College of Pharmacy
- Advanced Institute for Medical Sciences
- Dalian Medical University
- Dalian 116044
| | - Tony D. James
- Department of Chemistry, University of Bath
- Bath, BA2 7AY
- UK
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Huh JH, Lee M, Park SY, Kim JH, Lee BW. Glycated Albumin Is a More Useful Glycation Index than HbA1c for Reflecting Renal Tubulopathy in Subjects with Early Diabetic Kidney Disease. Diabetes Metab J 2018; 42:215-223. [PMID: 29885104 PMCID: PMC6015965 DOI: 10.4093/dmj.2017.0091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate which glycemic parameters better reflect urinary N-acetyl-β-D-glucosaminidase (uNAG) abnormality, a marker for renal tubulopathy, in subjects with type 2 diabetes mellitus (T2DM) subjects with normoalbuminuria and a normal estimated glomerular filtration rate (eGFR). METHODS We classified 1,061 participants with T2DM into two groups according to uNAG level-normal vs. high (>5.8 U/g creatinine)-and measured their biochemical parameters. RESULTS Subjects with high uNAG level had significantly higher levels of fasting and stimulated glucose, glycated albumin (GA), and glycosylated hemoglobin (HbA1c) and lower levels of homeostasis model assessment of β-cell compared with subjects with normal uNAG level. Multiple linear regression analyses showed that uNAG was significantly associated with GA (standardized β coefficient [β]=0.213, P=0.016), but not with HbA1c (β=?0.137, P=0.096) or stimulated glucose (β=0.095, P=0.140) after adjusting confounding factors. In receiver operating characteristic analysis, the value of the area under the curve (AUC) for renal tubular injury of GA was significantly higher (AUC=0.634; 95% confidence interval [CI], 0.646 to 0.899) than those for HbA1c (AUC=0.598; 95% CI, 0.553 to 0.640), stimulated glucose (AUC=0.594; 95% CI, 0.552 to 0.636), or fasting glucose (AUC=0.558; 95% CI, 0.515 to 0.600). The optimal GA cutoff point for renal tubular damage was 17.55% (sensitivity 59%, specificity 62%). CONCLUSION GA is a more useful glycation index than HbA1c for reflecting renal tubulopathy in subjects with T2DM with normoalbuminuria and normal eGFR.
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Affiliation(s)
- Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Elevated urinary N-acetyl-β-D-glucosaminidase is associated with high glycoalbumin-to-hemoglobin A1c ratio in type 1 diabetes patients with early diabetic kidney disease. Sci Rep 2018; 8:6710. [PMID: 29712934 PMCID: PMC5928247 DOI: 10.1038/s41598-018-25023-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/12/2018] [Indexed: 01/23/2023] Open
Abstract
Urinary N-acetyl-β-D-glucosaminidase (uNAG) predicted the progression of diabetic kidney disease (DKD) prior to development of albuminuria in diabetes patients. We sought whether uNAG level is associated with glycoalbumin-to-hemoglobin A1c ratio (G/A ratio), a marker of postprandial hyperglycemia and glycemic excursion, independent of albuminuria and kidney function. The association between uNAG excretion and G/A ratio was assessed in 204 consecutive subjects with type 1 diabetes (T1D) (mean age 43.9 years; 49.0% men). uNAG excretion level increased along with older age, hyperglycemia, and degree of albuminuria, but was not correlated with body mass index or estimated glomerular filtration rate (eGFR). Elevated uNAG showed robust association with higher G/A ratio (adjusted β = 0.103, P = 0.020) after adjustment for age, sex, body mass index, duration of diabetes, uACR, angiotensin blockers use, fasting plasma glucose, and hemoglobin level. uNAG showed better discriminatory performance for individuals with high G/A ratio than albuminuria (AUC 0.613 vs. 0.518, P = 0.038). Measurement of uNAG improved AUC for high G/A ratio from 0.699 to 0.748 (P = 0.043) when added to conventional risk factors (cutoff 5.24 U/g creatinine; sensitivity 62.5% and specificity 58.0%). In conclusion, Elevated uNAG was found to be associated with high G/A ratio in patients with T1D with early stage DKD, independent of age and albuminuria.
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30
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Zhang X, Zhou H, Li Y. Combined Detection of Urinary Micro Albumin, α1-microglobulin and N-acetyl-β-D-glucosaminidase in the Early Diagnosis of Diabetic Nephropathy. Pak J Med Sci 2017; 33:1324-1327. [PMID: 29492052 PMCID: PMC5768818 DOI: 10.12669/pjms.336.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To analyze the values of combined detection of urinary micro albumin (mAlb), α1-microglobulin (α1-MG) and N-acetyl-β-D-glucosaminidase (NAG) in the early diagnosis of diabetic nephropathy (DN). Methods: Ninety-four patients with early DN who were admitted to the hospital between April 2015 and April 2016 were selected and set as a DN group. Moreover, seventy-six patients with diabetes who were admitted to the hospital in the same period were selected and set as a diabetes group, and sixty-four healthy people were selected as set as a control group. The urinary mAlb, α1-MG and NAG of the three groups were detected. Moreover, the patients were divided into a favorable blood glucose control group and a poor blood glucose control group according to the blood glucose control condition of the patients. The detection results of the three groups were compared and statistically analyzed. Results: The urinary mAlb, α1-MG and NAG levels of the DN group were significantly higher than those of the diabetes group and control group, and the differences had statistical significance (P<0.05). The detection indicator values of the favorable blood glucose control group were much lower than those of the poor blood glucose control group, and the difference was statistically significant (P<0.05). The positive rate of the combined detection of mAlb, α1-MG and NAG levels was 90.2%, which was much higher than that of single indicator (P<0.05). Conclusion: Combined detection of urinary mAlb, α1-MG and NAG is sensitive in diagnosing early renal damages in DN patients.
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Affiliation(s)
- Xuejun Zhang
- Xuejun Zhang, Clinical Laboratory, Binzhou People's Hospital, Shandong, 256610, China
| | - Hongyan Zhou
- Hongyan Zhou Clinical Laboratory, Binzhou People's Hospital, Shandong, 256610, China
| | - Yan Li
- Yan Li, Department of Blood Transfusion, Binzhou People's Hospital, Shandong, 256610, China
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Papadopoulou-Marketou N, Kanaka-Gantenbein C, Marketos N, Chrousos GP, Papassotiriou I. Biomarkers of diabetic nephropathy: A 2017 update. Crit Rev Clin Lab Sci 2017; 54:326-342. [DOI: 10.1080/10408363.2017.1377682] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nektaria Papadopoulou-Marketou
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
- Department of Endocrinology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Christina Kanaka-Gantenbein
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | | | - George P. Chrousos
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
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32
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Kim SR, Lee YH, Lee SG, Kang ES, Cha BS, Lee BW. The renal tubular damage marker urinary N-acetyl-β-D-glucosaminidase may be more closely associated with early detection of atherosclerosis than the glomerular damage marker albuminuria in patients with type 2 diabetes. Cardiovasc Diabetol 2017; 16:16. [PMID: 28122570 PMCID: PMC5267389 DOI: 10.1186/s12933-017-0497-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/13/2017] [Indexed: 01/17/2023] Open
Abstract
Background To determine the association between urinary N-acetyl-β-d-glucosaminidase (NAG), a marker of renal tubulopathy, and carotid intima-media thickness (IMT) and plaques in patients with type 2 diabetes mellitus (T2D) and to compare the predictive value of NAG versus albuminuria, a marker of renal glomerulopathy. Methods A total of 343 participants were enrolled in this retrospective cross-sectional study. We recruited participants with T2D who were tested for blood glucose parameters, urinary NAG, and urinary albumin-to-creatinine ratio (ACR) and had been checked for carotid ultrasonography. Results We classified participants into a below-median urinary NAG group (Group I; n = 172) or an above-median group (Group II; n = 171). Mean, maximum, and mean of maximum carotid IMT and the proportion of patients with carotid plaques were significantly higher in Group II compared with Group I. In multiple linear regression analyses, high urinary NAG (Group II) was significantly associated with carotid IMT, independently of urinary ACR and other confounding factors. In terms of carotid plaques, both urinary NAG and ACR were significantly higher in participants with carotid plaques than in those without carotid plaques. After adjustment for confounding factors, both urinary NAG and ACR were significantly associated with the presence of carotid plaques. Conclusions Elevated urinary NAG, a marker of renal tubular damage, was related to increased carotid IMT and the presence of carotid plaques in patients with T2D. Urinary NAG may be a more sensitive biomarker than urinary albumin for early detection of atherosclerosis. Electronic supplementary material The online version of this article (doi:10.1186/s12933-017-0497-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- So Ra Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. .,Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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