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Sans L, Radosevic A, Quintian C, Montañés R, Gràcia S, Vilaplana C, Mojal S, Ballarin JA, Fernández-Llama P, Torra R, Pascual J. Cystatin C estimated glomerular filtration rate to assess renal function in early stages of autosomal dominant polycystic kidney disease. PLoS One 2017; 12:e0174583. [PMID: 28346513 PMCID: PMC5367702 DOI: 10.1371/journal.pone.0174583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/01/2017] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Height-adjusted total kidney volume (htTKV) is the best marker of disease progression in early autosomal dominant polycystic kidney disease (ADPKD) when renal function still remains normal. The usefulness of cystatin-C as a biomarker to assess renal function according to renal volume has not been studied in ADPKD patients. Methods Observational and cross-sectional study of 62 ADPKD patients. htTKV, creatinine and cystatin-C estimated glomerular filtration rate (eGFR) were determined. Correlations between htTKV and eGFR were studied. A control group was used to determine the association between renal function differences and htTKV. Results htTKV significantly correlated with cystatin-C-eGFR (r = -0.384, p = 0.002) but not with creatinine-eGFR (r = -0.225, p = 0.078). With htTKV stratified into tertiles, a significant difference of cystatin-C-eGFR but not in creatinine-eGFR was detected in the third tertile when compared with the first tertile group (110.0±22.2 vs 121.3±7.2; p = 0.023 and 101.8±17.2 vs 106.9±15.1; p = 0.327 respectively). When cystatin-C-eGFR of the controls was used as the reference, htTKV above 605 ml/m identified with a 75% sensitivity and 84.9% specificity those patients with a significant worse kidney function. However, this cut-off value could not be identified using creatinine-eGFR. Conclusions Cystatin-C-eGFR but not creatinine-eGFR correlated with htTKV in ADPKD patients in early stages of the disease. Differences in cystatin-C-eGFR but not in creatinine-eGFR have been identified through htTKV tertiles. A htTKV above 605 ml/m is associated with a worse renal function only if cystatin-C-eGFR is used. Cystatin-C-eGFR should be studied in prospective studies of early stages of ADPKD to determine its usefulness as an early marker of disease progression.
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Affiliation(s)
- Laia Sans
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Institut Mar for Medical Research, Barcelona, Spain
- Red Temática de Investigación Cooperativa (RedinRen), Instituto Carlos III, Madrid, Spain
| | | | | | | | - Silvia Gràcia
- Laboratory Department, Fundació Puigvert, Barcelona, Spain
| | - Carles Vilaplana
- Laboratory Department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Sergi Mojal
- Institut Mar for Medical Research, Barcelona, Spain
| | - José A. Ballarin
- Red Temática de Investigación Cooperativa (RedinRen), Instituto Carlos III, Madrid, Spain
- Department of Nephrology, Fundació Puigvert, Barcelona, Spain
- Universitat Autònoma de Barcelona. Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Patricia Fernández-Llama
- Department of Nephrology, Fundació Puigvert, Barcelona, Spain
- Universitat Autònoma de Barcelona. Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Roser Torra
- Red Temática de Investigación Cooperativa (RedinRen), Instituto Carlos III, Madrid, Spain
- Department of Nephrology, Fundació Puigvert, Barcelona, Spain
- Universitat Autònoma de Barcelona. Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Institut Mar for Medical Research, Barcelona, Spain
- Red Temática de Investigación Cooperativa (RedinRen), Instituto Carlos III, Madrid, Spain
- * E-mail:
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Benzer M, Tekin Neijmann S, Gültekin ND, Uluturk Tekin A. Urinary L-FABP as a marker of vesicoureteral reflux in children: could it also have a protective effect on the kidney? Int Urol Nephrol 2016; 49:1-12. [PMID: 27550232 DOI: 10.1007/s11255-016-1389-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Liver-type fatty acid-binding protein is a small cytoplasmic protein which is expressed in the human renal proximal tubular epithelium and synthesized in response to renal tubular injury. The aim of the present study was to investigate the importance of urinary liver-type fatty acid-binding protein levels in children who diagnosed with vesicoureteral reflux. METHODS Fifty-six patients with vesicoureteral reflux and 51 healthy controls were enrolled to the study. The cases were divided into three groups as follows: group A-the controls, group B-the patients who had renal parenchymal scarring and group C-the patients who had no scarring. Urinary liver-type fatty acid-binding protein was measured by enzyme-linked immunosorbent assay method. Creatinine was measured by modified Jaffe method, protein was measured by turbidimetric method, and urine density was determined by using the "falling drop" procedure. RESULTS Urinary liver-type fatty acid-binding protein and urinary liver-type fatty acid-binding protein/creatinine levels were significantly higher in the whole patient group than in the controls (p = 0.016, 0.006). Significant differences were also determined by comparing the three groups (p = 0.015, 0.014), and those levels were found as significantly higher in group C. CONCLUSION Urinary liver-type fatty acid-binding protein was considered to be helpful for the diagnosis of vesicoureteral reflux, and also it might contribute to understand the mechanisms causing scar tissue formation especially for the patients who had vesicoureteral reflux. Further clinical and experimental investigations are required to elucidate in detail the physiology of liver-type fatty acid-binding protein.
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Affiliation(s)
- Meryem Benzer
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Division of Pediatric Nephrology, Istanbul, Turkey. .,Bakırköy Dr Sadi Konuk Training and Research Hospital, Division of Pediatrics, İstanbul, Turkey.
| | - Sebnem Tekin Neijmann
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Division of Biochemistry, İstanbul, Turkey
| | - Nazlı Dilay Gültekin
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Division of Pediatrics, İstanbul, Turkey
| | - Aslı Uluturk Tekin
- European Commission, DG Joint Research Centre, Institute for Health and Consumer Protection, Ispra (Varese), Italy
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Gansevoort RT, Meijer E, Chapman AB, Czerwiec FS, Devuyst O, Grantham JJ, Higashihara E, Krasa HB, Ouyang J, Perrone RD, Torres VE. Albuminuria and tolvaptan in autosomal-dominant polycystic kidney disease: results of the TEMPO 3:4 Trial. Nephrol Dial Transplant 2015; 31:1887-1894. [PMID: 26681730 DOI: 10.1093/ndt/gfv422] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/17/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The TEMPO 3:4 Trial results suggested that tolvaptan had no effect compared with placebo on albuminuria in autosomal-dominant polycystic kidney disease (ADPKD) patients. However, the use of categorical 'albuminuria events' may have resulted in a loss of sensitivity to detect changes. The aim of this study is to investigate the effects of tolvaptan on albuminuria as a continuous variable. METHODS Post hoc analysis of a 3-year prospective, blinded randomized controlled trial, including 1375 ADPKD patients. Albuminuria was measured in a spot morning urine sample prior to tolvaptan dosing and expressed as albumin-to-creatinine ratio (ACR). RESULTS Baseline median (interquartile range) ACR was 3.2 (1.7-7.1) mg/mmol. Of note, 47.9% of ADPKD patients had normal, 48.7% moderately increased and 3.4% severely increased ACR. Subjects with higher baseline ACR had higher blood pressure and total kidney volume (TKV) and lower estimated glomerular filtration rate (eGFR). During follow-up, higher baseline ACR was associated with more rapid eGFR loss (P < 0.0001 for trend), but not with rate of growth in TKV. During the 3-year trial, ACR rose in placebo- and decreased in tolvaptan-treated patients (+0.23 versus -0.40 mg/mmol). The difference ACR increased over time, reaching a maximum of 24% at Month 36 (P < 0.001). At that time only a minor difference in blood pressure was observed (mean arterial pressure -1.9 mmHg for tolvaptan). The decrease in ACR was similar in all subgroups investigated, and remained after withdrawal of study drug. The beneficial effect of tolvaptan on TKV growth and eGFR loss was stronger in patients with higher baseline ACR. CONCLUSIONS In ADPKD, higher baseline albuminuria was associated with more eGFR loss. Tolvaptan decreased albuminuria compared with placebo, independent of blood pressure. Treatment efficacy of tolvaptan on changes in TKV and eGFR was more readily detected in patients with higher albuminuria.
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Affiliation(s)
- Ron T Gansevoort
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Esther Meijer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Arlene B Chapman
- Division of Nephrology, Emory University School of Medicine, 201 Dowman Drive, Atlanta, Ga. 30322, US
| | - Frank S Czerwiec
- Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD 20850 USA
| | - Olivier Devuyst
- Division of Nephrology, Cliniques Universitaires St. Luc, Université Catholique de Louvain Medical School, 10 Avenue Hippocrate 1200, Brussels, Belgium.,Institute of Physiology, Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Häldeliweg 2, 8044 Zürich, Switzerland
| | - Jared J Grantham
- Kidney Institute and the Department of Internal Medicine, Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160 Kansas City, KS, USA
| | - Eiji Higashihara
- Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo. 181-8611 Japan
| | - Holly B Krasa
- Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD 20850 USA
| | - John Ouyang
- Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD 20850 USA
| | - Ronald D Perrone
- Department of Medicine, Division of Nephrology, TuftsMedical Center, Tufts University School of Medicine, 800 Washington St # 400, Boston, MA 02111, USA
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First St. SW Rochester, MN 55905, USA
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Increased urinary Angiotensinogen/Creatinine (AGT/Cr) ratio may be associated with reduced renal function in autosomal dominant polycystic kidney disease patients. BMC Nephrol 2015; 16:86. [PMID: 26092580 PMCID: PMC4475321 DOI: 10.1186/s12882-015-0075-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/21/2015] [Indexed: 01/31/2023] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary kidney diseases that frequently result in renal failure. In this cross-sectional observational cohort study, we evaluated urinary angiotensinogen (AGT) as a potential biomarker to assess renal function in ADPKD. Methods Urinary AGT was measured in 233 ADPKD patients and its association with estimated glomerular filtration rate (eGFR) and height-adjusted total kidney volume (htTKV) were evaluated. The localization of AGT and other renin-angiotensin system (RAS)-related molecules were identified using immunohistochemistry in human ADPKD tissues. Results Baseline urinary AGT/Cr was negatively correlated with CKD-EPI eGFR (r2
= 0.162, P < 0.001) and positively correlated with htTKV (r2 = 0.107, P < 0.001). Both urinary AGT/Cr and plasma renin activity levels were significantly elevated in hypertensive ADPKD patients. Among hypertensive subjects, urinary AGT/Cr was significantly increased in the advanced CKD stages (III-V) compared to early CKD stages (I-II) (28.6 ± 60.3 vs. 93.2 ± 139.3 μg/g, P < 0.001). Immunohistochemical study showed strong expression of AGT along the cyst-lining epithelial cells as well as the nearby compressed tubular epithelial cells. Conclusions Our results suggested that urinary AGT/Cr may be a valuable biomarker for renal damage in ADPKD since intrarenal ischemic insults induced by cyst growth and subsequent intrarenal RAS activation may play a potential role in the development of hypertension and renal dysfunction in ADPKD. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0075-8) contains supplementary material, which is available to authorized users.
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Changes in Urinary Albumin Excretion, Inflammatory and Oxidative Stress Markers in ADPKD Patients with Hypertension. Am J Med Sci 2012; 343:46-51. [DOI: 10.1097/maj.0b013e31821f0552] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Virzì GM, Corradi V, Panagiotou A, Gastaldon F, Cruz DN, de Cal M, Clementi M, Ronco C. ADPKD: Prototype of Cardiorenal Syndrome Type 4. Int J Nephrol 2010; 2011:490795. [PMID: 21234092 PMCID: PMC3017903 DOI: 10.4061/2011/490795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022] Open
Abstract
The cardiorenal syndrome type 4 (Chronic Renocardiac Syndrome) is characterized by a condition of primary chronic kidney disease (CKD) that leads to an impairment of the cardiac function, ventricular hypertrophy, diastolic dysfunction, and/or increased risk of adverse cardiovascular events. Clinically, it is very difficult to distinguish between CRS type 2 (Chronic Cardiorenal Syndrome) and CRS type 4 (Chronic Renocardiac Syndrome) because often it is not clear whether the primary cause of the syndrome depends on the heart or the kidney. Autosomal dominant polycystic kidney disease (ADPKD), a genetic disease that causes CKD, could be viewed as an ideal prototype of CRS type 4 because it is certain that the primary cause of cardiorenal syndrome is the kidney disease. In this paper, we will briefly review the epidemiology of ADPKD, conventional and novel biomarkers which may be useful in following the disease process, and prevention and treatment strategies.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
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Meijer E, Boertien WE, Nauta FL, Bakker SJL, van Oeveren W, Rook M, van der Jagt EJ, van Goor H, Peters DJM, Navis G, de Jong PE, Gansevoort RT. Association of urinary biomarkers with disease severity in patients with autosomal dominant polycystic kidney disease: a cross-sectional analysis. Am J Kidney Dis 2010; 56:883-95. [PMID: 20888104 DOI: 10.1053/j.ajkd.2010.06.023] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 06/22/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Disease monitoring of autosomal dominant polycystic kidney disease (ADPKD) will become more important with potential upcoming therapeutic interventions. Because serum creatinine level is considered of limited use and measurement of effective renal blood flow (ERBF) and total renal volume are time consuming and expensive, there is a need for other biomarkers. We aimed to investigate which urinary markers have increased levels in patients with ADPKD; whether these urinary markers are associated with measured glomerular filtration rate (mGFR), ERBF, and total renal volume; and whether these associations are independent of albuminuria (urine albumin excretion [UAE]). STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS 102 patients with ADPKD (Ravine criteria) and 102 age- and sex-matched healthy controls. INDEX TEST 24-hour urinary excretion of glomerular (immunoglobulin G), proximal tubular (kidney injury molecule 1 [KIM-1], N-acetyl-β-d-glucosaminidase, neutrophil gelatinase-associated lipocalin [NGAL], and β(2)-microglobulin), and distal tubular (heart-type fatty acid binding protein [H-FABP]) damage markers and inflammatory markers (monocyte chemotactic protein 1 [MCP-1] and macrophage migration inhibitory factor). REFERENCE TEST Disease severity assessed using measures of kidney function (mGFR and ERBF, measured using clearance of iothalamate labeled with iodine 125 and hippuran labeled with iodine 131 during continuous infusion, respectively) and structure (total renal volume, measured using magnetic resonance imaging). OTHER MEASUREMENTS 24-hour UAE. RESULTS In 102 patients with ADPKD (aged 40 ± 11 years; 58% men), levels of all measured urinary biomarkers were increased compared with healthy controls. Excretion of immunoglobulin G and albumin relatively were most increased. ERBF and mGFR values were associated with urinary excretion of β(2)-microglobulin, NGAL, and H-FABP independent of UAE, whereas total renal volume was associated with KIM-1, NGAL, and MCP-1 independent of UAE. LIMITATIONS Cross-sectional, single center. CONCLUSIONS Levels of markers for multiple parts of the nephron are increased in patients with ADPKD. In addition to measurement of UAE, measurement of urinary β(2)-microglobulin, KIM-1, H-FABP, MCP-1, and especially NGAL could be of value for determination of disease severity in patients with ADPKD.
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Affiliation(s)
- Esther Meijer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Ahrabi AK, Jouret F, Marbaix E, Delporte C, Horie S, Mulroy S, Boulter C, Sandford R, Devuyst O. Glomerular and proximal tubule cysts as early manifestations of Pkd1 deletion. Nephrol Dial Transplant 2009; 25:1067-78. [PMID: 19945952 DOI: 10.1093/ndt/gfp611] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The homozygous deletion of Pkd1 in the mouse results in embryonic lethality with renal cysts and hydrops fetalis, but there is no precise data on the segmental origin of cysts and potential changes associated with polyhydramnios. METHODS We used Pkd1-null mice to investigate cystogenesis and analyze the amniotic fluid composition from embryonic day 12.5 (E12.5) to birth (n = 257 embryos). RESULTS Polyhydramnios was consistently observed from E13.5 in Pkd1(-/-) embryos, in absence of placental abnormalities but with a significantly higher excretion of sodium and glucose from E13.5 through E16.5, and increased cyclic adenosine 3'5-monophosphate (cAMP) levels at E14.5 and E15.5. The Pkd1(-/-) embryos started to die at E13.5, with lethality peaking at E15.5, corresponding to the onset of cystogenesis. The first cysts in Pkd1(-/-) kidneys emerged at E15.5 in mesenchyme-derived segments at the cortico-medullary junction, with a majority of glomerular cysts and fewer proximal tubule cysts (positive for megalin). The cysts extended to ureteric bud-derived collecting ducts (positive for Dolichos biflorus agglutinin lectin) from E16.5. CONCLUSIONS These studies indicate that Pkd1 deletion is associated with a massive loss of solutes (from E13.5) and increased cAMP levels (E14.5) associated with polyhydramnios. These abnormalities precede renal cysts (E15.5), first derived from glomeruli and proximal tubules and later from the collecting ducts, reflecting the expression pattern of Pkd1 in maturing epithelial cells.
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Affiliation(s)
- Ali K Ahrabi
- Division of Nephrology, Université catholique de Louvain Medical School, Brussels, Belgium
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Azurmendi PJ, Fraga AR, Galan FM, Kotliar C, Arrizurieta EE, Valdez MG, Forcada PJ, Stefan JSS, Martin RS. Early renal and vascular changes in ADPKD patients with low-grade albumin excretion and normal renal function. Nephrol Dial Transplant 2009; 24:2458-63. [DOI: 10.1093/ndt/gfp136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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