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Zhang Y, Xiang C, Gong L, Zhang Y, Zhen J, Hu Z, Xiao X. Kidney injury molecule-1 levels are associated with therapeutic outcomes and renal tubulointerstitial injury severity in idiopathic membranous nephropathy. Exp Ther Med 2021; 22:1434. [PMID: 34707715 PMCID: PMC8543435 DOI: 10.3892/etm.2021.10869] [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: 07/16/2020] [Accepted: 04/28/2021] [Indexed: 11/06/2022] Open
Abstract
Kidney injury molecule-1 (KIM-1) has an important role in chronic kidney disease development. The present study aimed to retrospectively analyze patients with idiopathic membranous nephrology (IMN) with different therapeutic outcomes to investigate the association between KIM-1 levels and therapeutic outcomes. A total of 51 patients with IMN and 20 healthy controls were included. Patients were classified into three groups: Spontaneous remission, remission with immunosuppressive therapy (IST) and nonremission with IST. Clinical and biochemical variables were collected. Urinary KIM-1 levels were measured by ELISA and renal KIM-1 expression was evaluated by immunohistochemistry. Patients with IMN were characterized as having elevated urinary and renal KIM-1 levels compared with those in the controls. Significantly increased urinary and renal KIM-1 levels were observed in the nonremission with IST group compared with those in the spontaneous remission group, and the same trend was observed for the plasma anti-podocyte antigen phospholipase A2 receptor antibody levels. Patients with more severe tubular injury (T2 index) presented with significantly higher urinary and renal KIM-1 levels than those with the T0 index. Urinary and renal KIM-1 levels were positively correlated with blood urea nitrogen, serum creatinine, serum cystatin-C, urinary albumin/creatinine ratio, urinary β2-microglobulin and the renal interstitial fibrosis index, and they were negatively correlated with serum albumin. Furthermore, urinary KIM-1 levels were positively correlated with the renal KIM-1 levels. In conclusion, the measurement of urinary and renal KIM-1 levels may be helpful in guiding medication selection and predicting therapeutic outcomes for patients with IMN.
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Affiliation(s)
- Yidan Zhang
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chunhong Xiang
- Department of Nephrology, The No. 4 Hospital of Jinan, Shandong 250031, P.R. China
| | - Liying Gong
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yuanyuan Zhang
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Junhui Zhen
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaoyan Xiao
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Abstract
Membranous nephropathy (MN) is a glomerular disease that can occur at all ages. In adults, it is the most frequent cause of nephrotic syndrome. In ~80% of patients, there is no underlying cause of MN (primary MN) and the remaining cases are associated with medications or other diseases such as systemic lupus erythematosus, hepatitis virus infection or malignancies. MN is an autoimmune disease characterized by a thickening of the glomerular capillary walls due to immune complex deposition. Identification of the phospholipase A2 receptor (PLA2R) as the major antigen in adults in 2009 induced a paradigm shift in disease diagnosis and monitoring and several other antigens have since been characterized. Disease outcome is difficult to predict and around one-third of patients will undergo spontaneous remission. In those at high risk of progression, immunosuppressive therapy with cyclophosphamide plus corticosteroids has substantially reduced the need for kidney replacement therapy. Owing to carcinogenic risk, other treatments (calcineurin inhibitors and CD20-targeted B cell depletion therapy (rituximab)) have been developed. However, disease relapses are frequent when calcineurin inhibitors are stopped and the remission rate with rituximab is lower than with cyclophosphamide, particularly in patients with high PLA2R antibody titres. Other new drugs are already available and antigen-specific immunotherapies are being developed.
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Wu Q, Troost JP, Dai T, Nast C, Eddy S, Wei B, Wang Y, Gipson DS, Dell KM, Gibson KL, Kretzler M, Adler S. Kidney Injury Molecule-1 and Periostin Urinary Excretion and Tissue Expression Levels and Association with Glomerular Disease Outcomes. GLOMERULAR DISEASES 2021; 1:45-59. [PMID: 34337593 DOI: 10.1159/000513166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introductions Kidney injury molecule-1 (KIM-1) and periostin (POSTN) are proximal and distal tubule injury biomarkers. We tested whether baseline urine KIM-1/creatinine (uKIM-1/cr) and/or uPOSTN/cr correlated with disease severity or improved a remission prediction model. Methods Baseline uKIM1/cr and uPOSTN/cr were measured on spot urine samples from immunosuppression-free patients enrolled in Nephrotic Syndrome Study Network until December 15, 2014. Urine protein/creatinine (UPCR) and albumin/creatinine (UACR) were measured at baseline, 4 months, and until last follow-up. Glomerular and tubulointerstitial (TI) expression arrays were analyzed from a baseline research renal biopsy core collected during a clinically indicated biopsy.Renal diagnoses were centrally confirmed, sections scanned, and measured morphometrically. Correlations between baseline uKIM-1/cr and uPOSTN/cr and UPCR, UACR, histopathologic features, glomerular and TI KIM-1 and POSTN expression levels, and renal outcomes were assessed. Results Baseline uKIM-1/cr correlated with UPCR and UACR, and were associated with complete remission after adjustment for proteinuria, histopathologic diagnosis, and treatment. Baseline uKIM-1/cr also correlated with degree of foot process effacement and acute tubular injury. Glomerular and TI KIM-1 expression levels correlated with UPCR and UACR. Higher TI KIM-1 expression levels correlated with interstitial fibrosis, tubular atrophy, and global glomerulosclerosis, while glomerular KIM-1 expression correlated with time to remission. Findings for POSTN were of lesser statistical strength. Discussion/Conclusion Lower baseline uKIM-1/cr values were associated with more rapid time to complete remission after adjusting for proteinuria, histopathologic diagnosis, and treatment. Increased TI KIM-1 expression levels in proteinuric states were associated with chronic morphological injury; lower glomerular expression levels were associated with a greater potential for proteinuria reversibility.
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Affiliation(s)
- Qiaoyan Wu
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, CA.,Department of Nephrology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Tiane Dai
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, CA
| | - Cynthia Nast
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Eddy
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Boxian Wei
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Ying Wang
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, CA
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | | | - Keisha L Gibson
- Department of Pediatrics, Case Western Reserve University and Cleveland Clinic Children's, Cleveland, Ohio
| | - Matthias Kretzler
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sharon Adler
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, CA
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Wang Y, Jia Y, Wang C, Gao X, Liu Y, Yue B. Urinary neutrophil gelatinase-associated lipocalin rapidly decreases in the first week after kidney transplantation. J Clin Lab Anal 2020; 34:e23445. [PMID: 32592171 PMCID: PMC7595893 DOI: 10.1002/jcla.23445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recipient delayed graft function, which is defined as dialysis in the first week after transplantation, is one of the most common early complications after kidney transplantation. This study aimed to evaluate the daily changes in renal function-related biomarkers in the first week post-transplant. METHODS A total of 72 kidney transplant recipients were retrospectively included in this study. Clinical and laboratory data were collected daily during the first week post-transplant, including urinary concentrations of neutrophil gelatinase-associated lipocalin (NGAL), serum concentrations of NGAL, creatinine, urea nitrogen, uric acid (UA), β2-microglobulin, cystatin C, and estimated glomerular filtration rate (eGFR). RESULTS There were no significant differences in urea nitrogen (P = .375), UA (P = .090), and cystatin C (P = .691), while urinary NGAL (P < .0001), serum NGAL (P < .0001), creatinine (P < .0001), β2-microglobulin (P < .0001), and eGFR (P < .0001) were statistically significant in the first week post-transplant. In comparison with serum NGAL (P < .0001), creatinine (P < .0001), β2-microglobulin (P = .001), and eGFR (P = .001), the change ratios of urinary NGAL changed the most between day 1 and day 2 after renal transplantation, while the changing degree of urinary NGAL showed no significant difference compared with these indicators between day 1 and day 7 after kidney transplantation. CONCLUSION Urinary NGAL is a sensitive marker for indicating renal function. Urinary NGAL combined with other markers can be more helpful for evaluating renal function in the first week following kidney transplantation.
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Affiliation(s)
- Yaqi Wang
- Department of Laboratory Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Jia
- Clinical Laboratory of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyan Wang
- Clinical Laboratory of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojuan Gao
- Department of Laboratory Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuke Liu
- Department of Laboratory Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baohong Yue
- Department of Laboratory Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Faculty of Laboratory Medicine, Zhengzhou University, Zhengzhou, China.,Key Laboratory Medicine of Henan Province, Faculty of Laboratory Medicine of Zhengzhou University, Zhengzhou, China.,Open Laboratory, Henan Province Key Subject of Clinical Medicine, Zhengzhou, China
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High Blood Pressure Is Associated with Tubulointerstitial Damage along with Glomerular Damage in Glomerulonephritis. A large Cohort Study. J Clin Med 2020; 9:jcm9061656. [PMID: 32492793 PMCID: PMC7355847 DOI: 10.3390/jcm9061656] [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: 04/16/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
The key role of arterial hypertension in chonic kidney disease (CKD) progression is widely recognized, but its contribution to tubulointerstitial damage (TID) in glomerulonephritis (GN) remains uncertain. Hence, the objective of this study is to clarify whether TID is associated with glomerular damage, and whether the damage at the tubulointerstitial compartment is more severe in hypertensive patients. The study included retrospectively consecutive patients referred to the Nephrology Unit with diagnoses of primary glomerulonephritis, lupus nephritis (LN), and nephroangiosclerosis (NAS) at biopsy. At least six glomeruli per biopsy were analysed through light and immunofluorescence microscopy. Global glomerulosclerosis (GGS%), TID, and arteriolar hyalinosis (AH) were used as markers of CKD severity. Of the 448 patients of the cohort, 403 received a diagnosis of GN, with the remaining being diagnosed with NAS. Hypertension was found in 52% of the overall patients, with no significant differences among those with GN, and reaching 88.9% prevalence rate in NAS. The hypertensive patients with GN had more marked damage in glomerular and tubular compartments than normotensives independently of the amount of proteinuria. Moreover, hypertension and GGS% were found to be strongly associated with TID in GN. In GN patients, not only the severity of glomerular damage but also the extent of TID was associated with high blood pressure.
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An C, Akankwasa G, Liu J, Wang D, Cheng G, Zhang J, Qin X. Urine markers of renal tubular injury in idiopathic membranous nephropathy: A cross sectional study. Clin Chim Acta 2019; 492:7-11. [PMID: 30684459 DOI: 10.1016/j.cca.2019.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Idiopathic membranous nephropathy (IMN) is a primary glomerular disease and a major cause of adult nephrotic syndrome. Presently, little is known about the capabilities of the urine markers to reflect the severity of IMN. We aimed at establishing whether urinary N-acetyl-β-glucosaminidase (NAG), Retinol binding protein (RBP), Kidney injury molecule-1 (KIM-1) and Neutrophil gelatianse-associated lipocalin (NGAL) are related with renal parameters and the histological grades tubular injury. METHODS The levels of urinary NAG, RBP, KIM-1 and NGAL were determined in 165 biopsy-proven patients and 64 healthy controls. Their levels were then compared between patients and healthy subjects, and between patients with and without nephrotic syndrome. Their linearity with renal parameters and associations with histological grades of renal tubular injury were also assessed. RESULTS All biomarkers were significantly increased in patients (p < .001). However, no significant increase was observed between patients exhibiting moderate and severe grades tubular injury and those exhibiting mild histological grade. With exception of RBP, all biomarkers were higher in patients with nephrotic syndrome (p < .001) and significantly correlated with majority of renal parameters including proteinuria. CONCLUSION Our findings suggest that although urine markers of tubular injury are increased in IMN, they may not offer a reflection of histological grades.
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Affiliation(s)
- Changjuan An
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China
| | - Gilbert Akankwasa
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China
| | - Jianhua Liu
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China
| | - Dandan Wang
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China
| | - Guixue Cheng
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China
| | - Jin Zhang
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China
| | - Xiaosong Qin
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China.
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Guo L, Zhao Y, Yong Z, Zhao W. Evaluation value of neutrophil gelatinase-associated lipocalin for the renal dysfunction of patients with chronic kidney disease: A meta-analysis. Aging Med (Milton) 2018; 1:185-196. [PMID: 31942496 PMCID: PMC6880667 DOI: 10.1002/agm2.12033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The role of neutrophil gelatinase-associated lipocalin (NGAL) for the evaluation of renal function in chronic kidney disease (CKD) has not yet to be determined. We aimed to perform a meta-analysis exploring the correlation between NGAL and glomerular filtration rate (GFR) in CKD patients, and to further identify factors affecting NGAL's performance. METHODS Studies dated before November 2017 were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. A total of 28 relevant studies (involving 3082 patients from 17 countries) were included. The second version of the Quality Assessment for Studies of Diagnostic Accuracy demonstrated that no significant bias had influenced the methodological quality of the included studies. RESULTS Neutrophil gelatinase-associated lipocalin showed a strong negative correlation with measured glomerular filtration rate (mGFR). The pooled correlation coefficient (r) with corresponding 95% confidence intervals for the correlation between serum NGAL (sNGAL) and GFR was -0.48, meanwhile that for urine NGAL (uNGAL) and GFR was -0.34. However, NGAL's performance is different in subgroups restricted by clinical settings, race, sex, age, and staging of renal function. CONCLUSION Neutrophil gelatinase-associated lipocalin could be a renal function evaluation marker for patients with renal dysfunction in CKD. Compared with uNGAL, there was a significant negative correlation between sNGAL and GFR. The performances of sNGAL and uNGAL were restricted by clinical factors that should be considered in regards to the sampling source selection.
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Affiliation(s)
- Lulu Guo
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Yaya Zhao
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Zhenzhu Yong
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Weihong Zhao
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
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