The measurement of renal injury

Research-Relevant Clinical Pathology Resources: Emphasis on Mice, Rats, Rabbits, Dogs, Minipigs, and Non-Human Primates

Clinical pathology testing for investigative or biomedical research and for preclinical toxicity and safety assessment in laboratory animals is a distinct specialty requiring an understanding of species specific and other influential variables on results and interpretation. This review of clinical pathology principles and testing recommendations in laboratory animal species aims to provide a useful resource for researchers, veterinary specialists, toxicologists, and clinical or anatomic pathologists.

Effects of benfotiamine and coenzyme Q10 on kidney damage induced gentamicin

OBJECTIVE

Gentamicin (GM) is an effective antibiotic against severe infection but has limitations related to nephrotoxicity. In this study, we investigated whether benfotiamine (BFT) and coenzyme Q10 (CoQ10), could ameliorate the nephrotoxic effect of GM in rats.

METHODS

Rats were divided into five groups. Group 1 and 2 served as control and sham respectively, Group 3 as GM group, Group 4 as GM+CoQ10 and Group 5 as GM+BFT for 8days. At the end of the study, all rats were euthanized by cervical decapitation and then blood samples and kidneys were collected for further analysis. Serum urea, creatinine, cytokine TNF-a, oxidant and antioxidant parameters, as well as histopathological examination of kidney tissues were assessed.

RESULTS

Gentamicin administration caused a severe nephrotoxicity which was evidenced by an elevated serum creatinine, urea and KIM-1 level as compared with the controls. Moreover, a significant increase in serum malondialdehyde, reduced glutathione. Histopathological examination of renal tissue in gentamisin administered group, there were extremly pronounced necrotic tubules in the renal cortex and hyalen cast accumulation in the medullar tubuli. BFT given to GM rats reduced these nephrotoxicity parameters. Serum creatinine, urea, and KIM-1 were almost normalized in the GM+BFT group. Benfotiamin treatment was significantly decreased necrotic tubuli and hyalen deposition in gentamisin plus benfotiamin group. CoQ10 given to GM rats did not cause any statistically significant alterations in these nephrotoxicity parameters when compared with GM group but histopathological examination of renal tissue in GM+CoQ10 administered group, CoQ10 treatment was decreased necrotic tubuli rate and hyalen accumulation in tubuli.

CONCLUSION

The results from our study indicate that BFT supplement attenuates gentamicin-induced renal injury via the amelioration of oxidative stress and inflammation of renal tubular cells.

Preoperative assessment of the deceased-donor kidney: from macroscopic appearance to molecular biomarkers

Variation in deceased-donor kidney quality can significantly affect outcomes after kidney transplantation. Suboptimal organ selection for a given recipient can result in primary nonfunction, premature graft failure, or inappropriate discard of a suitable organ. Appraisal and appropriate selection of deceased-donor kidneys for use in transplantation is therefore critical. A number of predictive tools have been developed to assist the transplant team in evaluating the suitability of a deceased-donor kidney for transplantation to a given recipient. These include stratification of donors into "standard-" or "expanded-criteria" categories based on clinical parameters, pre-implantation biopsy scores, donor risk scores, machine perfusion characteristics, functional kidney weight, donor biomarkers and molecular diagnostic tools, ex vivo viability assessment using postmortem normothermic perfusion, and overall macroscopic appraisal by the surgical team. Consensus as to the role and predictive value of each of these tools is lacking and clinical practice regarding evaluation and selection of kidneys varies considerably.In this review, we seek to critically appraise the literature and evaluate the levels of evidence for tools used to assess deceased-donor kidneys. Although a plethora of appraisal tools exist, very few demonstrate desirable predictive power to be useful in clinical decision-making. Further research using large, well-designed prospective studies is urgently needed to advance this important field of transplantation science.

Metabolomics for early detection of drug-induced kidney injury: review of the current status

The identification of biomarkers of drug-induced kidney injury is an area of intensive focus in drug development. Traditional markers of renal function, including blood urea nitrogen and serum creatinine, are not region-specific and only increase significantly after substantial kidney injury. Therefore, more sensitive markers of kidney injury are needed. The ideal biomarkers will identify nephrotoxicity early in the drug-discovery process, resulting in decreased development costs and safer drugs. Metabolomics, the study of the small biochemicals present in a biological sample, has become a promising player in the nephrotoxicity arena. In this review, we describe the current status of the identification of metabolic biomarkers for drug-induced kidney toxicity screening. Many of these markers have been confirmed across multiple studies and can detect nephrotoxicity earlier than the traditional clinical chemistry and histopathology methods. Upon further validation, such markers will offer clear benefits for the pharmaceutical industry and regulatory agencies.

The value of machine perfusion perfusate biomarkers for predicting kidney transplant outcome

BACKGROUND

Retrospective evidence suggests that lactate dehydrogenase, aspartate aminotransferase, total glutathione-S-transferase (GST), alanine-aminopeptidase, N-acetyl-β-D-glucosaminidase (NAG), and heart-type fatty acid binding protein (H-FABP) measured during kidney machine perfusion (MP) could have predictive value for posttransplant outcome. However, these data may be biased due to organ discard based on biomarker measurements, and previous analyses were not adjusted for likely confounding factors. No reliable prospective evidence has been available so far. Nevertheless, some centers already use these biomarkers to aid decisions on accepting or discarding a donor kidney.

METHODS

From 306 deceased-donor kidneys donated after brain death or controlled cardiac death and included in an international randomized controlled trial, these six biomarkers were measured in the MP perfusate. In this unselected prospective data set, we tested whether concentrations were associated with delayed graft function, primary nonfunction, and graft survival. Multivariate regression models investigated whether the biomarkers remained independent predictors when adjusted for relevant confounding factors.

RESULTS

GST, NAG, and H-FABP were independent predictors of delayed graft function but not of primary nonfunction and graft survival. Lactate dehydrogenase, aspartate aminotransferase, and alanine-aminopeptidase had no independent prognostic potential for any of the endpoints. Perfusate biomarker concentrations had no relevant correlation with cold ischemic time or renal vascular resistance on the pump.

CONCLUSIONS

Increased GST, NAG, or H-FABP concentrations during MP are an indication to adjust posttransplant recipient management. However, this study shows for the first time that perfusate biomarker measurements should not lead to kidney discard.

Food flavor cinnamaldehyde-induced biochemical and histological changes in the kidney of male albino wistar rat

Rats were given food flavor cinnamaldehyde (CNMA) orally by gavage at the dose of 2.14, 6.96, 22.62 and 73.5mg/kg body weight/day for 10, 30 and 90 days. Only the group of rats treated with CNMA at the dose 73.5mg/kg body weight/day for 90 days showed histological changes in the kidney followed by increased activities of renal, serum and urinary enzymes. CNMA-induced glucosuria in these rats was accompanied by marked proteinuria and creatinuria. Increased serum blood urea nitrogen and serum creatinine and decreased serum protein and glucose levels were observed in these rats. Thus, CNMA at the dose of 73.5mg/kg body weight/day for 90 days exert its effect on kidney of male albino wistar rat and its effect is time and dose dependent.

Metabonomics evaluations of age-related changes in the urinary compositions of male Sprague Dawley rats and effects of data normalization methods on statistical and quantitative analysis

Background

Urine from male Sprague-Dawley rats 25, 40, and 80 days old was analyzed by NMR and UPLC/MS. The effects of data normalization procedures on principal component analysis (PCA) and quantitative analysis of NMR-based metabonomics data were investigated. Additionally, the effects of age on the metabolic profiles were examined by both NMR and UPLC/MS analyses.

Results

The data normalization factor was shown to have a great impact on the statistical and quantitative results indicating the need to carefully consider how to best normalize the data within a particular study and when comparing different studies. PCA applied to the data obtained from both NMR and UPLC/MS platforms reveals similar age-related differences. NMR indicated many metabolites associated with the Krebs cycle decrease while citrate and 2-oxoglutarate, also associated with the Krebs cycle, increase in older rats.

Conclusion

This study compared four different normalization methods for the NMR-based metabonomics spectra from an age-related study. It was shown that each method of normalization has a great effect on both the statistical and quantitative analyses. Each normalization method resulted in altered relative positions of significant PCA loadings for each sample spectra but it did not alter which chemical shifts had the highest loadings. The greater the normalization factor was related to age, the greater the separation between age groups was observed in subsequent PCA analyses. The normalization factor that showed the least age dependence was total NMR intensity, which was consistent with UPLC/MS data. Normalization by total intensity attempts to make corrections due to dietary and water intake of the individual animal, which is especially useful in metabonomics evaluations of urine. Additionally, metabonomics evaluations of age-related effects showed decreased concentrations of many Krebs cycle intermediates along with increased levels of oxidized antioxidants in urine of older rats, which is consistent with current theories on aging and its association with diminishing mitochondrial function and increasing levels of reactive oxygen species. Analysis of urine by both NMR and UPLC/MS provides a comprehensive and complementary means of examining metabolic events in aging rats.

Effect of perioperative steroids on renal function after liver transplantation*

Subclinical renal dysfunction is thought to occur as a systemic manifestation of ischaemia-reperfusion injury of other organs. Liver transplantation is associated with major ischaemia-reperfusion injury. Thirty-four patients undergoing elective liver transplantation were randomly allocated to receive either saline or 10 mg.kg(-1) methylprednisolone on induction of anaesthesia. Urine was taken for N-acetyl-beta-D-glucosaminidase, creatinine and other markers of tubular function. Serum chemistry was measured for 7 days. Creatinine concentration increased in the saline group but not in the methylprednisolone group (p < 0.0001), with the greatest difference on the third postoperative day (mean (SD) 164.8 (135.8) mumol.l(-1)vs 88.5 (39.4) mumol.l(-1), respectively). Similar changes were seen in postoperative alanine transferase (865 (739) U.l(-1)vs 517 (608) U.l(-1), respectively; p < 0.0001) on the second postoperative day. Both groups exhibited increases in markers of renal tubular dysfunction and of glomerular permeability. Patients in the saline group sustained more adverse events (8/17 (47%) vs 2/17 (12%); p = 0.02). The data confirm increased proximal tubular lysosomal turnover, consistent with an increased tubular protein load, following liver transplantation, and suggest that methylprednisolone protects against renal and hepatic dysfunction.

Genomic-based biomarkers of drug-induced nephrotoxicity

Typical drug development timelines are 10 - 15 years, with high attrition rates that make it difficult for companies to sustain productive pipelines. Investigational and discovery toxicology are novel and revolutionary extensions of the field of general toxicology, which has been created to fulfil the growing need for generating higher throughput, and integrative and predictive toxicological information, in an effort to reduce attrition. Included in this new paradigm is transcript profiling, and recent innovations have led some to speculate that genomics would help revolutionise drug development, as more better predictive biomarkers of organ damage would be identified. The kidney has been a focus of toxicogenomics investigations, and candidate genomic-based biomarkers of renal damage have been identified for rodent as well as nonhuman primate models of nephrotoxicity. This review highlights published results that have led to the preliminary identification of candidate genomic-based markers of nephrotoxicity and provides insight into the future of toxicogenomics.

Assessment of renal injury in vivo

The ICH S7A (Safety Pharmacology for Human Pharmaceuticals) guidelines specify that potential adverse pharmacologic effects of a test substance on renal function should be evaluated in supplemental studies when there is a cause for concern (ICH, 2001). For the most part, this can easily be accomplished by examination of the appropriate analytes in urine and blood collected as part of the routine preclinical safety studies. This review will serve as an overview of the selection, interpretation and limitations of standard clinical pathology methods (serum chemistry and urinalysis) for assessment of renal function in such studies, as well as provide some information on emerging biomarkers of renal function.

Overview on the application of transcription profiling using selected nephrotoxicants for toxicology assessment

Microarrays allow for the simultaneous measurement of changes in the levels of thousands of messenger RNAs within a single experiment. As such, the potential for the application of transcription profiling to preclinical safety assessment and mechanism-based risk assessment is profound. However, several practical and technical challenges remain. Among these are nomenclature issues, platform-specific data formats, and the lack of uniform analysis methods and tools. Experiments were designed to address biological, technical, and methodological variability, to evaluate different approaches to data analysis, and to understand the application of the technology to other profiling methodologies and to mechanism-based risk assessment. These goals were addressed using experimental information derived from analysis of the biological response to three mechanistically distinct nephrotoxins: cisplatin, gentamicin, and puromycin aminonucleoside. In spite of the technical challenges, the transcription profiling data yielded mechanistically and topographically valuable information. The analyses detailed in the articles from the Nephrotoxicity Working Group of the International Life Sciences Institute Health and Environmental Sciences Institute suggest at least equal sensitivity of microarray technology compared to traditional end points. Additionally, microarray analysis of these prototypical nephrotoxicants provided an opportunity for the development of candidate bridging biomarkers of nephrotoxicity. The potential future extension of these applications for risk assessment is also discussed.

Do tissue damage biomarkers used to assess machine-perfused NHBD kidneys predict long-term renal function post-transplant?

BACKGROUND

Renal transplantation in many units is limited by the availability of donor organs. Kidneys obtained from non-heart-beating donors (NHBD) represent an important resource, with the potential to substantially increase the available donor organ pool. Such kidneys are associated with increased warm ischaemic tissue injury which may be assessed by hypothermic machine perfusion. Within our transplant centre, a key component of such damage assessment and viability screening involves the quantification of the tissue damage biomarkers glutathione S-transferase in kidney perfusates.

METHODS

Since 1998, 126 NHBD kidneys were machine-perfused prior to implantation, resulting in 74 transplants. Kidney perfusate samples were assayed for glutathione S-transferase in "real time", and alanine aminopeptidase and fatty acid binding protein in "retrospect".

RESULTS

The pre-transplant concentration of these tissue injury biomarkers determined pre-transplant did not correlate with subsequent longer-term renal function, as assessed by measurement of serum creatinine (tGST: Spearman correlation r=-0.02; Ala-AP: r=0.02; H-FABP: r=-0.05) and creatinine clearance (tGST: r=0.08; Ala-AP: r=-0.02; H-FABP: r=0.14) for those kidneys that had passed their viability tests.

CONCLUSIONS

Thus whilst these biomarkers may represent reliable pre-transplant indicators of immediate kidney viability and short-term kidney function, they do not predict the efficacy of renal function in the longer term.

Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass

BACKGROUND AND OBJECTIVE

A variable incidence rate of renal dysfunction (3-35%) after cardiac surgery with cardiopulmonary bypass has been reported. The aim was to define the typical pattern of renal dysfunction that follows coronary surgery with cardiopulmonary bypass using albumin, immunoglobulin (IgG), alpha1-microglobulin and beta-glucosaminidase (beta-NAG) excretion as indicators.

METHODS

Twenty patients with preoperative normal renal function, defined by plasma creatinine, creatinine clearance, fractional excretion of sodium and renal excretion of proteins, undergoing elective myocardial revascularization surgery with cardiopulmonary bypass, were prospectively studied. Variables recorded were demographic and haemodynamic variables, duration of cardiopulmonary bypass and aortic clamping, intra- and postoperative urine output, plasma creatinine concentration, creatinine clearance and excretion of sodium, albumin, IgG, beta-glucosaminidase (beta-NAG), and alpha1-microglobulin. Measurements were made preoperatively, immediately before and then during and immediately after cardiopulmonary bypass, and again at 1, 24, 72 h, 7 and 40 days following surgery.

RESULTS

Albumin and IgG excretion rose significantly during cardiopulmonary bypass (P < 0.05), remaining at these levels at 24 h postoperatively. An increase of alpha1-microglobulin and beta-NAG concentrations was observed during cardiopulmonary bypass (P < 0.05), which were maintained until the seventh postoperative day and remained elevated in some patients at the 40th postoperative day. This correlated with preoperative diabetes mellitus (P < 0.001), low cardiac output after cardiopulmonary bypass (P < 0.001) and the duration of stay in the intensive care unit (P < 0.001).

CONCLUSIONS

The pattern of renal dysfunction after cardiopulmonary bypass for myocardial revascularization is characterized by temporary renal dysfunction at both glomerular and tubular levels with an onset within 24 h of surgery and which lasts between 24 h and 40 days, respectively, following surgery.

The effect of a single gavage dose of fumonisin B(1) on the sphinganine and sphingosine levels in vervet monkeys

This is the first report of sphinganine (Sa) and sphingosine (So) levels determined in serum and urine of vervet monkeys (Cercopithecus aethiops) dosed with pure fumonisin B(1) (FB(1)). Initially, experimental vervet monkeys were given a single gavage dose of either 1 or 10 mg FB(1) /kg body weight. Blood and urine were sampled daily and on day seven the monkeys were terminated and the kidneys and livers harvested. In a subsequent experiment, other vervet monkeys were similarly dosed and blood and urine samples were collected over a 50-day period. In the high-dose monkeys the serum Sa/So ratio, as well as levels of serum cholesterol and liver function enzymes, increased during the first week after dosing and remained elevated for several weeks thereafter. The urinary Sa/So ratio and the serum renal function indicators showed a more rapid response and a correspondingly more rapid return to pre-dosing levels. In the low-dose monkeys serum Sa and the Sa/So ratio were the only parameters to increase above the control levels. The Sa/So ratio in liver and kidney tissue showed an elevation over controls in a dose-dependent manner. The serum Sa/So ratio was exclusively elevated above the control levels in the low- and high-dose monkeys and seems more relevant as a marker for fumonisin exposure than any of the other indicators.

Analytical biochemistry and clinical significance of N-acetyl-beta-D-glucosaminidase and related enzymes

Human N-acetyl-beta-D-glucosaminidase, N-acetyl-alpha-D-glucosaminidase, endo-beta-N-acetylglucosaminidase, hexosaminidase, beta-N-acetylgalactosaminidase and glucocerebrosidase have not been so widely studied as the beta-N-acetylhexosaminidases in bacteria, fungi and arthropods. Their biochemical role has been elucidated, however, and their urinary and plasma determination is being adopted for the early detection of diseases before clinical manifestation, in particular for hypertension, renal injuries and disorders, depression and lysosomal storage diseases. The spectrophotometric determinations of N-acetyl-beta-D-glucosaminidase, most often done with 3-cresolsulphone phthaleinyl N-acetyl-beta-D-glucosaminide, have been recently simplified and adapted to automatic instruments.