1
|
Lin KM, Su CC, Chen JY, Pan SY, Chuang MH, Lin CJ, Wu CJ, Pan HC, Wu VC. Biomarkers in pursuit of precision medicine for acute kidney injury: hard to get rid of customs. Kidney Res Clin Pract 2024; 43:393-405. [PMID: 38934040 PMCID: PMC11237332 DOI: 10.23876/j.krcp.23.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/08/2024] [Accepted: 02/13/2024] [Indexed: 06/28/2024] Open
Abstract
Traditional acute kidney injury (AKI) classifications, which are centered around semi-anatomical lines, can no longer capture the complexity of AKI. By employing strategies to identify predictive and prognostic enrichment targets, experts could gain a deeper comprehension of AKI's pathophysiology, allowing for the development of treatment-specific targets and enhancing individualized care. Subphenotyping, which is enriched with AKI biomarkers, holds insights into distinct risk profiles and tailored treatment strategies that redefine AKI and contribute to improved clinical management. The utilization of biomarkers such as N-acetyl-β-D-glucosaminidase, tissue inhibitor of metalloprotease-2·insulin-like growth factor-binding protein 7, kidney injury molecule-1, and liver fatty acid-binding protein garnered significant attention as a means to predict subclinical AKI. Novel biomarkers offer promise in predicting persistent AKI, with urinary motif chemokine ligand 14 displaying significant sensitivity and specificity. Furthermore, they serve as predictive markers for weaning patients from acute dialysis and offer valuable insights into distinct AKI subgroups. The proposed management of AKI, which is encapsulated in a structured flowchart, bridges the gap between research and clinical practice. It streamlines the utilization of biomarkers and subphenotyping, promising a future in which AKI is swiftly identified and managed with unprecedented precision. Incorporating kidney biomarkers into strategies for early AKI detection and the initiation of AKI care bundles has proven to be more effective than using care bundles without these novel biomarkers. This comprehensive approach represents a significant stride toward precision medicine, enabling the identification of high-risk subphenotypes in patients with AKI.
Collapse
Grants
- MOST 107-2314-B-002-026-MY3, 108-2314B-002-058, 110-2314-B-002-241, 110-2314-B-002-239 Ministry of Science and Technology (MOST) of the Republic of China (Taiwan)
- NSTC 109-2314-B-002-174-MY3, 110-2314-B-002124-MY3, 111-2314-B-002-046, 111-2314-B-002-058 National Science and Technology Council
- PH-102-SP-09 National Health Research Institutes
- 109-S4634, PC-1246, PC-1309, VN109-09, UN109-041, UN110-030, 111-FTN0011 National Taiwan University Hospital
Collapse
Affiliation(s)
- Kun-Mo Lin
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ching-Chun Su
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Szu-Yu Pan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Hsiang Chuang
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Primary Aldosteronism Center of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- NSARF (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan
| |
Collapse
|
2
|
Klinkhammer BM, Boor P. Kidney fibrosis: Emerging diagnostic and therapeutic strategies. Mol Aspects Med 2023; 93:101206. [PMID: 37541106 DOI: 10.1016/j.mam.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
An increasing number of patients worldwide suffers from chronic kidney disease (CKD). CKD is accompanied by kidney fibrosis, which affects all compartments of the kidney, i.e., the glomeruli, tubulointerstitium, and vasculature. Fibrosis is the best predictor of progression of kidney diseases. Currently, there is no specific anti-fibrotic therapy for kidney patients and invasive renal biopsy remains the only option for specific detection and quantification of kidney fibrosis. Here we review emerging diagnostic approaches and potential therapeutic options for fibrosis. We discuss how translational research could help to establish fibrosis-specific endpoints for clinical trials, leading to improved patient stratification and potentially companion diagnostics, and facilitating and optimizing development of novel anti-fibrotic therapies for kidney patients.
Collapse
Affiliation(s)
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany.
| |
Collapse
|
3
|
Copur S, Demiray A, Basile C, Kanbay M. Endocrinological disorders in acute kidney injury: an often overlooked field of clinical research. J Nephrol 2023; 36:885-893. [PMID: 36652168 DOI: 10.1007/s40620-022-01554-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/05/2022] [Indexed: 01/19/2023]
Abstract
Acute kidney injury (AKI) is a common comorbidity, affecting approximately one in five hospitalized adults. The kidney is the site for the production, metabolism or excretion of most hormones, including the production of erythropoietin (EPO), the active form of vitamin D, renin, thrombopoietin, and the excretion of insulin, catecholamines, gastrin and many other hormones. Therefore, it is reasonable to say that AKI can have a considerable impact on the endocrine system. Although the effects of AKI on various parameters, including cardiovascular parameters, serum electrolytes and acid-base disorders, neuro-humoral mechanisms and neurological outcomes have been extensively studied, the endocrinological consequences of AKI are understudied. Thyroid dysfunction, mainly euthyroid sick syndrome, hypo/hyperglycemia, bone mineral disorders, changes in EPO and atrial natriuretic peptide (ANP) levels are commonly found in AKI. EPO, thyroxine and ANP administration have been evaluated as potential tools to prevent or treat AKI with varying success, while the effects of AKI on some key hormones, including cortisol and insulin, have never been studied. Aim of this narrative review is to illustrate what is known and what is not known about the endocrinological outcomes of AKI. Few clinical trials are ongoing: however, there is a clear need for large-scale randomized controlled trials investigating the endocrinological consequences of AKI.
Collapse
Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Atalay Demiray
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
4
|
Jiang W, Chen Z, Xu J, Luo Z, Teng J, Ding X, Zhao S, Xu X. Proteinuria is a risk factor for acute kidney injury after cardiac surgery in patients with stages 3-4 chronic kidney disease: a case control study. BMC Cardiovasc Disord 2023; 23:77. [PMID: 36759765 PMCID: PMC9912481 DOI: 10.1186/s12872-023-03102-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication after cardiac surgery, and preoperative renal dysfunction is an important risk factor. Proteinuria indicates renal structural damage, but there are few studies on proteinuria and the risk of AKI after cardiac surgery in patients with renal dysfunction. This study aimed to elucidate whether proteinuria can predict AKI after cardiac surgery in patients with renal dysfunction. METHODS Patients with stages 3-4 chronic kidney disease (CKD) who underwent cardiac surgery were included in this retrospective study. AKI was defined according to the KDIGO criteria. The association between proteinuria and AKI in patients with CKD stages 3-4 was investigated. RESULTS The incidence of AKI in the entire cohort (n = 1546) was 53.55%. The in-hospital mortality of patients with was higher than patients without AKI (AKI vs. no AKI, 4.7 vs. 0.8%, P < 0.001). Multivariate logistic regression analysis showed that proteinuria was an independent risk factor for AKI (trace to 1+ OR 2.37; 2+ -3+ OR 5.16) and AKI requiring renal replacement therapy (AKI-RRT) (trace to 1+ OR 3.64; 2+-3+ OR 5.71). Mild proteinuria (trace to 1+ OR 2.59) was also an independent risk factor for in-hospital death. In patients with diabetes mellitus, mild proteinuria (OR 1.925), instead of severe proteinuria (2-3+), was a risk factor of AKI in patients with kidney dysfunction and diabetes. CONCLUSIONS In the population of patients with renal dysfunction, the incidence of AKI was high, which significantly compromised renal and overall prognosis. As a simple and inexpensive routine test, preoperative proteinuria still has value in predicting AKI in patients with impaired renal function.
Collapse
Affiliation(s)
- Wuhua Jiang
- grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China ,grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032 China ,Shanghai Medical Center of Kidney, Shanghai, China ,grid.413087.90000 0004 1755 3939Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Zhihong Chen
- grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China ,grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032 China ,Shanghai Medical Center of Kidney, Shanghai, China ,grid.413087.90000 0004 1755 3939Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Jiarui Xu
- grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032 China ,Shanghai Medical Center of Kidney, Shanghai, China ,grid.413087.90000 0004 1755 3939Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Zhe Luo
- grid.8547.e0000 0001 0125 2443Department of Critical Care, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Teng
- grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China ,grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032 China ,Shanghai Medical Center of Kidney, Shanghai, China ,grid.413087.90000 0004 1755 3939Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Xiaoqiang Ding
- grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China ,grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032 China ,Shanghai Medical Center of Kidney, Shanghai, China ,grid.413087.90000 0004 1755 3939Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Shuan Zhao
- grid.413087.90000 0004 1755 3939Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032 China ,Shanghai Medical Center of Kidney, Shanghai, China ,grid.413087.90000 0004 1755 3939Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Xialian Xu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Medical Center of Kidney, Shanghai, China. .,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
| |
Collapse
|
5
|
Zhang L, Qin W. Research progress of fibroblast growth factor 23 in acute kidney injury. Pediatr Nephrol 2022:10.1007/s00467-022-05791-z. [PMID: 36416954 DOI: 10.1007/s00467-022-05791-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/19/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022]
Abstract
Fibroblast growth factor 23 (FGF23) is primarily produced in bones and mainly regulates calcium and phosphorus metabolism. The level of circulating FGF23 increases rapidly in the early stage of acute kidney injury (AKI). Recent studies have shown that FGF23 may serve as a biomarker for the diagnosis and poor prognosis of AKI. The mechanism of increased FGF23 in AKI may include increased production of FGF23, decreased renal clearance of FGF23, and some new regulatory factors, such as inflammation and glycerol 3-phosphate. However, the biological effects of elevated FGF23 in AKI are still unclear. It is also not known whether reducing the level of circulating FGF23 could alleviate AKI or its poor prognosis. Here, we review the pathophysiological mechanism and possible regulation of FGF23 in AKI and discuss the possibility of using FGF23 as a therapeutic target.
Collapse
Affiliation(s)
- Lina Zhang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.,Division of Nephrology, Henan Key Laboratory for Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Fibroblast growth factor 23 (FGF23) excess is associated with left ventricular hypertrophy (LVH) and early mortality in patients with chronic kidney disease (CKD) and in animal models. Elevated Lipocalin-2 (LCN2), produced by the injured kidneys, contributes to CKD progression and might aggravate cardiovascular outcomes. The current review aims to highlight the role of LCN2 in CKD, particularly its interactions with FGF23. RECENT FINDINGS Inflammation, disordered iron homeostasis and altered metabolic activity are common complications of CKD, and are associated with elevated levels of kidney-produced LCN2 and bone-secreted FGF23. A recent study shows that elevated LCN2 increases FGF23 production, and contributes to cardiac injury in patients and animals with CKD, whereas LCN2 reduction in mice with CKD reduces FGF23, improves cardiovascular outcomes and prolongs lifespan. SUMMARY In this manuscript, we discuss the potential pathophysiological functions of LCN2 as a major kidney-bone crosstalk molecule, linking the progressive decline in kidney function to excessive bone FGF23 production. We also review associations of LCN2 with kidney, cardiovascular and bone and mineral alterations. We conclude that the presented data support the design of novel therapeutic approaches to improve outcomes in CKD.
Collapse
Affiliation(s)
- Guillaume Courbon
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Valentin David
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|