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Lei C, Liu H, Wang H, Liu C. Effectiveness and Renal Functions Safety of Treatments Used for Neonates with Patent Ductus Arteriosus: A Prospective Cohort Study. Med Sci Monit 2019; 25:3668-3675. [PMID: 31100058 PMCID: PMC6537663 DOI: 10.12659/msm.914181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Neutrophil gelatinase-associated lipocalin plays an important role in renal dysfunctions. The objective of this study was to test the hypothesis that indomethacin used in treating patent ductus arteriosus protects infants from renal dysfunction. Material/Methods This prospective cohort study assessed data on urine prostaglandin metabolites, urinary neutrophil gelatinase-associated lipocalin, and the renal functions of preterm infants with confirmed patent ductus arteriosus who had been injected with indomethacin (n=144, ID group) or acetaminophen (n=144, AP group). Results A reduction of neutrophil gelatinase-associated lipocalin in urine samples was found in the ID group (993±48 μG/L vs. 103±5 μG/L, p<0.0001). The reduction in prostaglandin (673±32 pg/mL vs. 139±7 pg/mL, p<0.0001) and the closure of ductus (2.64±0.89 mm vs. 2.31±0.81 mm, p=0.001) were found in the ID group after the first dose of indomethacin, but the closure of ductus (2.47±0.54 mm vs. 2.32±0.55 mm, p=0.02) and prostaglandin reduction (667±31 pg/mL vs. 129±7 pg/mL, p<0.0001) were found after the second dose of acetaminophen. Indomethacin had greater effect in reducing the risk of acute kidney injury than did acetaminophen (p=0.042). Conclusions Indomethacin treatment used in treating patent ductus arteriosus protects infants from renal dysfunction.
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Affiliation(s)
- Chunxia Lei
- Department of Neonatology, Wuhan Children's Hospital, Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Hanchu Liu
- Department of Neonatology, Wuhan Children's Hospital, Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Huizhen Wang
- Department of Neonatology, Wuhan Children's Hospital, Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Caixia Liu
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
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Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study. BMC Pediatr 2017; 17:7. [PMID: 28068947 PMCID: PMC5223413 DOI: 10.1186/s12887-016-0761-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background A patent ductus arteriosus (PDA) is frequently found in very preterm neonates and is associated with increased risk of morbidity and mortality. A shunt across a PDA can result in an unfavorable distribution of the cardiac output and may in turn result in poor renal perfusion. Urinary Neutrophil Gelatinase-associated Lipocalin (U-NGAL) is a marker of renal ischemia and may add to the evaluation of PDA. Our primary aim was to investigate if U-NGAL is associated with PDA in very preterm neonates. Secondary, to investigate whether U-NGAL and PDA are associated with AKI and renal dysfunction evaluated by fractional excretion of sodium (FENa) and urine albumin in a cohort of very preterm neonates. Methods A cohort of 146 neonates born at a gestational age less than 32 weeks were consecutively examined with echocardiography for PDA and serum sodium, and urine albumin and sodium were measured on postnatal day 3 and U-NGAL and serum creatinine day 3 and 6. AKI was defined according to modified neonatal Acute Kidney Injury Network (AKIN) criteria. The association between U-NGAL and PDA was investigated. And secondly we investigated if PDA and U-NGAL was associated with AKI and renal dysfunction. Results U-NGAL was not associated with a PDA day 3 when adjusted for gestational age and gender. A PDA day 3 was not associated with AKI when adjusted for gestational age and gender; however, it was associated with urine albumin. U-NGAL was not associated with AKI, but was found to be associated with urine albumin and FENa. Conclusions Based on our study U-NGAL is not considered useful as a diagnostic marker to identify very preterm neonates with a PDA causing hemodynamic changes resulting in early renal morbidity. The interpretation of NGAL in preterm neonates remains to be fully elucidated.
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Sweetman DU, Onwuneme C, Watson WR, O'Neill A, Murphy JF, Molloy EJ. Renal function and novel urinary biomarkers in infants with neonatal encephalopathy. Acta Paediatr 2016; 105:e513-e519. [PMID: 27551944 DOI: 10.1111/apa.13555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/10/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Abstract
AIM Perinatal asphyxia is associated with multi-organ injury including acute kidney injury (AKI). New urinary biomarkers may detect more subtle renal injury. METHODS Urinary biomarkers (albumin, beta-2 microglobulin, cystatin-C, epidermal growth factor, neutrophil gelatinase-associated lipocalin, osteopontin, uromodulin) were serially measured from days 1 to 7 in term infants with perinatal asphyxia and controls and compared to 'Kidney Disease Improving Global Outcome' scoring of renal injury and to encephalopathy grade. RESULTS A total of 255 urine samples were taken from infants exposed to perinatal asphyxia (n = 82) and term controls (n = 10). Thirty-nine infants underwent therapeutic hypothermia, four died and 30 infants had acute kidney injury. Infants with acute kidney injury had significantly higher levels of urinary albumin (day 2), cystatin-C (days 1, 2, 3 and 7), neutrophil gelatinase-associated lipocalin (days 2, 3 and 7) and osteopontin (days 2, 3 and 7) and lower epidermal growth factor and uromodulin (day 1) compared to those without AKI. Day 2 cystatin-C predicted AKI with an area under receiver operating characteristic curve of 0.89, p < 0.001, cut-off 9.8 × 104 pg/mL. NE grade II/III infants had significantly elevated levels of urinary cystatin-C, neutrophil gelatinase-associated lipocalin and decreased EGF compared to grade 0/I infants. CONCLUSION Asphyxiated infants who develop acute kidney injury have significantly altered urinary biomarkers postnatally. Validation of neonatal AKI urinary biomarkers in a large prospective study is required. Long-term follow-up of infants post-asphyxial insult for chronic renal injury is advised.
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Affiliation(s)
- Deirdre U. Sweetman
- Department of Neonatology; National Maternity Hospital; Dublin Ireland
- National Children's Research Centre; Crumlin Dublin Ireland
- Department of Paediatrics; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Chike Onwuneme
- Department of Neonatology; National Maternity Hospital; Dublin Ireland
- UCD School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - William R. Watson
- UCD School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - Amanda O'Neill
- UCD School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - John F.A. Murphy
- Department of Neonatology; National Maternity Hospital; Dublin Ireland
- UCD School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - Eleanor J. Molloy
- National Children's Research Centre; Crumlin Dublin Ireland
- Department of Paediatrics; Royal College of Surgeons in Ireland; Dublin Ireland
- UCD School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
- Department of Paediatrics; Trinity College Dublin; National Children's Hospital; Tallaght & Coombe Women's and Infant's University Hospital; Dublin Ireland
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Oncel MY, Canpolat FE, Arayici S, Alyamac Dizdar E, Uras N, Oguz SS. Urinary markers of acute kidney injury in newborns with perinatal asphyxia (.). Ren Fail 2016; 38:882-8. [PMID: 27055689 DOI: 10.3109/0886022x.2016.1165070] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) affects up to 60% of severely asphyxiated neonates. The diagnosis of AKI can be and is further challenged by a lack of good biomarkers. We studied the role of novel markers for AKI, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-18), Netrin-1 (NTN-1), and sodium hydrogen exchanger isoform 3 (NHE3) on development and early diagnosis of AKI in newborns with perinatal asphyxia (PA). METHODS Forty-one newborns with a diagnosis of PA (15 with AKI and 26 without AKI) and 20 healthy matched controls were involved to the study. Urinary samples were obtained on postnatal days 1 and 4 for patients with PA and on postnatal day 1 for the control subjects. AKI was defined using a serum creatinine-based modification of the acute kidney injury network criteria. RESULTS The levels of NGAL, NTN-1, NHE3, and IL-18 on the first postnatal day urine samples were higher in patients compared to controls (p < 0.001, p <0.001, p <0.02, p <0.001, respectively). In patients with AKI, the levels of NGAL and IL-18 were higher when compared to patients without AKI (p = 0.002, p <0.001, respectively). The levels of NTN-1 and NHE3 were similar in both groups. For the samples obtained on postnatal day 4, only NGAL levels were significantly higher in patients with AKI (p = 0.004) compared to those without AKI. CONCLUSION To our knowledge, this is the largest study, which evaluated the utility of urinary biomarkers in the diagnosis of AKI in newborns with PA. First day, urine NGAL and IL-18 levels have an important diagnostic power in such patients.
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Affiliation(s)
- Mehmet Yekta Oncel
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Fuat Emre Canpolat
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Sema Arayici
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Evrim Alyamac Dizdar
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Nurdan Uras
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Serife Suna Oguz
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
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Mussap M, Noto A, Fanos V, Van Den Anker JN. Emerging biomarkers and metabolomics for assessing toxic nephropathy and acute kidney injury (AKI) in neonatology. BIOMED RESEARCH INTERNATIONAL 2014; 2014:602526. [PMID: 25013791 PMCID: PMC4071811 DOI: 10.1155/2014/602526] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/25/2014] [Indexed: 01/07/2023]
Abstract
Identification of novel drug-induced toxic nephropathy and acute kidney injury (AKI) biomarkers has been designated as a top priority by the American Society of Nephrology. Increasing knowledge in the science of biology and medicine is leading to the discovery of still more new biomarkers and of their roles in molecular pathways triggered by physiological and pathological conditions. Concomitantly, the development of the so-called "omics" allows the progressive clinical utilization of a multitude of information, from those related to the human genome (genomics) and proteome (proteomics), including the emerging epigenomics, to those related to metabolites (metabolomics). In preterm newborns, one of the most important factors causing the pathogenesis and the progression of AKI is the interaction between the individual genetic code, the environment, the gestational age, and the disease. By analyzing a small urine sample, metabolomics allows to identify instantly any change in phenotype, including changes due to genetic modifications. The role of liquid chromatography-mass spectrometry (LC-MS), proton nuclear magnetic resonance (1H NMR), and other emerging technologies is strategic, contributing basically to the sudden development of new biochemical and molecular tests. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are closely correlated with the severity of kidney injury, representing noninvasive sensitive surrogate biomarkers for diagnosing, monitoring, and quantifying kidney damage. To become routine tests, uNGAL and KIM-1 should be carefully tested in multicenter clinical trials and should be measured in biological fluids by robust, standardized analytical methods.
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Affiliation(s)
- M. Mussap
- Department of Laboratory Medicine, IRCCS San Martino-IST, University Hospital, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - A. Noto
- Department of Pediatrics and Clinical Medicine, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, 09042 Cagliari, Italy
| | - V. Fanos
- Department of Pediatrics and Clinical Medicine, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, 09042 Cagliari, Italy
| | - J. N. Van Den Anker
- Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC 20010, USA
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Elmas AT, Tabel Y, İpek S. Determination of reference values for urinary neutrophil gelatinase-associated lipocalin in premature infants. J Matern Fetal Neonatal Med 2013; 27:187-91. [DOI: 10.3109/14767058.2013.806900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A standardized classification of acute kidney injury (AKI) has recently been proposed with the RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease) score. Such definition/classification has been applied both in adult and in paediatric patients. Neonatal definition of AKI likely results as a challenging task due to the peculiar renal pathophysiology of newborn critically ill patients. Their so-called 'immature kidneys' require careful management and neonatal AKI is frequently complicated by unfavourable outcomes. A recent attempt to implement the RIFLE score with a neonatal modification might lead to improvement on the knowledge of AKI incidence and epidemiology.
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Affiliation(s)
- Zaccaria Ricci
- Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sweetman DU, Molloy EJ. Biomarkers of acute kidney injury in neonatal encephalopathy. Eur J Pediatr 2013; 172:305-16. [PMID: 23138391 DOI: 10.1007/s00431-012-1890-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/24/2012] [Indexed: 01/11/2023]
Abstract
Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.
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Affiliation(s)
- D U Sweetman
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin, Ireland.
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Chakraborty S, Kaur S, Guha S, Batra SK. The multifaceted roles of neutrophil gelatinase associated lipocalin (NGAL) in inflammation and cancer. BIOCHIMICA ET BIOPHYSICA ACTA 2012; 1826:129-69. [PMID: 22513004 PMCID: PMC3362670 DOI: 10.1016/j.bbcan.2012.03.008] [Citation(s) in RCA: 280] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 02/06/2023]
Abstract
Neutrophil gelatinase associated lipocalin (NGAL), also known as oncogene 24p3, uterocalin, siderocalin or lipocalin 2, is a 24kDa secreted glycoprotein originally purified from a culture of mouse kidney cells infected with simian virus 40 (SV-40). Subsequent investigations have revealed that it is a member of the lipocalin family of proteins that transport small, hydrophobic ligands. Since then, NGAL expression has been reported in several normal tissues where it serves to provide protection against bacterial infection and modulate oxidative stress. Its expression is also dysregulated in several benign and malignant diseases. Its small size, secreted nature and relative stability have led to it being investigated as a diagnostic and prognostic biomarker in numerous diseases including inflammation and cancer. Functional studies, conducted primarily on lipocalin 2 (Lcn2), the mouse homologue of human NGAL have revealed that Lcn2 has a strong affinity for iron complexed to both bacterial siderophores (iron-binding proteins) and certain human proteins like norepinephrine. By sequestering iron-laden siderophores, Lcn2 deprives bacteria of a vital nutrient and thus inhibits their growth (bacteriostatic effect). In malignant cells, its proposed functions range from inhibiting apoptosis (in thyroid cancer cells), invasion and angiogenesis (in pancreatic cancer) to increasing proliferation and metastasis (in breast and colon cancer). Ectopic expression of Lcn2 also promotes BCR-ABL induced chronic myelogenous leukemia in murine models. By transporting iron into and out of the cell, NGAL also regulates iron responsive genes. Further, it stabilizes the proteolytic enzyme matrix metalloprotease-9 (MMP-9) by forming a complex with it, and thereby prevents its autodegradation. The factors regulating NGAL expression are numerous and range from pro-inflammatory cytokines like interleukins, tumor necrosis factor-α and interferons to vitamins like retinoic acid. The purpose of this review article is to examine the expression, structure, regulation and biological role of NGAL and critically assess its potential as a novel diagnostic and prognostic marker in both benign and malignant human diseases.
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Affiliation(s)
- Subhankar Chakraborty
- Department of Biochemistry and Molecular Biology, The UT MD Anderson Cancer Center, Houston, Texas
| | - Sukhwinder Kaur
- Department of Biochemistry and Molecular Biology, The UT MD Anderson Cancer Center, Houston, Texas
| | - Sushovan Guha
- Departments of Gastroenterology, Hepatology, and Nutrition, The UT MD Anderson Cancer Center, Houston, Texas
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, The UT MD Anderson Cancer Center, Houston, Texas
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
- Eppley Institute for Cancer Research, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
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Mussap M, Noto A, Fravega M, Fanos V. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and netrin-1: are they effectively improving the clinical management of sepsis-induced acute kidney injury (AKI)? J Matern Fetal Neonatal Med 2011; 24 Suppl 2:15-7. [DOI: 10.3109/14767058.2011.603913] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Atzori L, Mussap M, Noto A, Barberini L, Puddu M, Coni E, Murgia F, Lussu M, Fanos V. Clinical metabolomics and urinary NGAL for the early prediction of chronic kidney disease in healthy adults born ELBW. J Matern Fetal Neonatal Med 2011; 24 Suppl 2:40-3. [DOI: 10.3109/14767058.2011.606678] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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