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Dahiya K, Prashant P, Dhankhar R, Dhankhar K, Kumar S, Vashist S. Lipocalin-2 as a biomarker for diabetic nephropathy. World J Meta-Anal 2023; 11:92-101. [DOI: 10.13105/wjma.v11.i4.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Diabetes is a major global public health issue. The prevalence of type 1 diabetes is comparatively static, as hereditary and genetic causes are involved, while type 2 diabetes (T2D) prevalence is increasing day by day. T2D is associated with chronic complications, including diabetic neuropathy (DN), nephropathy, retinopathy, and other complications like diabetic foot. DN is the main complication of both types of diabetes. DN can be diagnosed by routine laboratory tests, microalbuminuria > 300 mg/24 h, and a gradual decrease in glomerular filtration rate. As the appearance of microalbuminuria is a late manifestation, an early marker for renal damage is needed. Lipocalin-2, also known as neutrophil gelatinase-associated lipocalin (NGAL), is a small protein purified from neutrophil granules and a good marker for kidney disease. NGAL is a transporter protein responsible for many physiological processes, such as inflammation, generation of the immune response, and metabolic homeostasis. NGAL has been reported to depict the early changes in renal damage when urine microalbumin is still undetecable. Therefore, elucidating the role of NGAL in detecting DN and understanding its mechanism can help establish it as a potential early marker for DN.
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Affiliation(s)
- Kiran Dahiya
- Department of Biochemistry, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Praveen Prashant
- Department of Biochemistry, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Rakesh Dhankhar
- Department of Radiation Oncology, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kumud Dhankhar
- Phase III, JSS Medical College, Mysuru 570015, Karnataka, India
| | | | - Sonia Vashist
- Department of Dermatology, Dr Sonia’s Dermatology Clinic, Rewari 123401, Haryana, India
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Neutrophil Gelatinase-Associated Lipocalin and Hypertensive Disorders of Pregnancy: A Cohort Study in Twin Pregnancies. J Clin Med 2022; 11:jcm11144163. [PMID: 35887927 PMCID: PMC9318711 DOI: 10.3390/jcm11144163] [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: 05/26/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023] Open
Abstract
Hypertensive disorders complicate more than 10% of twin pregnancies. Several studies showed increased neutrophil gelatinase-associated lipocalin (NGAL) values in women with singleton pregnancies and preeclampsia. This study aimed to assess NGAL values in twin pregnancies complicated by hypertensive disorders. We conducted a study of 242 consecutive twin pregnancies at the Medical University of Vienna. Serum NGAL was evaluated twice during pregnancy and once in the postpartum period. Furthermore, serum NGAL values were compared between women who developed hypertensive disorders and those who had normal blood pressure. In all twin pregnancies, mean NGAL values increased significantly from the first to the second visit (p = 0.004) and, further, after delivery (p < 0.001). NGAL was significantly higher in pregnancies that developed pregnancy hypertension or preeclampsia when compared to the control group at the first visit (109.2 ± 48.9 ng/mL vs. 91.9 ± 29.4 ng/mL, p = 0.04, respectively). The predictive power of first visit NGAL values for development of pregnancy hypertension or preeclampsia was evaluated. When using a cut-off value of 115 ng/mL, we obtained a sensitivity of 45% with a specificity of 77%. We conclude that women with twin pregnancies who develop hypertensive disorders of pregnancy showed increased NGAL values at 11−16 weeks.
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Tyagi A, Yadav P, Salhotra R, Das S, Singh PK, Garg D. Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin. Indian J Crit Care Med 2021; 25:1013-1019. [PMID: 34963719 PMCID: PMC8664012 DOI: 10.5005/jp-journals-10071-23966] [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] [Indexed: 12/03/2022] Open
Abstract
Background Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk factors for acute kidney injury (AKI). Although the use of neutrophil gelatinase-associated lipocalcin (NGAL) to predict AKI is previously validated, we could locate only scanty data regarding the epidemiology of AKI and role of NGAL in preeclamptic patients admitted to ICU. Methods Patients with preeclampsia admitted to our ICU were included. The incidence and severity of AKI during the entire ICU stay were assessed using kidney disease improving global outcomes criteria, while the a priori risk factors and serum NGAL were also evaluated. Results A total of 52 preeclamptic patients admitted to ICU were included, among whom the majority had eclampsia (75%). AKI developed in 25 (48.1%) patients with stages 1, 2, and 3 in 56, 36, and 8%, respectively. The incidence of sepsis (16 vs 0%), shock (40 vs 7.4%), and anemia (84 vs 59.3%) was significantly greater in patients with AKI (p < 0.05). ICU mortality (28 vs 3.7%), duration of ICU, and hospital stay were significantly higher in patients who developed AKI (p < 0.05). There was no association of serum NGAL [274 (240–335) ng/mL] with AKI or the mortality (p = 0.725, 0.861); there was, however, a significant discriminatory value for eclampsia [p = 0.019; area under curve = 0.736 (95% confidence interval: 0.569–0.904)]. Conclusions Although AKI is common among patients with preeclampsia admitted to ICU, serum NGAL does not predict its occurrence. How to cite this article Tyagi A, Yadav P, Salhotra R, Das S, Singh PK, Garg D. Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin. Indian J Crit Care Med 2021;25(9):1013–1019.
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Affiliation(s)
- Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Pooja Yadav
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Praveen K Singh
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Devansh Garg
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
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LI MINGQUN, GUO HONGYAN, XI HONGLI, ZHOU SUFEN. A STUDY ON THE CORRELATION BETWEEN THE ENDOTHELIN-1, NITRIC OXIDE FUNCTION AND THE RENAL HEMODYNAMICS IN PATIENTS WITH HYPERTENSIVE DISORDERS IN PREGNANCY IN HUBEI. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To analyze the correlation between the vascular endothelial function (characterized by endothelin-1 and nitric oxide) and the renal hemodynamics in patients with hypertensive disorders in pregnancy (HDP) by color Doppler ultrasound. Method: Depending on the severity of the disease, 76 HDP patients were divided into three groups, namely, pregnancy-induced hypertension (PIH) group ([Formula: see text]), mild preeclampsia (PE) group ([Formula: see text]), and severe PE group ([Formula: see text]). In the meantime, 28 healthy pregnant women were selected as controls. Color Doppler ultrasound was performed to determine the following parameters in the interlobar arteries of the kidney: Resistance index (RI), peak end-diastolic velocity (EDV), pulsatility index (PI), peak systolic velocity (PSV), and S/D ratio. The correlations of these parameters with the serum levels of ET-1 and NO were then analyzed. Result: (1) In the interlobar arteries of the kidney, RI, S/D, PI were positively significantly correlated to the serum level of ET-1 in HDP patients (All [Formula: see text]) and negatively to the serum level of NO (All [Formula: see text]). (2) RI, S/D, PI of the mild and severe PE groups were significantly higher than those of the control group (All [Formula: see text]). However, EDV of the mild and severe PE groups was significantly lower than that of the control group (All [Formula: see text]). (3) The serum level of ET-1 was significantly higher in the HDP patients than in the control group ([Formula: see text]). However, the serum level of NO was significantly lower in the former than in the latter ([Formula: see text]). As HDP became more severe, there was an elevation in the serum level of ET-1 and a decrease in NO. Conclusion: Indicators of renal hemodynamics measured by color Doppler ultrasound were correlated to the serum levels of ET-1 and NO characterizing the vascular endothelial function. They were sensitive indicators reflecting hemodynamic changes and renal impairment in HDP patients.
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Affiliation(s)
- MINGQUN LI
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - HONG YAN GUO
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - HONG LI XI
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - SU FEN ZHOU
- Department of Ultrasound, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine Xiangyang 441000, P. R. China
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Yuksel S, Ozyurek SE, Acar DK, Ozdemir C, Guler S, Kiyak H, Gedikbasi A. Urinary neutrophil gelatinase-associated lipocalin is associated with preeclampsia in a cohort of Turkish women. Hypertens Pregnancy 2019; 38:157-162. [DOI: 10.1080/10641955.2019.1621887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Semra Yuksel
- Department of Obstetrics and Gynecology, GOP Taksim Training and Research Hospital, Istanbul, Turkey
| | - Sefik Eser Ozyurek
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Deniz Kanber Acar
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Cagdas Ozdemir
- Department of Obstetrics and Gynecology, Tunceli State Hospital, Tunceli, Turkey
| | - Sebile Guler
- Department of Obstetrics and Gynecology, School of Medicine, VKV Koc University, Istanbul, Turkey
| | - Huseyin Kiyak
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Gedikbasi
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Baseline Serum Cystatin C Is a Potential Predictor for Acute Kidney Injury in Patients with Acute Pancreatitis. DISEASE MARKERS 2018; 2018:8431219. [PMID: 30581500 PMCID: PMC6276423 DOI: 10.1155/2018/8431219] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023]
Abstract
Aims The study is aimed at studying the incidence of acute kidney injury (AKI) and exploring the potential predictor for AKI in patients with acute pancreatitis. Methods A retrospective study adopting a stratified cohort sampling design was performed in a cohort of patients (n = 237) diagnosed with acute pancreatitis without any renal injury. The following information including age, gender, serum creatinine, serum urea nitrogen, serum uric acid, serum cystatin C, fasting serum glucose, serum amylase, serum lipase, serum choline esterase, total protein, albumin, globulin, total bilirubin, direct bilirubin, total bile acids, glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase, gamma glutamyl transpeptidase, and alkaline phosphatase were collected from each patient when they were diagnosed with acute pancreatitis. Student t-test was conducted to figure out the difference between patients with and without AKI. Univariate and multivariate logistic regression analyses were used for investigating the predictors for AKI in patients with acute pancreatitis. Results 18 (7.6%) patients in total had developed AKI among the study group. Compared with patients without AKI (1.01 ± 0.26 mg/L), the level of baseline serum cystatin C (CYS-C) was significantly higher in patients with AKI (3.64 ± 2.17 mg/L, P < 0.001). Baseline serum CYS-C (OR = 203.594, P < 0.001) was the independent and significant predictor for AKI in patients with acute pancreatitis. AKI in patients with acute pancreatitis could be identified with a sensitivity of 88.9% at specificity of 100% (AUC = 0.948, 95% CI 0.879–1.000) by baseline serum CYS-C (cut-off value = 1.865 mg/L). Conclusions Baseline serum CYS-C shall be adopted to predict the potential risk of AKI in patients with acute pancreatitis.
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Lei L, Li LP, Zeng Z, Mu JX, Yang X, Zhou C, Wang ZL, Zhang H. Value of urinary KIM-1 and NGAL combined with serum Cys C for predicting acute kidney injury secondary to decompensated cirrhosis. Sci Rep 2018; 8:7962. [PMID: 29784944 PMCID: PMC5962573 DOI: 10.1038/s41598-018-26226-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/03/2018] [Indexed: 02/05/2023] Open
Abstract
Urinary kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C (Cys C) are biomarkers of acute kidney injury (AKI). However, the efficacy of combining these indices to diagnose decompensated cirrhosis is unknown. This study involved 150 patients divided into AKI and non-AKI, and healthy individuals. Urinary KIM-1 and NGAL, serum Cys and creatine, and glomerular filtration rate (GFR) were compared based on Child-Pugh liver function class. Urinary KIM-1 and NGAL concentrations and serum Cys C levels were significantly higher in patients with AKI secondary to decompensated cirrhosis than in those with AKI not secondary to decompensated cirrhosis (p < 0.01). These were significantly associated with higher kidney injury index stages (p < 0.01) and negatively correlated with GFR in secondary AKI patients. Urinary KIM-1 and NGAL and serum Cys C increased significantly and GFR decreased as Child-Pugh class of decompensated cirrhosis significantly increased (p < 0.05). SCr levels were significantly increased in Child-Pugh class C patients (p < 0.05). Urinary KIM-1, urinary NGAL, serum Cys C, and the combined detection factor, as screening indices, could aid in the early diagnosis of AKI secondary to decompensated cirrhosis.
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Affiliation(s)
- Lei Lei
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Ping Li
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhen Zeng
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Xi Mu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Yang
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Chao Zhou
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhi Lan Wang
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Hu Zhang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China.
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Kell DB, Kenny LC. A Dormant Microbial Component in the Development of Preeclampsia. Front Med (Lausanne) 2016; 3:60. [PMID: 27965958 PMCID: PMC5126693 DOI: 10.3389/fmed.2016.00060] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia (PE) is a complex, multisystem disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused. We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation) is, in fact, microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent) microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS), also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained) immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, and urinary tract infection) and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of "preeclampsia" that we assessed has, in fact, also been shown to be raised in response to infection. An infectious component to PE fulfills the Bradford Hill criteria for ascribing a disease to an environmental cause and suggests a number of treatments, some of which have, in fact, been shown to be successful. PE was classically referred to as endotoxemia or toxemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the etiology of PE mirrors that for ulcers and other diseases that were previously considered to lack one.
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Affiliation(s)
- Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, UK
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
- Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, Manchester, UK
- *Correspondence: Douglas B. Kell,
| | - Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
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Siribamrungwong M, Chinudomwong P. Relation between acute kidney injury and pregnancy-related factors. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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