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Kamianowska M, Kamianowska A, Maciejczyk M, Kurowska A, Błażewicz B, Rogowska AM, Wasilewska A. The Urinary Concentrations of Neutrophil Gelatinase-Associated Lipocalin, Cystatin C and Osteopontin in the Healthy Term and Stable Preterm Neonates: A Pilot Study. J Clin Med 2023; 12:6512. [PMID: 37892649 PMCID: PMC10607199 DOI: 10.3390/jcm12206512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND In neonates, the assessment of kidney function with serum creatinine is limited; therefore, more effective biomarkers are needed. AIM The study aimed at analyzing the concentrations of renal biomarkers (osteopontin, cystatin C, and NGAL) in neonates. MATERIAL AND METHODS The study included 80 term and 20 preterm neonates aged 28-33 weeks of gestation. Biomarkers were measured in urine. Term neonates' urine was collected on the 1st day of life. Preterm neonates' urine was collected on the 1st, 8th, 15th, 22nd day of life. Biomarkers' concentrations were normalized to urinary creatinine (cr.) and presented as urinary biomarker/cr. ratios. RESULTS Median values of biomarker/creatine ratios in term and preterm neonates were the following: cystatin C/cr.: 7.26 and 439.49; osteopontin/cr.: 135.86 and 1633.37; NGAL/cr. in girls: 212.14 and 256.93; and NGAL/cr. in boys 27.123 and 65.29 ng/mg cr. In preterm neonates the cystatin C/cr. ratio was higher on the 1st than on the 8th day. The osteopontin/cr. ratio did not differ between the days. The NGAL/cr. ratio in girls was higher on the 8th than on the 22nd day, and in boys, the lowest was on the 22nd day. CONCLUSIONS Prematurity in stable, Caucasian neonates might cause higher osteopontin and cystatin C excretion, but not NGAL. The excretion of NGAL and cystatin C, but not osteopontin, may change during first weeks of premature neonate's life.
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Affiliation(s)
- Monika Kamianowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, 15-174 Bialystok, Poland
| | - Aleksandra Kamianowska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Bialystok, Poland
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomic, Medical University of Bialystok, 15-022 Bialystok, Poland
| | - Anna Kurowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, 15-174 Bialystok, Poland
| | - Bożena Błażewicz
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, 15-174 Bialystok, Poland
| | - Agnieszka Maria Rogowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, 15-174 Bialystok, Poland
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Bialystok, Poland
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Mitaka C, Teranishi K, Wakita M, Misawa S, Nojiri S, Satoh D, Hayashida M. Incidences of and risk factors for clinical and subclinical contrast-associated acute kidney injury in patients who underwent neuroendovascular surgery. Neuroradiol J 2023; 36:601-609. [PMID: 37106524 PMCID: PMC10569205 DOI: 10.1177/19714009231173104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) can develop after intravascular administration of iodinated contrast media. Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI that helps to detect subclinical CA-AKI. We investigated the incidence of and risk factors for clinical and subclinical CA-AKI in patients who underwent neuroendovascular surgery. METHODS We retrospectively investigated 228 patients who underwent neuroendovascular surgery in 2020. Changes in serum creatinine and urine output were used to detect clinical CA-AKI. Urine NGAL concentration was used to detect subclinical CA-AKI in 67 out of 228 patients. RESULTS In 228 patients, serum creatinine, hemoglobin, hematocrit, total protein, and blood urea nitrogen (BUN) decreased significantly (p < 0.001) after surgery. However, serum creatinine decreased less significantly (p < 0.05) than hemoglobin, hematocrit, total protein, and BUN on postoperative Day 3. Two patients out of 228 developed clinical CA-AKI, and seven patients out of 67 with urine NGAL measurements developed subclinical CA-AKI. Multivariate regression analysis revealed that diabetes mellitus and carotid artery stenosis were significantly (p < 0.05) associated with the development of clinical and/or subclinical CA-AKI. CONCLUSION There was a large difference between the incidences of clinical CA-AKI (0.88%) and subclinical CA-AKI (10.4%). The difference might have primarily resulted from the different sensitivities between serum creatinine and urine NGAL and possibly from underestimation of the incidence of clinical AKI due to a postoperative decrease in serum creatinine caused by hemodilution. In addition to diabetes mellitus, carotid artery stenosis could also be a risk factor for CA-AKI.
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Affiliation(s)
- Chieko Mitaka
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuru Wakita
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Shigeki Misawa
- Department of Clinical Laboratory Technology, Faculty Medical Science, Juntendo University, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Daizoh Satoh
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Parnell LKS, Luke N, Mathur M, Festa RA, Haley E, Wang J, Jiang Y, Anderson L, Baunoch D. Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/mL Indicate a Lower Threshold for Diagnosing UTIs. Diagnostics (Basel) 2023; 13:2688. [PMID: 37627948 PMCID: PMC10453813 DOI: 10.3390/diagnostics13162688] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The literature lacks consensus on the minimum microbial density required for diagnosing urinary tract infections (UTIs). This study categorized the microbial densities of urine specimens from symptomatic UTI patients aged ≥ 60 years and correlated them with detected levels of the immune response biomarkers neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-8), and interleukin-1-beta (IL-1β). The objective was to identify the microbial densities associated with significant elevation of these biomarkers in order to determine an optimal threshold for diagnosing symptomatic UTIs. Biobanked midstream voided urine samples were analyzed for microbial identification and quantification using standard urine culture (SUC) and multiplex-polymerase chain reaction (M-PCR) testing, while NGAL, IL-8, and IL-1β levels were measured via enzyme-linked immunosorbent assay (ELISA). NGAL, IL-8, and IL-1β levels were all significantly elevated at microbial densities ≥ 10,000 cells/mL when measured via M-PCR (p < 0.0069) or equivalent colony-forming units (CFUs)/mL via SUC (p < 0.0104) compared to samples with no detectable microbes. With both PCR and SUC, a consensus of two or more elevated biomarkers correlated well with microbial densities > 10,000 cells/mL or CFU/mL, respectively. The association between ≥10,000 cells and CFU per mL with elevated biomarkers in symptomatic patients suggests that this lower threshold may be more suitable than 100,000 CFU/mL for diagnosing UTIs.
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Affiliation(s)
- Laura K. S. Parnell
- Department of Scientific Writing, Precision Consulting, 6522 Harbor Mist, Missouri City, TX 77459, USA;
| | - Natalie Luke
- Department of Clinical Research, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA 92618, USA; (N.L.); (E.H.)
| | - Mohit Mathur
- Department of Medical Affairs, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA 92618, USA;
| | - Richard A. Festa
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA 92618, USA;
| | - Emery Haley
- Department of Clinical Research, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA 92618, USA; (N.L.); (E.H.)
| | - Jimin Wang
- Department of Statistical Analysis, Stat4Ward, 2 Edgemoor Lane, Pittsburgh, PA 15238, USA; (J.W.); (Y.J.)
| | - Yan Jiang
- Department of Statistical Analysis, Stat4Ward, 2 Edgemoor Lane, Pittsburgh, PA 15238, USA; (J.W.); (Y.J.)
| | - Lori Anderson
- Department of Diagnostic Market Access, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA 92618, USA;
| | - David Baunoch
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA 92618, USA;
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Akhtar M, Trombetta LD. Low Level Mancozeb Exposure Causes Copper Bioaccumulation in the Renal Cortex of Rats Leading to Tubular Injury. Environmental Toxicology and Pharmacology 2023; 100:104148. [PMID: 37182728 DOI: 10.1016/j.etap.2023.104148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
Mancozeb is a widely-used, broad-spectrum contact dithiocarbamate fungicide. Dithiocarbamates are known to trans-chelate metals. This study was designed to evaluate the potential of Mancozeb to mobilize and bioaccumulate essential trace metals in various tissues. Long-Evans rats were orally gavaged with 0, 50, or 100mg/kg/day of Mancozeb for 28 days. Mancozeb caused a significant increase in copper and manganese in the hippocampus and manganese in the liver. Exceedingly higher level of copper was detected in the renal cortex using ICP-OES in both dose groups. This was confirmed histologically in the tubular epithelial cells. In addition, copper-associated protein levels were also increased. Copper bioaccumulation in the renal cortex was accompanied by oxidative damage and tubular insult indicated by increased 4-HNE, KIM-1, and NGAL immunoreactivity. These findings demonstrate that low-dose Mancozeb exposure is a potential risk for kidney injury due to copper overload and warrants further in vivo and human population-based investigations.
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Affiliation(s)
- Mumtaz Akhtar
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Jamaica, NY 11439, USA
| | - Louis D Trombetta
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Jamaica, NY 11439, USA.
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Box DM, Makkar A, Yu Z, Chaaban H, Tran HH, Burge KY, Eckert JV. Placental Neutrophil Infiltration Associated with Tobacco Exposure but Not Development of Bronchopulmonary Dysplasia. Children (Basel) 2022; 9:children9030381. [PMID: 35327753 PMCID: PMC8947332 DOI: 10.3390/children9030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022]
Abstract
Objective: In utero inflammation is associated with bronchopulmonary dysplasia (BPD) in preterm infants. We hypothesized that maternal tobacco exposure (TE) might induce placental neutrophil infiltration, increasing the risk for BPD. Study design: We compared the composite outcome of BPD and death in a prospective pilot study of TE and no-TE mothers and their infants born <32 weeks. Placental neutrophil infiltration was approximated by neutrophil gelatinase-associated lipocalin (NGAL) ELISA, and total RNA expression was analyzed via NanoString© (Seattle, WA, USA). Result: Of 39 enrolled patients, 44% were classified as tobacco exposure. No significant difference was noted in the infant’s composite outcome of BPD or death based on maternal tobacco exposure. NGAL was higher in placentas of TE vs. non-TE mothers (p < 0.05). Placental RNA analysis identified the upregulation of key inflammatory genes associated with maternal tobacco exposure. Conclusion: Tobacco exposure during pregnancy was associated with increased placental neutrophil markers and upregulated inflammatory gene expression. These findings were not associated with BPD.
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Affiliation(s)
- David M. Box
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (D.M.B.); (A.M.); (H.C.); (K.Y.B.)
| | - Abhishek Makkar
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (D.M.B.); (A.M.); (H.C.); (K.Y.B.)
| | - Zhongxin Yu
- Pathology Department, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (Z.Y.); (H.H.T.)
| | - Hala Chaaban
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (D.M.B.); (A.M.); (H.C.); (K.Y.B.)
| | - Henry H. Tran
- Pathology Department, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (Z.Y.); (H.H.T.)
| | - Kathryn Y. Burge
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (D.M.B.); (A.M.); (H.C.); (K.Y.B.)
| | - Jeffrey V. Eckert
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (D.M.B.); (A.M.); (H.C.); (K.Y.B.)
- Correspondence: ; Tel.: +1-(405)-271-4755; Fax: +1-(405)-271-1236
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Menez S, Moledina DG, Thiessen-Philbrook H, Wilson FP, Obeid W, Simonov M, Yamamoto Y, Corona-Villalobos CP, Chang C, Garibaldi BT, Clarke W, Farhadian S, Dela Cruz C, Coca SG, Parikh CR. Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19. Am J Kidney Dis 2022; 79:257-267.e1. [PMID: 34710516 PMCID: PMC8542781 DOI: 10.1053/j.ajkd.2021.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE & OBJECTIVE Acute kidney injury (AKI) is common in patients with coronavirus disease 2019 (COVID-19) and associated with poor outcomes. Urinary biomarkers have been associated with adverse kidney outcomes in other settings and may provide additional prognostic information in patients with COVID-19. We investigated the association between urinary biomarkers and adverse kidney outcomes among patients hospitalized with COVID-19. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Patients hospitalized with COVID-19 (n=153) at 2 academic medical centers between April and June 2020. EXPOSURE 19 urinary biomarkers of injury, inflammation, and repair. OUTCOME Composite of KDIGO (Kidney Disease: Improving Global Outcomes) stage 3 AKI, requirement for dialysis, or death within 60 days of hospital admission. We also compared various kidney biomarker levels in the setting of COVID-19 versus other common AKI settings. ANALYTICAL APPROACH Time-varying Cox proportional hazards regression to associate biomarker level with composite outcome. RESULTS Out of 153 patients, 24 (15.7%) experienced the primary outcome. Twofold higher levels of neutrophil gelatinase-associated lipocalin (NGAL) (HR, 1.34 [95% CI, 1.14-1.57]), monocyte chemoattractant protein (MCP-1) (HR, 1.42 [95% CI, 1.09-1.84]), and kidney injury molecule 1 (KIM-1) (HR, 2.03 [95% CI, 1.38-2.99]) were associated with highest risk of sustaining primary composite outcome. Higher epidermal growth factor (EGF) levels were associated with a lower risk of the primary outcome (HR, 0.61 [95% CI, 0.47-0.79]). Individual biomarkers provided moderate discrimination and biomarker combinations improved discrimination for the primary outcome. The degree of kidney injury by biomarker level in COVID-19 was comparable to other settings of clinical AKI. There was evidence of subclinical AKI in COVID-19 patients based on elevated injury biomarker level in patients without clinical AKI defined by serum creatinine. LIMITATIONS Small sample size with low number of composite outcome events. CONCLUSIONS Urinary biomarkers are associated with adverse kidney outcomes in patients hospitalized with COVID-19 and may provide valuable information to monitor kidney disease progression and recovery.
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Affiliation(s)
- Steven Menez
- Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dennis G Moledina
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Heather Thiessen-Philbrook
- Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - F Perry Wilson
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Wassim Obeid
- Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michael Simonov
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Yu Yamamoto
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Celia P Corona-Villalobos
- Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Crystal Chang
- Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care, Department of Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, 3Division of Medical Microbiology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William Clarke
- Division of Clinical Chemistry, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Shelli Farhadian
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Charles Dela Cruz
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chirag R Parikh
- Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
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Yin M, Nie Y, Liu H, Liu L, Tang L, Dong Y, Hu C, Wang H. Development of a europium nanoparticles lateral flow immunoassay for NGAL detection in urine and diagnosis of acute kidney injury. BMC Nephrol 2022; 23:30. [PMID: 35031018 PMCID: PMC8758895 DOI: 10.1186/s12882-021-02493-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AKI is related to severe adverse outcomes and mortality with Coronavirus Disease 2019 (COVID-19) patients, that early diagnosed and intervened is imperative. Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising biomarkers for detection of acute kidney injury (AKI), but current detection methods are inadequacy, so more rapid, convenient and accuracy methods are needed to detect NGAL for early diagnosis of AKI. Herein, we established a rapid, reliable and accuracy lateral flow immunoassay (LFIA) based on europium nanoparticles (EU-NPS) for the detection of NGAL in human urine specimens. METHODS A double-antibody sandwich immunofluorescent assay using europium doped nanoparticles was employed and the NGAL monoclonal antibodies (MAbs) conjugate as labels were generated by optimizing electric fusion parameters. Eighty-three urine samples were used to evaluate the clinical application efficiency of this method. RESULTS The quantitative detection range of NGAL in AKI was 1-3000 ng/mL, and the detection sensitization was 0.36 ng/mL. The coefficient of variation (CV) of intra-assay and inter-assay were 2.57-4.98 % and 4.11-7.83 %, respectively. Meanwhile, the correlation coefficient between europium nanoparticles-based lateral fluorescence immunoassays (EU-NPS-LFIA) and ARCHITECT analyzer was significant (R2 = 0.9829, n = 83, p < 0.01). CONCLUSIONS Thus, a faster and easier operation quantitative assay of NGAL for AKI has been established, which is very important and meaningful to diagnose the early AKI, suggesting that the assay can provide an early warning of final outcome of disease.
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Affiliation(s)
- Moli Yin
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, 132013, Jilin, PR China
| | - Yuanwang Nie
- Academy of laboratory, Jilin Medical University, 132013, Jilin, PR China
| | - Hao Liu
- Academy of laboratory, Jilin Medical University, 132013, Jilin, PR China
| | - Lei Liu
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, 132013, Jilin, PR China
| | - Lu Tang
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, 132013, Jilin, PR China
| | - Yuan Dong
- Academy of laboratory, Jilin Medical University, 132013, Jilin, PR China
| | - Chuanmin Hu
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, 132013, Jilin, PR China
| | - Huiyan Wang
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, 132013, Jilin, PR China.
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Nie J, Deng Y, Tian F, Shi S, Zheng P. Detection of weak non-covalent cation-π interactions in NGAL by single-molecule force spectroscopy. Nano Res 2022; 15:4251-4257. [PMID: 35574260 PMCID: PMC9077643 DOI: 10.1007/s12274-021-4065-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 05/14/2023]
Abstract
UNLABELLED Cation-π interaction is an electrostatic interaction between a cation and an electron-rich arene. It plays an essential role in many biological systems as a vital driving force for protein folding, stability, and receptor-ligand interaction/recognition. To date, the discovery of most cation-π interactions in proteins relies on the statistical analyses of available three-dimensional (3D) protein structures and corresponding computational calculations. However, their experimental verification and quantification remain sparse at the molecular level, mainly due to the limited methods to dynamically measure such a weak non-covalent interaction in proteins. Here, we use atomic force microscopy-based single-molecule force spectroscopy (AFM-SMFS) to measure the stability of protein neutrophil gelatinase-associated lipocalin (also known as NGAL, siderocalin, lipocalin 2) that can bind iron through the cation-π interactions between its three cationic residues and the iron-binding tri-catechols. Based on a site-specific cysteine engineering and anchoring method, we first characterized the stability and unfolding pathways of apo-NGAL. Then, the same NGAL but bound with the iron-catechol complexes through the cation-π interactions as a holo-form was characterized. AFM measurements demonstrated stronger stabilities and kinetics of the holo-NGAL from two pulling sites, F122 and F133. Here, NGAL is stretched from the designed cysteine close to the cationic residues for a maximum unfolding effect. Thus, our work demonstrates high-precision detection of the weak cation-π interaction in NGAL. ELECTRONIC SUPPLEMENTARY MATERIAL Supplementary material (additional SDS-PAGE, UV-vis, protein sequences, and more experimental methods) is available in the online version of this article at 10.1007/s12274-021-4065-9.
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Affiliation(s)
- Jingyuan Nie
- State Key Laboratory of Coordination Chemistry, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Road, Nanjing, 210023 China
| | - Yibing Deng
- State Key Laboratory of Coordination Chemistry, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Road, Nanjing, 210023 China
| | - Fang Tian
- State Key Laboratory of Coordination Chemistry, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Road, Nanjing, 210023 China
| | - Shengchao Shi
- State Key Laboratory of Coordination Chemistry, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Road, Nanjing, 210023 China
| | - Peng Zheng
- State Key Laboratory of Coordination Chemistry, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Chemistry and Chemical Engineering, Nanjing University, 163 Xianlin Road, Nanjing, 210023 China
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Lu L, Li C, Deng J, Luo J, Huang C. Maternal serum NGAL in the first trimester of pregnancy is a potential biomarker for the prediction of gestational diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:977254. [PMID: 36465627 PMCID: PMC9708734 DOI: 10.3389/fendo.2022.977254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) has adverse effects on the health of mothers and their offspring. Currently, no known biomarker has been proven to have sufficient validity for the prediction of GDM in the first trimester of pregnancy. The aim of this study was to investigate the potential relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the first trimester of pregnancy and later GDM risk and to evaluate the performance of serum NGAL as a biomarker for the prediction of GDM. METHODS The study was conducted by recruiting participants at 8-13 weeks of gestation from The First Affiliated Hospital of Chengdu Medical College between January and June 2021; participants were followed up for oral glucose tolerance test (OGTT) screening at 24-28 gestational weeks. We examined the serum NGAL levels of all subjects in the first trimester who met the inclusion and exclusion criteria. Anthropometric, clinical, and laboratory parameters of the study subjects were obtained during the same study period. A logistic regression model was carried out to investigate the potential relationship between serum NGAL levels in the first trimester of pregnancy and later GDM risk. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the discrimination and calibration of serum NGAL as a biomarker for the prediction of GDM in the first trimester of pregnancy. RESULTS Serum NGAL levels in the first trimester of pregnancy were significantly higher in women who later developed GDM than in those who did not develop GDM. Serum NGAL levels in the first trimester of pregnancy were positively associated with an increased risk of GDM after adjustment for potential confounding factors. The risk prediction model for GDM constructed by using serum NGAL levels in the first trimester of pregnancy achieved excellent performance. CONCLUSIONS Maternal serum NGAL in the first trimester of pregnancy is a potential biomarker for the prediction of GDM, which could help guide the clinical practice of antenatal care.
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Affiliation(s)
| | | | | | - Jianbo Luo
- *Correspondence: Chaolin Huang, ; Jianbo Luo,
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Lupu L, Abukatash H, Banai A, Rozenfeld KL, Lewit D, Merdler I, Loewenstein I, Bornstein G, Banai S, Shacham Y. Relation of Baseline Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels and Contrast-Induced Nephropathy following Percutaneous Coronary Intervention among Chronic Kidney Disease Patients. J Clin Med 2021; 10:jcm10225403. [PMID: 34830685 PMCID: PMC8626017 DOI: 10.3390/jcm10225403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The risk of contrast-induced acute kidney injury (CI-AKI) following coronary intervention is particularly high among patients with chronic kidney disease (CKD). Among these patients, baseline neutrophil gelatinase-associated lipocalin (NGAL), a marker of tubular damage, reflects the severity of renal impairment. We evaluated whether the baseline serum NGAL level may be a marker for the development of CI-AKI following percutaneous coronary intervention (PCI). METHODS Eighty-eight CKD patients treated with PCI were included. Serum NGAL levels were drawn upon hospital admission. Receiver operator characteristic (ROC) methods were used to identify the optimal sensitivity and specificity for the observed NGAL level compared with the estimated glomerular filtration rate (eGFR) calculated for patients with CI-AKI. RESULTS Overall CI-AKI incidence was 43%. Baseline serum NGAL levels were significantly higher in patients with CI-AKI than in patients without CI-AKI (150 vs. 103 ng/mL, p < 0.001). According to the ROC curve, baseline NGAL levels performed better than eGFR to predict CI-AKI (AUC 0.753 vs. 0.604), with the optimal cutoff value for baseline NGAL to predict CI-AKI being 127 ng/mL (sensitivity of 68% and specificity of 68%, p < 0.001). In a multivariate logistic regression model, the NGAL level >127 ng/mL ng/mL was independently associated with CI-AKI (HR 9.84, 95% CI: 1.96-40.3; p = 0.01). CONCLUSION Baseline serum NGAL levels in CKD patients may identify a high-risk population for CI-AKI following PCI. Further studies on larger populations are required to validate the potential utility of NGAL measurements in monitoring specific CKD-associated conditions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yacov Shacham
- Correspondence: ; Tel.: +972-3-6973222 or +972-52-4262101; Fax: +972-3-6973704
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11
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Abstract
NGAL is mainly secreted by neutrophils which play the core role in AECOPD. MCP-1 is secreted specifically by monocytes and macrophages. Both biomarkers are involved in the core process of acute inflammatory reaction in COPD. So We analyzed serum NGAL and MCP-1levels to explore their potential clinical values in the chronic obstructive pulmonary disease (COPD) .This study enrolled 97 COPD patients and 50 healthy controls. All participants received blood collection and lung function test and arterial blood gas measurements. The expression levels of serum NGAL and MCP-1 were measured by ELISA. The serum NGAL and MCP-1 levels of COPD with community-acquired pneumonia (COPD-CAP) patients were significantly higher than those of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients and healthy adults. The NGAL levels of the GOLD III and IV groups were significantly higher than those of the GOLD II group. Spearman correlation analysis showed a negative correlation between NGAL and FEV1%pred, FVC% pred. ROC curves indicated that NGAL has a high diagnostic value for both AECOPD and COPD-CAP. NGAL has the value of distinguishing GOLD I and II from GOLD III and IV. MCP-1 have moderate diagnostic value for COPD-CAP and can differentiate COPD-CAP from AECOPD. This study shows NGAL has certain diagnostic value for AECOPD and COPD-CAP, but can not distinguish the two. NGAL is closely related to airway remodeling and can be used as a potential indicator to distinguish the higher GOLD degree. MCP-1 can be used as potential indicator for the diagnosis of COPD-CAP.
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Affiliation(s)
- Xing-Ru Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dao-Xin Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Korkmaz H, Asıl M, Temel T, Öztürk B, Kebapçılar L. Evaluation of serum neutrophil gelatinase-associated lipocalin (NGAL), asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) levels, and their relations with disease type and activity in inflammatory bowel diseases. Turk J Med Sci 2021; 51:2403-2412. [PMID: 33984894 DOI: 10.3906/sag-2103-220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/09/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Inflammatory bowel disease (IBD) mainly encompass two entities called ulcerative colitis (UC) and Crohn's disease (CD), both of which are chronic, progressive and, inflammatory conditions of the gastrointestinal tract. Various indicators and non-invasive markers have been sought and used in IBD patients to help assessing disease activity and treatment effectiveness, although none of them are proven to yield definite results in full correlation with the clinical, endoscopic, and histopathological examinations. The aim of the current study was to investigate the relationship of serum neutrophil gelatinase-associated lipocalin (NGAL), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) levels with disease type and activity and to assess their potential use in establishing diagnosis and activity status of IBD, namely UC and CD. MATERIALS AND METHODS A total of 111 IBD patients with determined active and inactive disease periods and 70 matched controls were recruited. Serum NGAL levels of the patients and the control group were measured using commercially available ELISA kits. ADMA and SMDA levels were accomplished by high performance liquid chromatography. RESULTS The IBD group had significantly higher serum levels of NGAL (p= 0.001), ADMA (p= 0.0001), and SDMA (p= 0.0001) in comparison to the control group. Likewise, serum NGAL, ADMA, and SDMA levels were significantly higher in the active IBD group compared to the inactive IBD group (p= 0.0001). Active UC and active CD patients similarly had significantly higher levels of serum NGAL, ADMA, and SDMA than the respective levels in inactive UK and inactive CD patients (p= 0.0001). CONCLUSION Serum NGAL, ADMA and SMDA levels are increased in patients with IBD and serum NGAL, ADMA and SMDA concentrations are significantly higher in active IBD patients than inactive IBD patients. Our results suggest these biomarkers may serve in estimating IBD activity and severity.
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Affiliation(s)
- Hüseyin Korkmaz
- Department of Internal Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Mehmet Asıl
- Department of Internal Medicine, Faculty of Medicine, Necmettin Erbakan University Konya, Turkey
| | - Tuncer Temel
- Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Bahadır Öztürk
- Department of Medical Biochemistry, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Levent Kebapçılar
- Department of Internal Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey
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13
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Albert C, Zapf A, Haase M, Röver C, Pickering JW, Albert A, Bellomo R, Breidthardt T, Camou F, Chen Z, Chocron S, Cruz D, de Geus HRH, Devarajan P, Di Somma S, Doi K, Endre ZH, Garcia-Alvarez M, Hjortrup PB, Hur M, Karaolanis G, Kavalci C, Kim H, Lentini P, Liebetrau C, Lipcsey M, Mårtensson J, Müller C, Nanas S, Nickolas TL, Pipili C, Ronco C, Rosa-Diez GJ, Ralib A, Soto K, Braun-Dullaeus RC, Heinz J, Haase-Fielitz A. Neutrophil Gelatinase-Associated Lipocalin Measured on Clinical Laboratory Platforms for the Prediction of Acute Kidney Injury and the Associated Need for Dialysis Therapy: A Systematic Review and Meta-analysis. Am J Kidney Dis 2020; 76:826-841.e1. [PMID: 32679151 PMCID: PMC8283708 DOI: 10.1053/j.ajkd.2020.05.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/24/2020] [Indexed: 01/02/2023]
Abstract
RATIONALE & OBJECTIVE The usefulness of measures of neutrophil gelatinase-associated lipocalin (NGAL) in urine or plasma obtained on clinical laboratory platforms for predicting acute kidney injury (AKI) and AKI requiring dialysis (AKI-D) has not been fully evaluated. We sought to quantitatively summarize published data to evaluate the value of urinary and plasma NGAL for kidney risk prediction. STUDY DESIGN Literature-based meta-analysis and individual-study-data meta-analysis of diagnostic studies following PRISMA-IPD guidelines. SETTING & STUDY POPULATIONS Studies of adults investigating AKI, severe AKI, and AKI-D in the setting of cardiac surgery, intensive care, or emergency department care using either urinary or plasma NGAL measured on clinical laboratory platforms. SELECTION CRITERIA FOR STUDIES PubMed, Web of Science, Cochrane Library, Scopus, and congress abstracts ever published through February 2020 reporting diagnostic test studies of NGAL measured on clinical laboratory platforms to predict AKI. DATA EXTRACTION Individual-study-data meta-analysis was accomplished by giving authors data specifications tailored to their studies and requesting standardized patient-level data analysis. ANALYTICAL APPROACH Individual-study-data meta-analysis used a bivariate time-to-event model for interval-censored data from which discriminative ability (AUC) was characterized. NGAL cutoff concentrations at 95% sensitivity, 95% specificity, and optimal sensitivity and specificity were also estimated. Models incorporated as confounders the clinical setting and use versus nonuse of urine output as a criterion for AKI. A literature-based meta-analysis was also performed for all published studies including those for which the authors were unable to provide individual-study data analyses. RESULTS We included 52 observational studies involving 13,040 patients. We analyzed 30 data sets for the individual-study-data meta-analysis. For AKI, severe AKI, and AKI-D, numbers of events were 837, 304, and 103 for analyses of urinary NGAL, respectively; these values were 705, 271, and 178 for analyses of plasma NGAL. Discriminative performance was similar in both meta-analyses. Individual-study-data meta-analysis AUCs for urinary NGAL were 0.75 (95% CI, 0.73-0.76) and 0.80 (95% CI, 0.79-0.81) for severe AKI and AKI-D, respectively; for plasma NGAL, the corresponding AUCs were 0.80 (95% CI, 0.79-0.81) and 0.86 (95% CI, 0.84-0.86). Cutoff concentrations at 95% specificity for urinary NGAL were>580ng/mL with 27% sensitivity for severe AKI and>589ng/mL with 24% sensitivity for AKI-D. Corresponding cutoffs for plasma NGAL were>364ng/mL with 44% sensitivity and>546ng/mL with 26% sensitivity, respectively. LIMITATIONS Practice variability in initiation of dialysis. Imperfect harmonization of data across studies. CONCLUSIONS Urinary and plasma NGAL concentrations may identify patients at high risk for AKI in clinical research and practice. The cutoff concentrations reported in this study require prospective evaluation.
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Affiliation(s)
- Christian Albert
- University Clinic for Cardiology and Angiology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Diaverum Renal Services Germany, Potsdam, Germany.
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Michael Haase
- Faculty of Medicine, Otto-von-Guericke University, Magdeburg, Germany; Diaverum Renal Services Germany, Potsdam, Germany
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - John W Pickering
- Department of Medicine, University of Otago Christchurch; Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - Annemarie Albert
- Diaverum Renal Services Germany, Potsdam, Germany; Department for Nephrology and Endocrinology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Rinaldo Bellomo
- Department of Intensive Care, The Austin Hospital, Melbourne, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| | - Tobias Breidthardt
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Nephrology, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Fabrice Camou
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, France
| | - Zhongquing Chen
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangdong, China
| | - Sidney Chocron
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Dinna Cruz
- Division of Nephrology-Hypertension, University of California, San Diego, CA
| | - Hilde R H de Geus
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH
| | - Salvatore Di Somma
- Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza' University of Rome S. Andrea Hospital, Rome, Italy
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
| | - Zoltan H Endre
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | | | - Peter B Hjortrup
- Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Georgios Karaolanis
- Vascular Unit, First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Cemil Kavalci
- Emergency Department, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Paolo Lentini
- Department of Nephrology and Dialysis, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | - Miklós Lipcsey
- CIRRUS, Hedenstierna laboratory, Anaesthesiology and Intensive care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Mårtensson
- Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Müller
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Nephrology, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Serafim Nanas
- First Critical Care Department, 'Evangelismos' General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas L Nickolas
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Chrysoula Pipili
- First Critical Care Department, 'Evangelismos' General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Claudio Ronco
- Department of Nephrology, Dialysis & Transplantation, University of Padova, Vicenza, Italy; International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
| | - Guillermo J Rosa-Diez
- Department of Nephrology, Dialysis and Transplantation, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Azrina Ralib
- Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Pahang, Malaysia
| | - Karina Soto
- Department of Nephrology, Hospital Fernando Fonseca, Lisbon, Portugal; CEAUL, Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
| | - Rüdiger C Braun-Dullaeus
- University Clinic for Cardiology and Angiology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Judith Heinz
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences, University of Potsdam, Potsdam, Germany
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Allegretti AS, Solà E, Ginès P. Clinical Application of Kidney Biomarkers in Cirrhosis. Am J Kidney Dis 2020; 76:710-719. [DOI: 10.1053/j.ajkd.2020.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
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Cao J, Lu X, Gao F, Zhang X, Xia X, Sun H. Assessment of neutrophil gelatinase-associated lipocalin as an early biomarker for canine renal ischemia-reperfusion injury. Ann Transl Med 2020; 8:1491. [PMID: 33313236 PMCID: PMC7729331 DOI: 10.21037/atm-20-6314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background The pathological mechanism of ischemia/reperfusion acute kidney injury (I/R-AKI) differs from other forms of AKI. Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive biomarker for early diagnosis of AKI, but its utility for diagnosis of canine I/R-AKI remains to be evaluated. The aims of this study were to establish an I/R-AKI model in dogs and to evaluate the diagnostic value of NGAL for canine I/R-AKI. Methods We randomly divided 12 beagle dogs into a sham and an I/R group. Artery and vein of the left kidneys of I/R group were cross-clamped for 60 min followed by reperfusion. The kidney samples were analyzed for histopathological lesions. Serum and urinary samples were analyzed for blood urea nitrogen (BUN), serum creatinine (sCr), serum NGAL (sNGAL), urinary creatinine (uCr), and urinary NGAL (uNGAL). Their detection sensitivities and specificities were compared using a receiver operating characteristics (ROC) method. The expression of NGAL in the renal tissues was analyzed by quantitative RT-PCR (qRT-PCR) and immunohistochemical (IHC) analysis. Results After I/R, histopathological analysis showed typical AKI lesions in the dog kidneys of the I/R group, but not in the sham group. Compared to that of the sham group, BUN and sCr of the I/R group rose to significant high levels from 24 h after I/R. Both uNGAL and sNGAL rose rapidly from 2 h, reached to the peak levels at 12 h, and then receded to the pre-operation levels by 72 h after I/R. The uNGAL/uCr ratio (uNCR) rose rapidly from 2 h and remained at variably high levels from 6 to 60 h after I/R. The ROC analysis showed that detection sensitivities of uNCR, uNGAL, and sNGAL were significantly (P<0.0001) higher than that of sCr, without significant difference in specificity. The cut-off values of sNGAL, uNGAL and uNCR were 14,642 pg/mL, 6,773 pg/mL, and 6,701 pg/mg, respectively. Both qRT-PCR and IHC analyses confirmed the dynamic expression of NGAL in the dog kidneys with ischemic acute kidney injury (I-AKI). Conclusions There is potential for NGAL to be used as a sensitive biomarker for early diagnosis of canine I-AKI.
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Affiliation(s)
- Jun Cao
- College of Veterinary Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China.,School of Life Sciences, Nantong University, Nantong, China
| | - Xiaofeng Lu
- School of Life Sciences, Nantong University, Nantong, China
| | - Fei Gao
- Ai-Bi Pet Hospital, Nantong, China
| | - Xinyu Zhang
- College of Veterinary Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
| | - Xiaoli Xia
- College of Veterinary Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
| | - Huaichang Sun
- College of Veterinary Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
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16
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Anderson AH, Xie D, Wang X, Baudier RL, Orlandi P, Appel LJ, Dember LM, He J, Kusek JW, Lash JP, Navaneethan SD, Ojo A, Rahman M, Roy J, Scialla JJ, Sondheimer JH, Steigerwalt SP, Wilson FP, Wolf M, Feldman HI. Novel Risk Factors for Progression of Diabetic and Nondiabetic CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2020; 77:56-73.e1. [PMID: 32866540 DOI: 10.1053/j.ajkd.2020.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE & OBJECTIVE Identification of novel risk factors for chronic kidney disease (CKD) progression may inform mechanistic investigations and improve identification of high-risk subgroups. The current study aimed to characterize CKD progression across levels of numerous risk factors and identify independent risk factors for CKD progression among those with and without diabetes. STUDY DESIGN The Chronic Renal Insufficiency Cohort (CRIC) Study is a prospective cohort study of adults with CKD conducted at 7 US clinical centers. SETTING & PARTICIPANTS Participants (N=3,379) had up to 12.3 years of follow-up; 47% had diabetes. PREDICTORS 30 risk factors for CKD progression across sociodemographic, behavioral, clinical, and biochemical domains at baseline. OUTCOMES Study outcomes were estimated glomerular filtration rate (eGFR) slope and the composite of halving of eGFR or initiation of kidney replacement therapy. ANALYTICAL APPROACH Stepwise selection of independent risk factors was performed stratified by diabetes status using linear mixed-effects and Cox proportional hazards models. RESULTS Among those without and with diabetes, respectively, mean eGFR slope was-1.4±3.3 and-2.7±4.7mL/min/1.73m2 per year. Among participants with diabetes, multivariable-adjusted hazard of the composite outcome was approximately 2-fold or greater with higher levels of the inflammatory chemokine CXCL12, the cardiac marker N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the kidney injury marker urinary neutrophil gelatinase-associated lipocalin (NGAL). Among those without diabetes, low serum bicarbonate and higher high-sensitivity troponin T, NT-proBNP, and urinary NGAL levels were all significantly associated with a 1.5-fold or greater rate of the composite outcome. LIMITATIONS The observational study design precludes causal inference. CONCLUSIONS Strong associations for cardiac markers, plasma CXCL12, and urinary NGAL are comparable to that of systolic blood pressure≥140mm Hg, a well-established risk factor for CKD progression. This warrants further investigation into the potential mechanisms that these markers indicate and opportunities to use them to improve risk stratification.
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Affiliation(s)
- Amanda H Anderson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Dawei Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Xue Wang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Robin L Baudier
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Paula Orlandi
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Laura M Dember
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - John W Kusek
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Baylor University College of Medicine, Houston, TX
| | - Akinlolu Ojo
- University of Kansas School of Medicine, Kansas City, KS
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Julia J Scialla
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - James H Sondheimer
- Division of Nephrology and Hypertension, Wayne State University School of Medicine, Detroit
| | - Susan P Steigerwalt
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - F Perry Wilson
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Abstract
Introduction: Acute kidney injury following cardiac surgery is a dreaded complication contributing to early mortality. Diagnosing AKI using serum creatinine usually results in a delay. To combat this, certain kidney damage specific biomarkers were investigated to identify if they can serve as early predictors of cardiac surgery-associated AKI (CSA-AKI). This study systematically reviews three such biomarkers; NGAL, tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP7) to identify if they can serve as early predictors of CSA-AKI.Methods: Systematic search was carried out on literature reporting the diagnostic ability of the three biomarkers from databases in accordance with PRISMA guidelines.Results: We found 43 articles reporting urinary-NGAL levels (n = 34 in adults, n = 9 in children) and 10 studies reporting TIMP-2 and IGFBP7 levels among adults. Interestingly, NGAL showed high diagnostic value in predicting AKI in children (seven among nine studies with AUROC > 0.8). The cell cycle arrest biomarkers, namely TIMP-2 and IGFBP7, showed high diagnostic value in predicting AKI in adults (five among ten studies with AUROC > 0.8).Conclusion: In predicting CSA-AKI; the diagnostic value of NGAL is high in the paediatric population while the diagnostic value of TIMP-2 and IGFBP7 is high in adults.
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Affiliation(s)
- Mohmmed Laique Hussain
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
| | - Pousette Farouk Hamid
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
| | - Ntema Chakane
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
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Cetinkaya PU, Azik FM, Karakus V, Huddam B, Yilmaz N. β2-Microglobulin, Neutrophil Gelatinase-Associated Lipocalin, and Endocan Values in Evaluating Renal Functions in Patients with β-Thalassemia Major. Hemoglobin 2020; 44:147-152. [PMID: 32441176 DOI: 10.1080/03630269.2020.1766486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic anemia, transfusion-associated iron deposition, and chelating agents lead to renal impairment in β-thalassemia (β-thal) patients. The present study aimed to determine the most reliable and practical method in assessing and predicting renal injury in β-thal major (β-TM) patients. Therefore, we assessed the predictive values of urine β2-microglobulin (β2-MG) and neutrophil gelatinase-associated lipocalin (NGAL) levels, their ratios to urine creatinine, and serum endocan level. Sixty β-TM patients and 30 healthy controls were included. Renal functions of the patients and controls were evaluated by means of urine protein/creatinine ratio, urine β2-MG, urine NGAL, and serum endocan level. The β-TM and control groups were comparable in terms of the demographic characteristics. Of the β-TM patients, 26.7% had glomerular hyperfiltration and 41.7% had proteinuria. Compared with the control group, the β-TM group had significantly higher levels of urine protein/creatinine, urine β2-MG, urine β2-MG/creatinine, urine NGAL, urine NGAL/creatinine, and serum endocan. These parameters did not differ between the chelating agent subgroups in the patient group. Urine β2-MG/creatinine and NGAL/creatinine ratios were the parameters with high specificity in predicting proteinuria. There were significant correlations of urine β2-MG, urine NGAL, and serum endocan levels with serum ferritin concentration. Urine β2-MG/creatinine, NGAL/creatinine, and protein/creatinine ratios were correlated with each other in the patient group. Positive correlations of urine β2-MG, urine NGAL, and serum endocan levels with serum ferritin concentration indicated that iron deposition was associated with endothelial damage and renal injury.
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Affiliation(s)
- Petek Uzay Cetinkaya
- Department of Child Health and Diseases, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Fatih Mehmet Azik
- Department of Child Health and Diseases, Hematology Oncology, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
| | - Volkan Karakus
- Department of Hematology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Bulent Huddam
- Department of Nephrology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Nigar Yilmaz
- Department of Biochemistry, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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Li F, Hu L, Zhao X, Ge W, Pan H, Zhang W, Jiang Y, Xu X, Hou J, Pu J. The value of cystatin C and urinary and serum neutrophil gelatinase-associated lipocalin during the perioperative period of renal transplantation. Transl Androl Urol 2019; 8:432-441. [PMID: 31807420 DOI: 10.21037/tau.2019.08.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background The perioperative management of renal transplantation is complex. Our research aimed to study the clinical value of cystatin-C (Cys-C) and urinary and serum neutrophil gelatinase-associated lipocalin (NGAL) during the perioperative period of renal transplantation. Methods We collected the clinical information of 47 renal transplantation patients. Urine and serum samples were collected daily until the second week and then weekly until discharge to determine serum NGAL (s-NGAL), urine NGAL (u-NGAL), serum creatinine (s-Cr), and Cys-C levels. Receiver-operating characteristic (ROC) analysis was used, and the area under the curve (AUC) was compared to evaluate the accuracy of the diagnosis of delayed graft function (DGF). Multivariable analysis was used to find the association between the markers and renal function at discharge. Results In our research, the value of Cys-C, serum NGAL, and urine NGAL were higher in DGF group. In the ROC analysis, Cys-C had the highest AUC (0.939) compared with s-NGAL (0.909), u-NGAL (0.856), and s-Cr (0.747). Multivariable analysis showed that Cys-C levels in the first week after the operation and cold ischemia time were independently associated with estimated glomerular filtration rate (eGFR) at discharge (P<0.05). Conclusions Our results showed that Cys-C, serum NGAL, and urine NGAL could reflect renal function sensitively. Cys-C had the highest sum of sensitivity and specificity at 4.77 mg/L, with a sensitivity of 0.818 and specificity of 0.889. The Cys-C level during the first week after the operation was independently associated with eGFR at discharge and could predict the short-term prognosis of renal transplantation patients.
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Affiliation(s)
- Feng Li
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Linkun Hu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Xiaojun Zhao
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Wenqing Ge
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Hao Pan
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Wei Zhang
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Yufeng Jiang
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Xu Xu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Jianquan Hou
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Jinxian Pu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
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Ondee T, Gillen J, Visitchanakun P, Somparn P, Issara-Amphorn J, Dang Phi C, Chancharoenthana W, Gurusamy D, Nita-Lazar A, Leelahavanichkul A. Lipocalin-2 (Lcn-2) Attenuates Polymicrobial Sepsis with LPS Preconditioning (LPS Tolerance) in FcGRIIb Deficient Lupus Mice. Cells 2019; 8:cells8091064. [PMID: 31514375 PMCID: PMC6769833 DOI: 10.3390/cells8091064] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 02/08/2023] Open
Abstract
In patients with active lupus, spontaneous endotoxemia and possibly tolerance to lipopolysaccharide (LPS) is a potentially adverse complication. Similarly, previous reports have demonstrated that FcGRIIb deficient mice (FcGRIIb-/-; a lupus mouse model) are susceptible to LPS tolerance-induced decreased cytokine responses that inadequate for the organismal control. Thus, understanding the relationship between FcGRIIb and LPS tolerance could improve the therapeutic strategy for lupus. LPS tolerance can be induced through sequential LPS stimulations in either cells or a model organism. In RAW264.7 (a mouse macrophage cell-line), sequential LPS stimulation induced the secretion of Lipocalin-2 (Lcn-2) despite reduced cytokine secretion and severe energy depletion, as measured by the extracellular flux analysis, typical of LPS tolerance. In contrast, treatment with recombinant Lcn-2 (rLcn-2) attenuated LPS tolerance, as shown by an increase in secreted cytokines and altered macrophage polarization toward M1 (increased iNOS and TNF-α) in RAW264.7 cells. These results suggest a role of Lcn-2 in LPS tolerance attenuation. In bone marrow derived macrophages, Lcn-2 level was similar in LPS tolerant FcGRIIb-/- and wild-type (WT) cells despite the increased LPS tolerance of FcGRIIb-/- cells, suggesting relatively low basal levels of Lcn-2 produced in FcGRIIb-/- cells. In addition, attenuation of LPS tolerance effectuated by granulocyte-monocyte colony stimulating factor (GM-CSF) reduced Lcn-2 in both cell types, implying an inverse correlation between Lcn-2 and the severity of LPS tolerance. Consequently, rLcn-2 improved LPS tolerance only in FcGRIIb-/- macrophages and attenuated disease severity of cecal ligation and puncture (CLP) sepsis pre-conditioning with sequential LPS injection (LPS-CLP model) only in FcGRIIb-/- mice, but not in WT mice. To summarize, inadequate Lcn-2 production in FcGRIIb-/- macrophage might, at least in part, be responsible for the inordinate LPS tolerance compared with WT cells. Additionally, supplementation of rLcn-2 attenuates LPS tolerance in FcGRIIb-/- macrophages in vitro, and in FcGRIIb-/- mice with LPS-CLP sepsis in vivo. In conclusion, Lcn-2 secreted by macrophages is possibly an autocrine signal to counter the reduced cytokine secretion in LPS tolerance.
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Affiliation(s)
- Thunnicha Ondee
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Joseph Gillen
- Functional Cellular Networks Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1892, USA
| | - Peerapat Visitchanakun
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Poorichaya Somparn
- Center of Excellence in Systems Biology, Research affairs, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jiraphorn Issara-Amphorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Cong Dang Phi
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Wiwat Chancharoenthana
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Devikala Gurusamy
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Aleksandra Nita-Lazar
- Functional Cellular Networks Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1892, USA
| | - Asada Leelahavanichkul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
- Translational Research in Inflammation and Immunology Research Unit (TRIRU), Department of Microbiology, Chulalongkorn University, Bangkok 10330, Thailand.
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Carey I, Byrne R, Childs K, Horner M, Bruce M, Wang B, Dusheiko G, Agarwal K. Serum NGAL can act as an early renal safety biomarker during long-term nucleos(t)ide analogue antiviral therapy in chronic hepatitis B. J Viral Hepat 2018; 25:1139-1150. [PMID: 29660209 DOI: 10.1111/jvh.12916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/20/2018] [Indexed: 12/26/2022]
Abstract
Tubular renal toxicity is a side-effect of long-term therapy with nucleos(t)ide analogue(s) (NA) in chronic hepatitis B (CHB). There are no established surrogate markers in plasma of early NA-related toxicity. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein produced by tubular cells following renal damage. We aimed therefore to retrospectively compare conventional renal markers (estimated glomerular filtration rates (eGFR) and urinary protein/creatinine ratio uPCR) with a sensitive biomarker (NGAL) in CHB patients on long-term NA therapy and assess the ability of new markers to predict NA-related renal toxicity (new onset of nonalbumin proteinuria). A total of 192 naïve CHB patients (median age 41 years, 78% males, 25% HBeAg+, 35% cirrhosis) were NA treated for at least 5 years (median 8.34 years, range 5.54-11.1 years). The eGFR and uPCR were compared at baseline and last clinical visit with serum NGAL concentrations measured by ELISA at same time-points and assessed according to the presence/absence of nonalbumin proteinuria at last visit. While baseline and last visit eGFR were similar (median:78 vs 84 mL/min), serum NGAL concentrations increased during therapy (median:9.4 vs 16.4 ng/mL, P < .05). The proportion of patients with proteinuria (uPCR > 15) increased between baseline and last visit (4.6% vs 21.4%, P < .05), with 30 (16%) patients having de novo nonalbumin proteinuria at last visit. High baseline NGAL concentrations were exclusive to patients with de novo nonalbumin proteinuria (median:31.7 vs 7.8 ng/mL, P < .01) and baseline NGAL levels >25 mg/mL were predictive of nonalbumin proteinuria at last visit (AUROC = 0.813). In conclusion, serum NGAL can act as a surrogate marker of early renal injury (de novo nonalbumin proteinuria) in CHB on long-term NA therapy.
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Affiliation(s)
- I Carey
- Institute of Liver Studies, King's College Hospital, London, UK
| | - R Byrne
- Institute of Liver Studies, King's College Hospital, London, UK
| | - K Childs
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Horner
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Bruce
- Institute of Liver Studies, King's College Hospital, London, UK
| | - B Wang
- Institute of Liver Studies, King's College Hospital, London, UK
| | - G Dusheiko
- Institute of Liver Studies, King's College Hospital, London, UK
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
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Albert C, Albert A, Bellomo R, Kropf S, Devarajan P, Westphal S, Baraki H, Kutschka I, Butter C, Haase M, Haase-Fielitz A. Urinary neutrophil gelatinase-associated lipocalin-guided risk assessment for major adverse kidney events after open-heart surgery. Biomark Med 2018; 12:975-985. [PMID: 30088425 DOI: 10.2217/bmm-2018-0071] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIM To assess weather doctors' clinical risk-assessment for major adverse kidney events (MAKE) and acute kidney injury (AKI) after open-heart surgery would improve when being informed about neutrophil gelatinase-associated lipocalin (NGAL) test result at ICU admission. PATIENTS & METHODS Clinical risk-assessment for MAKE and AKI were performed with and without providing NGAL test result and compared in an exploratory- and a validation-cohort using reclassification metrics, exemplary category-free net reclassification improvement (cfNRI). RESULTS Exploratory cohort: doctors' prediction of MAKE (cfNRI = 0.750 [0.130-1.370]; p = 0.018) and AKI (cfNRI = 0.565 [0.001-1.129]; p = 0.049) improved being provided with NGAL test information. This finding was confirmed in the validation-cohort (MAKE cfNRI = 0.930 [0.188-1.672]; p = 0.014) and the combined-cohort (MAKE: cfNRI = 0.847 [0.371-1.323], p < 0.001); AKI: cfNRI = 0.468 [0.099-0.836; p = 0.013]). Improvements mostly generated from correctly reclassifying patients who not developed events (p < 0.001). CONCLUSION Biomarker informed risk-assessment is superior in predicting MAKE and AKI after open-heart surgery.
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Affiliation(s)
- Christian Albert
- Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany.,Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany.,Diaverum Deutschland, Potsdam, BB, Germany
| | - Annemarie Albert
- Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany.,Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany.,Diaverum Deutschland, Potsdam, BB, Germany
| | - Rinaldo Bellomo
- School of Medicine, Intensive Care Unit, Austin Hospital, Heidelberg, VIC, 3084 Australia
| | - Siegfried Kropf
- Institute for Biometrics & Medical Informatics, Otto-von-Guericke University, Magdeburg, ST, Germany
| | - Prasad Devarajan
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Sabine Westphal
- Institute of Laboratory Medicine, Hospital Dessau, Dessau, ST, Germany
| | - Hassina Baraki
- Department of Thoracic, Cardiac & Vascular Surgery, University of Göttingen, Göttingen, NI, Germany
| | - Ingo Kutschka
- Department of Thoracic, Cardiac & Vascular Surgery, University of Göttingen, Göttingen, NI, Germany
| | - Christian Butter
- Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany.,Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, BB, Germany
| | - Michael Haase
- Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany.,Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany.,Diaverum Deutschland, Potsdam, BB, Germany
| | - Anja Haase-Fielitz
- Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany.,Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, BB, Germany.,Institute of Social Medicine & Health Economics, Otto-von-Guericke University, Magdeburg, ST, Germany
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Jo YS, Kwon SO, Kim J, Kim WJ. Neutrophil gelatinase-associated lipocalin as a complementary biomarker for the asthma-chronic obstructive pulmonary disease overlap. J Thorac Dis 2018; 10:5047-5056. [PMID: 30233879 DOI: 10.21037/jtd.2018.07.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background There is no standardized definition of the asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Although the blood eosinophil count is regarded as a biomarker for identifying ACO, it has no distinct value. This study aimed to measure plasma levels of neutrophil gelatinase-associated lipocalin (NGAL), a potential biomarker for distinguishing between ACO and non-ACO COPD. Methods We used the Korean cohort in the COPD in dusty area (CODA) study which included 137 subjects with COPD confirmed by spirometry. We defined ACO by a positive bronchodilator response (forced expiratory volume in 1 s, FEV1 >12% and >200 mL from baseline) or based on a previous history of asthma. Plasma levels of NGAL were determined by enzyme immunoassay. Results Among the 137 subjects, 77 were ACO and 60 were non-ACO COPD. Overall, the plasma NGAL levels were 15.9±7.9 and 15.6±6.6 ng/mL for non-ACO and ACO subjects respectively, and not significantly different. However, NGAL levels were significantly higher in female subjects with ACO (17.0±6.4 vs. 11.1±4.5, P=0.01). In female subjects, NGAL levels showed a good predictive ability to discriminate between ACO and non-ACO COPD [area under the receiver operating characteristic curve (AUROC), 0.77]; the predictive ability was similar to that of the blood eosinophil count (AUROC, 0.79). There was a higher probability of discriminating ACO from non-ACO among subjects in the highest tertile of NGAL levels (odds ratio, 1.72; 95% confidence interval, 0.69-4.28; P for trend =0.01). Conclusions NGAL levels were significantly higher in ACO compared to non-ACO COPD in female subjects. After adjusting for gender as a confounding factor, the ability to distinguish ACO was better at higher levels of NGAL.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Ok Kwon
- Biomedical Research Institute, Kangwon National University, Chuncheon, Korea
| | - Jeeyoung Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Jotwani V, Katz R, Ix JH, Gutiérrez OM, Bennett M, Parikh CR, Cummings SR, Sarnak MJ, Shlipak MG. Urinary Biomarkers of Kidney Tubular Damage and Risk of Cardiovascular Disease and Mortality in Elders. Am J Kidney Dis 2018; 72:205-213. [PMID: 29602632 DOI: 10.1053/j.ajkd.2017.12.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/23/2017] [Indexed: 01/07/2023]
Abstract
RATIONALE & OBJECTIVE Novel urinary biomarkers have enabled earlier detection of kidney tubular damage, but their prognostic value for adverse cardiovascular outcomes is uncertain. We hypothesized that tubular damage, measured by urine α1-microglobulin (A1M), amino-terminal propeptide of type III procollagen (PIIINP), and neutrophil gelatinase-associated lipocalin (NGAL), would be associated with higher risks for cardiovascular events and mortality among elders. STUDY DESIGN Case-cohort study. SETTING & PARTICIPANTS This study included a randomly selected subcohort (n=502), cardiovascular disease (CVD) cases (n=245), and heart failure cases (n=220) from the Health, Aging, and Body Composition (Health ABC) Study. PREDICTORS Baseline urine A1M, PIIINP, and NGAL concentrations. OUTCOMES Incident CVD, heart failure, and all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models were used to evaluate biomarker associations with each outcome. RESULTS At baseline, mean age was 74 years and estimated glomerular filtration rate was 73mL/min/1.73m2. After adjustment for demographics, estimated glomerular filtration rate, albumin-creatinine ratio, and other cardiovascular risk factors, each doubling in biomarker concentration was associated with the following adjusted HRs for CVD: A1M, 1.51 (95% CI, 1.16-1.96); PIIINP, 1.21 (95% CI, 1.00-1.46); and NGAL, 1.12 (95% CI, 1.05-1.20). There were 248 deaths in the subcohort during a median follow-up of 12.4 years. Adjusted associations of each biomarker (HR per doubling) with all-cause mortality were: A1M, 1.29 (95% CI, 1.10-1.51); PIIINP, 1.05 (95%, 0.94-1.18); and NGAL, 1.07 (95% CI, 1.02-1.12). Biomarker concentrations did not have statistically significant associations with heart failure after multivariable adjustment. LIMITATIONS Urine biomarkers were measured at a single time point; no validation cohort available. CONCLUSIONS Kidney tubular damage is an independent risk factor for CVD and death among elders. Future studies should investigate mechanisms by which kidney tubular damage may adversely affect cardiovascular risk.
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Affiliation(s)
- Vasantha Jotwani
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA.
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, AL
| | - Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT; Program of Applied Translational Research, Yale University, New Haven, CT
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Michael G Shlipak
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA
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Donadei C, Cappuccilli M, La Manna G. An intriguing link between human leukocyte antigen G, T-regulatory cells and neutrophil gelatinase-associated lipocalin in immune tolerance induction. Cytotherapy 2018; 20:477-478. [PMID: 29352667 DOI: 10.1016/j.jcyt.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Chiara Donadei
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy.
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Sivalingam Z, Larsen SB, Grove EL, Hvas AM, Kristensen SD, Magnusson NE. Neutrophil gelatinase-associated lipocalin as a risk marker in cardiovascular disease. Clin Chem Lab Med 2017; 56:5-18. [PMID: 28672731 DOI: 10.1515/cclm-2017-0120] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/07/2017] [Indexed: 12/21/2022]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a promising diagnostic biomarker of early acute kidney injury. Increasing evidence suggests that NGAL may also be involved in inflammatory processes in cardiovascular disease. NGAL modulates the enzymatic activity of matrix metalloproteinase-9 (MMP-9), which is an important mediator of plaque instability in atherosclerosis. The complex formation between NGAL and MMP-9 therefore suggests that NGAL might play a role in progression of atherothrombotic disease. This review summarises current data on NGAL in atherosclerosis, acute myocardial infarction, and heart failure.
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Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption. Clin Chem Lab Med 2017; 55:1074-1089. [PMID: 28076311 DOI: 10.1515/cclm-2016-0973] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.
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Bleskestad IH, Thorsen IS, Jonsson G, Skadberg Ø, Gøransson LG. The impact of calcineurin inhibitors on neutrophil gelatinase-associated lipocalin and fibroblast growth factor 23 in long-term kidney transplant patients. Clin Transplant 2017; 31. [PMID: 28523792 DOI: 10.1111/ctr.13015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neutrophil gelatinase-associated lipocalin (NGAL), a protein with bacteriostatic functions rapidly excreted from stimulated or damaged epithelial cells, is elevated in acute and chronic kidney disease. A calcineurin dependent signaling pathway for fibroblast growth factor 23 (FGF23) has been revealed, but the effect of calcineurin inhibitors (CNIs) on the levels of NGAL and markers of mineral metabolism in long-term kidney transplant patients has not been explored. METHODS In a cross-sectional study, 39 patients who received a first kidney transplant more than 10 years ago were split into two groups based on whether (n=28) or not (n=11) they used CNIs. Only patients with well-functioning grafts defined as an estimated glomerular filtration rate ≥45 mL/min per 1.73 m2 were included. RESULTS The median levels of NGAL, intact parathyroid hormone (iPTH), and iFGF23 were significantly higher in CNI users vs CNI nonusers, 167.0 (134.0-235.0) ng/mL vs 105.0 (91.3-117.0) ng/mL, P<.001, 13.8 (10.0-17.3) pmol/L vs 8.4 (6.4-9.9) pmol/L, P=.003, and 81.6 (56.4-116.5) pg/mL vs 61.8 (43.3-72.1) pg/mL, P=.04 respectively. CONCLUSIONS The median levels of iFGF23 were higher in CNI users compared to CNI nonusers giving support to the notion of a CNI induced FGF23 resistance in the parathyroid. The net result of CNIs side effects needs to be further explored.
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Affiliation(s)
| | - Inga Strand Thorsen
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Grete Jonsson
- Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Skadberg
- Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Lasse Gunnar Gøransson
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM. Biomarkers in acute kidney injury - pathophysiological basis and clinical performance. Acta Physiol (Oxf) 2017; 219:554-572. [PMID: 27474473 DOI: 10.1111/apha.12764] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
Various biomarkers of acute kidney injury (AKI) have been discovered and characterized in the recent past. These molecules can be detected in urine or blood and signify structural damage to the kidney. Clinically, they are proposed as adjunct diagnostics to serum creatinine and urinary output to improve the early detection, differential diagnosis and prognostic assessment of AKI. The most obvious requirements for a biomarker include its reflection of the underlying pathophysiology of the disease. Hence, a biomarker of AKI should derive from the injured kidney and reflect a molecular process intimately connected with tissue injury. Here, we provide an overview of the basic pathophysiology, the cellular sources and the clinical performance of the most important currently proposed biomarkers of AKI: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinase 2 (TIMP-2) and calprotectin (S100A8/9). We also acknowledge each biomarker's advantages and disadvantages as well as important knowledge gaps and perspectives for future studies.
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Affiliation(s)
- E. V. Schrezenmeier
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
| | - J. Barasch
- Division of Nephrology; Columbia University College of Physicians and Surgeons; New York NY USA
| | - K. Budde
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Westhoff
- Medical Department I; Universitätsklinikum Marien Hospital Herne; Ruhr University of Bochum; Bochum Germany
| | - K. M. Schmidt-Ott
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
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Beghini J, Giraldo PC, Eleutério J, Amaral RLD, Polpeta NC, Gonçalves AK. Vaginal Inflammation: Association between Leukocyte Concentration and Levels of Immune Mediators. Am J Reprod Immunol 2016; 75:126-33. [PMID: 26773532 DOI: 10.1111/aji.12475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/07/2015] [Indexed: 01/08/2023] Open
Abstract
PROBLEM A wide variety of mediators are involved in inflammatory processes. However, the identity of those participating in vaginal immune responses has not been established. We correlated extracellular matrix metalloproteinase inducer (EMMPRIN), matrix metalloproteinase-8 (MMP-8), hyaluronan (HA), hyaluronidase-1 (Hyal-1), human β-defensin-2 (hBD2), and neutrophil gelatinase-associated lipocalin (NGAL) concentrations with the extent of leukocyte infiltration into the vagina and suggest their participation in vaginal inflammation. METHODS OF STUDY Vaginal fluid was obtained from 233 women seen at the outpatient clinic in the Department of Obstetrics and Gynecology at Campinas University, Brazil. The magnitude of vaginal inflammation was determined by the leukocyte count on vaginal smears and categorized as no inflammation (0 leukocytes/field), moderate inflammation (1-4 leukocytes/field), and intense inflammation (>4 leukocytes/field). Concentrations of EMMPRIN, MMP-8, HA, Hyal-1, hBD2, and NGAL were determined in vaginal fluid by ELISA. RESULTS EMMPRIN, MMP-8, HA, hBD2, and NGAL concentration increased with elevated leukocyte numbers (P < 0.05), while Hyal-1 did not. EMMPRIN concentrations were correlated with HA and MMP-8 levels. CONCLUSION EMMPRIN, MMP-8, HA, β-defensin, and NGAL are elevated in women with vaginal inflammation.
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Affiliation(s)
- Joziani Beghini
- Department of Gynecology and Obstetrics, University of Campinas, Campinas, Brazil
| | - Paulo C Giraldo
- Department of Gynecology and Obstetrics, University of Campinas, Campinas, Brazil
| | - José Eleutério
- Department of Motherhood and Child, Federal University of Ceará, Fortaleza, Brazil
| | - Rose Luce do Amaral
- Department of Gynecology and Obstetrics, University of Campinas, Campinas, Brazil
| | - Nádia C Polpeta
- Department of Gynecology and Obstetrics, University of Campinas, Campinas, Brazil
| | - Ana Katherine Gonçalves
- Department of Gynecology and Obstetrics, Federal University of Rio Grande do Norte, Natal, Brazil
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Chagan-Yasutan H, Chen Y, Lacuesta TL, Leano PS, Iwasaki H, Hanan F, Taurustiati D, Ohmoto Y, Ashino Y, Saitoh H, Kiyomoto H, Suzuki Y, Telan FO, Hattori T. Urine Levels of Defensin α1 Reflect Kidney Injury in Leptospirosis Patients. Int J Mol Sci 2016; 17:E1637. [PMID: 27689992 DOI: 10.3390/ijms17101637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/31/2022] Open
Abstract
Leptospirosis is a zoonotic disease whose severe forms are often accompanied by kidney dysfunction. In the present study, urinary markers were studied for potential prediction of disease severity. Urine samples from 135 patients with or without leptospirosis at San Lazaro Hospital, the Philippines, were analyzed. Urine levels of defensin α1 (uDA1) were compared with those of neutrophil gelatinase-associated lipocalin (uNGAL) and N-acetyl-β-d-glucosidase (uNAG). Serum creatinine (Cr) was used as a marker of kidney injury. The levels of uDA1/Cr, uNGAL/Cr, and uNAG/Cr were positive in 46%, 90%, and 80% of leptospirosis patients, and 69%, 70%, and 70% of non-leptospirosis patients, respectively. In leptospirosis patients, the correlation of uDA1/Cr, uNGAL/Cr and uNAG/Cr levels with serum Cr were r = 0.3 (p < 0.01), r = 0.29 (p < 0.01), and r = 0.02 (p = 0.81), respectively. uDA1/Cr levels were correlated with uNGAL/Cr levels (r = 0.49, p < 0.01) and uNAG/Cr levels (r = 0.47, p < 0.0001) in leptospirosis patients. These findings suggest that uDA1, uNGAL, and uNAG were elevated in leptospirosis patients and reflected various types of kidney damage. uDA1 and uNGAL can be used to track kidney injury in leptospirosis patients because of their correlation with the serum Cr level.
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Laws RL, Brooks DR, Amador JJ, Weiner DE, Kaufman JS, Ramírez-Rubio O, Riefkohl A, Scammell MK, López-Pilarte D, Sánchez JM, Parikh CR, McClean MD. Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers. Am J Kidney Dis 2015; 67:209-17. [PMID: 26454687 DOI: 10.1053/j.ajkd.2015.08.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 08/11/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Central America, an epidemic of chronic kidney disease of unknown cause disproportionately affects young male agricultural workers. STUDY DESIGN Longitudinal cohort study. SETTING & PARTICIPANTS 284 sugarcane workers in 7 jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected before and near the end of the 6-month harvest season. PREDICTORS Job category (cane cutter, seeder, seed cutter, agrichemical applicator, irrigator, driver, and factory worker); self-reported water and electrolyte solution intake. OUTCOMES & MEASUREMENTS Changes in levels of urinary kidney injury biomarkers normalized to urine creatinine level, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N-acetyl-β-d-glucosaminidase (NAG), and albumin; serum creatinine-based estimated glomerular filtration rate (eGFR). RESULTS Mean eGFR was 113 mL/min/1.73 m(2) and <5% of workers had albuminuria. Field workers had increases in NGAL and IL-18 levels that were 1.49 (95% CI, 1.06 to 2.09) and 1.61 (95% CI, 1.12 to 2.31) times as high, respectively, as in non-field workers. Cane cutters and irrigators had the greatest increases in NGAL levels during the harvest, whereas cane cutters and seeders had the greatest increases in IL-18 levels. Electrolyte solution consumption was associated with lower mean NGAL and NAG levels among cane cutters and lower mean IL-18 and NAG levels among seed cutters; however, there was no overall effect of hydration among all workers. On average, workers with the largest increases in NGAL and NAG levels during the harvest had declines in eGFRs of 4.6 (95% CI, 1.0 to 8.2) and 3.1 (95% CI, -0.6 to 6.7) mL/min/1.73 m(2), respectively. LIMITATIONS Surrogate exposure measure, loss to follow-up. CONCLUSIONS Results are consistent with the hypothesis that occupational heat stress and volume depletion may be associated with the development of kidney disease, and future studies should directly measure these occupational factors. The presence of urine tubular injury markers supports a tubulointerstitial disease that could occur with repeated tubular injury.
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Affiliation(s)
- Rebecca L Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA.
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - James S Kaufman
- Research Service, VA New York Harbor Healthcare System, New York, NY; Department of Medicine, New York University School of Medicine, New York, NY
| | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Preventive Medicine and Public Health Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Riefkohl
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | | | - José Marcel Sánchez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University and VA Medical Center, New Haven, CT; Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
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Schuh MP, Nehus E, Ma Q, Haffner C, Bennett M, Krawczeski CD, Devarajan P. Long-term Stability of Urinary Biomarkers of Acute Kidney Injury in Children. Am J Kidney Dis 2015; 67:56-61. [PMID: 26032628 DOI: 10.1053/j.ajkd.2015.04.040] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/21/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recent meta-analyses support the utility of urinary biomarkers for the diagnosis and prognosis of acute kidney injury. It is critical to establish optimal sample handling conditions for short-term processing and long-term urinary storage prior to widespread clinical deployment and meaningful use in prospective clinical trials. STUDY DESIGN Prospective study. SETTING & PARTICIPANTS 80 children (median age, 1.1 [IQR, 0.5-4.2] years) undergoing cardiac surgery with cardiopulmonary bypass at our center. 50% of patients had acute kidney injury (defined as ≥50% increase in serum creatinine from baseline). PREDICTORS We tested the effect on biomarker concentrations of short-term urine storage in ambient, refrigerator, and freezer conditions. We also tested the effects of multiple freeze-thaw cycles, as well as prolonged storage for 5 years. OUTCOMES Urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), and interleukin 18 (IL-18). MEASUREMENTS All biomarkers were measured using commercially available kits. RESULTS All 3 biomarkers were stable in urine stored at 4°C for 24 hours, but showed significant degradation (5.6%-10.1% from baseline) when stored at 25°C. All 3 biomarkers showed only a small although significant decrease in concentration (0.77%-2.9% from baseline) after 3 freeze-thaw cycles. Similarly, all 3 biomarkers displayed only a small but significant decrease in concentration (0.84%-3.2%) after storage for 5 years. LIMITATIONS Only the 3 most widely studied biomarkers were tested. Protease inhibitors were not evaluated. CONCLUSIONS Short-term storage of urine samples for measurement of NGAL, KIM-1, and IL-18 may be performed at 4°C for up to 24 hours, but not at room temperature. These urinary biomarkers are stable at -80°C for up to 5 years of storage. Our results are reassuring for the deployment of these assays as biomarkers in clinical practice, as well as in prospective clinical studies requiring long-term urine storage.
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Affiliation(s)
- Meredith P Schuh
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Edward Nehus
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Qing Ma
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Christopher Haffner
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Michael Bennett
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Catherine D Krawczeski
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Prasad Devarajan
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
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Beghini J, Giraldo PC, Linhares IM, Ledger WJ, Witkin SS. Neutrophil Gelatinase-Associated Lipocalin Concentration in Vaginal Fluid: Relation to Bacterial Vaginosis and Vulvovaginal Candidiasis. Reprod Sci 2015; 22:964-8. [PMID: 25670719 DOI: 10.1177/1933719115570914] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neutrophil gelatinase-associated lipocalin (NGAL) is a component of innate immunity that prevents iron uptake by microorganisms. We evaluated whether NGAL was present in vaginal fluid and whether concentrations were altered in women with bacterial vaginosis (BV) or vulvovaginal candidiasis (VVC). METHODS Vaginal secretions from 52 women with VVC, 43 with BV, and 77 healthy controls were assayed by enzyme-linked immunosorbent assay for NGAL and for concentrations of L-lactic acid. RESULTS The median concentration of NGAL in vaginal fluid was significantly higher in control women (561 pg/mL) than in women with BV (402 pg/mL; P = .0116) and lower in women with VVC (741 pg/mL; P = .0017). Median lactic acid levels were similar in controls (0.11 mmol/L) and women with VVC (0.13 mmol/L) and were lower in women with BV (0.02 mmol/L; P < .0001). The NGAL and lactic acid concentrations were highly correlated (P < .0001). CONCLUSION A decrease in Lactobacilli and/or lactic acid plus the absence of leukocytes results in lower vaginal NGAL levels that might facilitate the growth of bacteria associated with BV.
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Affiliation(s)
- Joziani Beghini
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA Department of Gynecology and Obstetrics, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Paulo C Giraldo
- Department of Gynecology and Obstetrics, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Iara M Linhares
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA Department of Gynecology and Obstetrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William J Ledger
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Steven S Witkin
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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Itenov TS, Bangert K, Christensen PH, Jensen JU, Bestle MH. Serum and plasma neutrophil gelatinase associated lipocalin (NGAL) levels are not equivalent in patients admitted to intensive care. J Clin Lab Anal 2014; 28:163-7. [PMID: 24395189 DOI: 10.1002/jcla.21662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/24/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Neutrophil gelatinase associated lipocalin (NGAL) is proposed as a biomarker of acute kidney injury (AKI). NGAL has been studied in a range of body fluids including serum and EDTA plasma. The aim of the present study was to establish relationship between serum NGAL concentrations and EDTA plasma NGAL concentrations in patients admitted to intensive care units (ICUs) and whether these determinations are directly comparable in this setting. METHODS NGAL was measured in 40 paired samples of serum and EDTA plasma from 25 patients admitted to intensive care with a commercial particle-enhanced turbidimetric immunoassay (The NGAL Test™, BioPorto Diagnostics A/S, Gentofte, Denmark) on a Roche Hitachi 917 (Roche-Hitachi, Inc., Tokyo, Japan) analyzer. RESULTS Serum NGAL concentrations ranged from 26.8 to 1,808 ng/ml (median 281 ng/ml, interquartile range (IQR) 453 ng/ml). EDTA plasma NGAL concentrations ranged from 25.7 to 1,752 ng/ml (median 225 ng/ml, IQR 352 ng/ml). The difference in NGAL concentrations in paired serum and EDTA plasma samples (serum- plasma) ranged from -13.8 to 321 ng/ml (median 79 ng/ml, IQR 116 ng/ml; difference from zero, P < 0.0001, Wilcoxon's signed rank test). Although serum and EDTA plasma values were correlated (Spearman's r = 0.95, P < 0.0001), Deming regression analysis showed a slope of 1.1 that was not significantly different from unity (95% confidence interval (CI) 1.0-1.1) and a highly significant intercept of 67.9 ng/ml with a wide confidence interval (95% CI 29.8-106). CONCLUSION NGAL concentration values measured in serum and EDTA plasma cannot be directly compared and should not be used as equivalents in studies of patients admitted to intensive care.
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Affiliation(s)
- Theis Skovsgaard Itenov
- Department of Anesthesiology, Nordsjaellands Hospital, Copenhagen University Hospital, Hillerød, Denmark
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van de Vrie M, Deegens JK, van der Vlag J, Hilbrands LB. Effect of long-term storage of urine samples on measurement of kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). Am J Kidney Dis 2013; 63:573-6. [PMID: 24268306 DOI: 10.1053/j.ajkd.2013.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/03/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Levels of urinary biomarkers, such as kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), can determine the risk of renal damage and predict the outcome of multiple kidney diseases, including transplant rejection. Studies of urinary biomarkers frequently use urine that has been stored frozen before analysis without taking into account the potential of biomarker degradation during storage. STUDY DESIGN Observational study. SETTING & PARTICIPANTS 39 kidney transplant patients visiting an outpatient clinic. PREDICTOR Urine storage conditions (4°C and -80°C with or without protease inhibitors) and centrifugation after thawing of samples. OUTCOMES Urinary concentrations of NGAL and KIM-1. MEASUREMENTS NGAL and KIM-1 were measured with commercially available enzyme-linked immunosorbent assay kits. RESULTS Urinary NGAL and KIM-1 concentrations were stable in urine up to 48 hours when stored at 4°C and up to 6 months when stored at -80°C, independent of the addition of protease inhibitors. A centrifugation step prior to biomarker measurement did not change urinary biomarker concentrations of urine stored at -80°C. LIMITATIONS Only KIM-1 and NGAL were measured, which possibly limits the relevance of the findings when making determinations about other urinary biomarkers. CONCLUSIONS This study recommends that urine samples collected for the assessment of KIM-1 or NGAL are immediately cooled to 4°C and subsequently frozen at -80°C within 2 days. At -80°C, both KIM-1 and NGAL concentrations are stable for at least 6 months.
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Affiliation(s)
- Mathijs van de Vrie
- Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Jeroen K Deegens
- Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Johan van der Vlag
- Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
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Rybakowski JK, Abramowicz M, Chłopocka-Wozniak M, Czekalski S. Novel markers of kidney injury in bipolar patients on long-term lithium treatment. Hum Psychopharmacol 2013; 28:615-8. [PMID: 24519695 DOI: 10.1002/hup.2362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/19/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We assessed kidney function in long-term lithium-treated bipolar patients compared with age-matched patients not taking lithium, including novel markers of kidney injury such as plasma neutrophil gelatinase-associated lipocalin (NGAL) and urinary beta-2 microglobulin (β2-MG) METHODS: The study comprised 120 patients with bipolar disorder of which 90 (30 males and 60 females) have been receiving lithium for 5-38 (mean 16) years, and 30 (10 males and 20 females) have never been exposed to lithium. RESULTS Lithium-treated patients, both men and women, showed significantly higher plasma NGAL and urinary β2-MG and lower urine specific gravity and estimated glomerular filtration rate (eGFR), compared with patients not taking lithium. In these patients, serum NGAL did not correlate with any clinical feature or other parameter of kidney function. Urinary β2-MG correlated with serum creatinine and eGFR in the whole group of lithium-treated patients and in addition, in males, with duration of illness, duration of lithium treatment, and urine specific gravity. CONCLUSIONS Lithium treatment causes an impairment of kidney function reflected also by abnormal levels of novel markers of kidney injury. Of these, urinary β2-MG, as a marker of tubular function seems to be better predictor than serum NGAL in lithium-treated patients because it shows multiple clinical and biochemical correlations, especially in men.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Silberstein JL, Sprenkle PC, Su D, Power NE, Tarin TV, Ezell P, Sjoberg DD, Feifer A, Fleisher M, Russo P, Touijer KA. Neutrophil gelatinase-associated lipocalin (NGAL) levels in response to unilateral renal ischaemia in a novel pilot two-kidney porcine model. BJU Int 2013; 112:517-25. [PMID: 23510358 DOI: 10.1111/bju.12066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To test a novel porcine two-kidney model for evaluating the effect of controlled acute kidney injury (AKI) related to induced unilateral ischaemia on both renal units (RUs) To use neutrophil gelatinase-associated lipocalin (NGAL) and physiological serum and urinary markers to assess AKI and renal function. METHODS Twelve female Yorkshire pigs had bilateral cutaneous ureterostomies placed laparoscopically with identical duration of pneumoperitoneum for all cases. An experimental group (n = 9) underwent induced unilateral renal ischaemia with left hilar clamping of timed duration (15, 30, 60 min) and a control group (n = 3) had no induced renal ischaemia. Urine was collected and analysed from each RU to assess creatinine and NGAL concentration preoperatively and at multiple postoperative time points. Serum was collected and analysed daily for creatinine and NGAL levels. Statistical comparisons were made using the rank-sum and sign-rank tests. RESULTS Three pigs were excluded because of intra-operative and postoperative complications. In the RUs that experienced renal ischaemia (n = 7),the median urine volume was lower (P = 0.04) at 6, 12, 24 and 48 h and the median NGAL concentration was higher (P = 0.04) at 12 and 48 h compared with the RUs of control pigs that experienced no renal ischaemia (n = 2). When comparing the ischaemic (left) RU of the pigs in the experimental group with their contralateral non-ischaemic (right) RU, ischaemic RUs had a lower median cumulative urine volume at 6, 12, 24 and 48 h (P = 0.05) and a higher median NGAL concentration at 12, 24 and 48 h (P < 0.05). At 48 h, no significant increase was found in serum NGAL in pigs in the experimental group compared with controls (P = 0.2). Creatinine clearance (CC) was lower in ischaemic RUs compared with non-ischaemic RUs 1 day after surgery (P = 0.04) with decreasing CC as the duration of ischaemia increased. CONCLUSIONS We have developed a promising novel small-scale pilot surgical model that allowed the evaluation of bilateral RU function separately during and after unilateral renal ischaemia. The induction of unilateral renal ischaemia corresponds with physiological changes in both the ischaemic and contralateral RU. AKI as measured by increases in NGAL and decreased renal function as measured by decreases in CC, are specific to the RU exposed to ischaemia.
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Affiliation(s)
- Jonathan L Silberstein
- Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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