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Zhuang Y, Ouyang Y, Ding L, Xu M, Shi F, Shan D, Cao D, Cao X. Source Tracing of Kidney Injury via the Multispectral Fingerprint Identified by Machine Learning-Driven Surface-Enhanced Raman Spectroscopic Analysis. ACS Sens 2024; 9:2622-2633. [PMID: 38700898 DOI: 10.1021/acssensors.4c00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Early diagnosis of drug-induced kidney injury (DIKI) is essential for clinical treatment and intervention. However, developing a reliable method to trace kidney injury origins through retrospective studies remains a challenge. In this study, we designed ordered fried-bun-shaped Au nanocone arrays (FBS NCAs) to create microarray chips as a surface-enhanced Raman scattering (SERS) analysis platform. Subsequently, the principal component analysis (PCA)-two-layer nearest neighbor (TLNN) model was constructed to identify and analyze the SERS spectra of exosomes from renal injury induced by cisplatin and gentamycin. The established PCA-TLNN model successfully differentiated the SERS spectra of exosomes from renal injury at different stages and causes, capturing the most significant spectral features for distinguishing these variations. For the SERS spectra of exosomes from renal injury at different induction times, the accuracy of PCA-TLNN reached 97.8% (cisplatin) and 93.3% (gentamicin). For the SERS spectra of exosomes from renal injury caused by different agents, the accuracy of PCA-TLNN reached 100% (7 days) and 96.7% (14 days). This study demonstrates that the combination of label-free exosome SERS and machine learning could serve as an innovative strategy for medical diagnosis and therapeutic intervention.
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Affiliation(s)
- Yanwen Zhuang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, P. R. China
| | - Yu Ouyang
- Department of Clinical Laboratory, The Affiliated Taizhou Second People's Hospital of Yangzhou University, Taizhou 225300, P. R. China
| | - Li Ding
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, P. R. China
| | - Miaowen Xu
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, P. R. China
| | - Fanfeng Shi
- Yangzhou Polytechnic Institute, Yangzhou 225002, P. R. China
| | - Dan Shan
- School of Information Engineering/Carbon Based Low Dimensional Semiconductor Materials and Device Engineering Research Center of Jiangsu Province, Yangzhou Polytechnic Institute, Yangzhou 225127, P. R. China
| | - Dawei Cao
- Yangzhou Polytechnic Institute, Yangzhou 225002, P. R. China
- School of Information Engineering/Carbon Based Low Dimensional Semiconductor Materials and Device Engineering Research Center of Jiangsu Province, Yangzhou Polytechnic Institute, Yangzhou 225127, P. R. China
| | - Xiaowei Cao
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, P. R. China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Medical College, Yangzhou University, Yangzhou 225001, P. R. China
- Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Medical College, Yangzhou University, Yangzhou 225001, P. R. China
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Zhou L, Yang Y, Fu X, Xia B, Li C, Lu C, Qi Y, Zhang H, Liu T. The protective effect and molecular mechanism of glycyrrhizic acid glycosides against Tripterygium glycosides induced nephrotoxicity based on the RhoA/ROCK1 signalling pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117100. [PMID: 37648177 DOI: 10.1016/j.jep.2023.117100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/27/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tripterygium glycosides (TG), which are extracted from the traditional Chinese medicine, Tripterygium wilfordii Hook F. (TwHF), has promising applications in the treatment of renal diseases; however, since its active components exerts bidirectional kidney toxicity, its clinical application is severely restricted. AIM OF THE STUDY Recent investigations have demonstrated definite toxicity-reducing effects from glycyrrhizic acid glycosides (GA) when combined with TG; however, the mechanism remains unclear. To our knowledge, this is the first study to investigate the specific molecular mechanism by which GA alleviates TG-induced renal toxicity from the perspective of tight junctions. MATERIALS AND METHODS Dynamic analyses, which investigated the changes in kidney toxicity biomarkers for different combinations and concentrations of TG and GA, were conducted for three weeks on SD rats and renal tissue structural changes were examined after three weeks of administration. Additionally, the transcription and translation levels of the relevant tight junctions and RhoA/ROCK1/MLC signalling proteins were analysed in HK-2 cells. RESULTS Our study showed that TG can cause transient tubulotoxicity at certain doses, and that the combined application of GA and TG can repair tight junction structures by regulating the key factors in the RhoA/ROCK1/MLC signalling pathway, thus reducing TG-induced nephrotoxicity. CONCLUSIONS Overall, this study provides a new strategy to reduce TG-induced toxicity by protecting renal tight junctions.
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Affiliation(s)
- Liu Zhou
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Yifei Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Xiaotong Fu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Bing Xia
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Chun Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Chenna Lu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Ying Qi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Haijing Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
| | - Ting Liu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing, 100700, China.
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Paiva AAM, Magro MCDS, Magro PPM, Duarte TTDP. Impact of renal recovery on in-hospital and post-discharge mortality. Rev Esc Enferm USP 2023; 57:e20230144. [PMID: 38047745 PMCID: PMC10695170 DOI: 10.1590/1980-220x-reeusp-2023-0144en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE To verify the impact of renal recovery on mortality in non-critically ill patients with acute kidney injury. METHOD A prospective cohort study was carried out in a public hospital in the Federal District with patients with acute kidney injury admitted to a non-critical care unit. Renal recovery was assessed based on the ratio of serum creatinine to baseline creatinine and the patient was followed up for 6 months. Mortality was assessed during hospitalization and after discharge. RESULTS Of the 90 patients with hospital-acquired kidney injury, renal recovery was identified in 34.1% to 75% of cases, depending on the time of assessment, considering a follow-up period of up to 6 months. Recovery of renal function during follow-up had an impact on in-hospital mortality [95% CI 0.15 (0.003 - 0.73; p = 0019). CONCLUSION Recovery of renal function has been shown to be a protective factor for mortality in patients admitted to the non-critical care unit. Early identification of kidney damage and monitoring of physiological and laboratory variables proved to be fundamental in identifying the severity of the disease and reducing mortality.
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Karimzadeh I, Barreto EF, Kellum JA, Awdishu L, Murray PT, Ostermann M, Bihorac A, Mehta RL, Goldstein SL, Kashani KB, Kane-Gill SL. Moving toward a contemporary classification of drug-induced kidney disease. Crit Care 2023; 27:435. [PMID: 37946280 PMCID: PMC10633929 DOI: 10.1186/s13054-023-04720-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
Drug-induced kidney disease (DIKD) accounts for about one-fourth of all cases of acute kidney injury (AKI) in hospitalized patients, especially in critically ill setting. There is no standard definition or classification system of DIKD. To address this, a phenotype definition of DIKD using expert consensus was introduced in 2015. Recently, a novel framework for DIKD classification was proposed that incorporated functional change and tissue damage biomarkers. Medications were stratified into four categories, including "dysfunction without damage," "damage without dysfunction," "both dysfunction and damage," and "neither dysfunction nor damage" using this novel framework along with predominant mechanism(s) of nephrotoxicity for drugs and drug classes. Here, we briefly describe mechanisms and provide examples of drugs/drug classes related to the categories in the proposed framework. In addition, the possible movement of a patient's kidney disease between certain categories in specific conditions is considered. Finally, opportunities and barriers to adoption of this framework for DIKD classification in real clinical practice are discussed. This new classification system allows congruencies for DIKD with the proposed categorization of AKI, offering clarity as well as consistency for clinicians and researchers.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Awdishu
- Division of Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA, USA
| | | | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Pharmacy, UPMC, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, Department of Biomedical Informatics, School of Medicine and the Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Zhou Z, Zhang D, Wang Y, Liu C, Wang L, Yuan Y, Xu X, Jiang Y. Urinary exosomes: a promising biomarker of drug-induced nephrotoxicity. Front Med (Lausanne) 2023; 10:1251839. [PMID: 37809338 PMCID: PMC10556478 DOI: 10.3389/fmed.2023.1251839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Drug-induced nephrotoxicity (DIN) is a big concern for clinical medication, but the clinical use of certain nephrotoxic drugs is still inevitable. Current testing methods make it hard to detect early renal injury accurately. In addition to understanding the pathogenesis and risk factors of drug-induced nephrotoxicity, it is crucial to identify specific renal injury biomarkers for early detection of DIN. Urine is an ideal sample source for biomarkers related to kidney disease, and urinary exosomes have great potential as biomarkers for predicting DIN, which has attracted the attention of many scholars. In the present paper, we will first introduce the mechanism of DIN and the biogenesis of urinary exosomes. Finally, we will discuss the changes in urinary exosomes in DIN and compare them with other predictive indicators to enrich and boost the development of biomarkers of DIN.
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Affiliation(s)
- Zunzhen Zhou
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Dailiang Zhang
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yongjing Wang
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Chongzhi Liu
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Limei Wang
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yi Yuan
- Orthopedic Department, Dazhou Integrated TCM and Western Medicine Hospital, Dazhou Second People’s Hospital, Dazhou, China
| | - Xiaodan Xu
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yuan Jiang
- Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Azırak S, Özgöçmen M. Linalool prevents kidney damage by inhibiting rifampicin-induced oxidative stress and apoptosis. Tissue Cell 2023; 82:102097. [PMID: 37104973 DOI: 10.1016/j.tice.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
Today, kidney diseases are increasing day by day and life quality is decreasing. In hospitalized patients of all ages, acute kidney injury (AKI) is commonly observed and associated with high rates of morbidity and mortality. Rifampicin (RF) or rifampin is an antibiotic drug from the rifamycin group with a bactericidal effect. RF causes acute kidney injury, often anemia, thrombocytopenia, liver damage and side effect such as cell death. RF causes tissue damage by means of oxidative stress and apoptosis. Thus, in this study, it was examined whether linalool (LN) which had antinociceptive, antimicrobial, antioxidant and anti-inflammatory effects, was beneficial for kidney damage in order to eliminate the side effects of RF. NGAL mRNA, creatinine (Cr), blood urea nitrogen (BUN), Caspase 9 (CAS-9) and nuclear factor-κB (NF-κB) levels increased in the group treated with RF compared to the control group, while the levels of albumin, uric acid and total protein were decreased in the RF-treated group. NGAL mRNA, BUN, Cr, CAS-9 and NF-κB levels decreased significantly in RF+LN administered rats, while it was observed that there was an increase in the levels of albumin, uric acid and total protein. From the results obtained, it was observed that LN was determined to be very effective in preventing tissue damage in kidneys caused by oxidative stress by RF.
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Affiliation(s)
- Sebile Azırak
- Vocational School of Health Services, University of Adıyaman, Adıyaman, Turkey.
| | - Meltem Özgöçmen
- Suleyman Demirel University, Faculty of Medicine, Department of Histology and Embryology, Isparta, Turkey
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Behal ML, Flannery AH, Barreto EF. Medication Management in the Critically Ill Patient with Acute Kidney Injury. Clin J Am Soc Nephrol 2023; 18:01277230-202308000-00016. [PMID: 36723347 PMCID: PMC10564345 DOI: 10.2215/cjn.0000000000000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
ABSTRACT AKI occurs frequently in critically ill patients. Patients with AKI, including those who require KRT, experience multiple pharmacokinetic and pharmacodynamic perturbations that dynamically influence medication effectiveness and safety. Patients with AKI may experience both subtherapeutic drug concentrations, which lead to ineffective therapy, and supratherapeutic drug concentrations, which increase the risk for toxicity. In critically ill patients with AKI not requiring KRT, conventional GFR estimation equations, especially those based on serum creatinine, have several limitations that can limit the accuracy when used for medication dosing. Alternative methods to estimate kidney function may be informative, including use of measured urinary creatinine clearance, kinetic eGFR, and equations that integrate novel kidney biomarkers. For critically ill patients with AKI requiring KRT, physicochemical properties of the drug, the KRT prescription and circuit configuration, and patient-specific factors each contribute to medication clearance. Evidence-based guidance for medication dosing during AKI requiring KRT is often limited. A working knowledge of the basic tenets of drug elimination during KRT can provide a framework for how to approach decision making when the literature is lacking. Iterative re-evaluation of a patient's progress toward therapeutic goals with a medication must occur over the arc of critical illness, including and especially in the setting of dynamic kidney function.
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Affiliation(s)
- Michael L. Behal
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky
| | - Alexander H. Flannery
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky
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