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Gäckler A, Ertasoglu O, Rohn H, Friebus-Kardash J, Ickerott PC, Witzke O, Kribben A, Vogt B, Dahdal S, Arampatzis S, Eisenberger U. Urinary Biomarkers for Cell Cycle Arrest TIMP-2 and IGFBP7 for Prediction of Graft Function Recovery after Kidney Transplantation. Int J Mol Sci 2024; 25:4169. [PMID: 38673754 PMCID: PMC11050222 DOI: 10.3390/ijms25084169] [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: 02/17/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
TIMP-2 and IGFBP7 have been identified and validated for the early detection of renal injury in critically ill patients, but data on recovery of allograft function after kidney transplantation (KTx) are scarce. In a prospective observational multicenter cohort study of renal transplant recipients, urinary [TIMP-2] × [IGFBP7] was evaluated daily from day 1 to 7 after KTx. Different stages of early graft function were defined: immediate graft function (IGF) (decrease ≥ 10% in serum creatinine (s-crea) within 24 h post KTx); slow graft function (SGF) (decrease in s-crea < 10% within 24 h post KTx); and delayed graft function (DGF) (any dialysis needed within the first week after KTx). A total of 186 patients were analyzed. [TIMP-2] × [IGFBP7] was significantly elevated as early as day 1 in patients with DGF compared to SGF and IGF. ROC analysis of [TIMP-2] × [IGFBP7] at day 1 post-transplant for event "Non-DGF" revealed a cut-off value of 0.9 (ng/mL)2/1000 with a sensitivity of 87% and a specificity of 71%. The positive predictive value for non-DGF was 93%. [TIMP-2] × [IGFBP7] measured at day 1 after KTx can predict early recovery of transplant function and is therefore a valuable biomarker for clinical decision making.
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Affiliation(s)
- Anja Gäckler
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Onurcan Ertasoglu
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Hana Rohn
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.R.); (O.W.)
| | - Justa Friebus-Kardash
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Philipp-Christopher Ickerott
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.R.); (O.W.)
| | - Andreas Kribben
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Suzan Dahdal
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Spyridon Arampatzis
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Ute Eisenberger
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
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Lai C, Yee SY, Ying T, Chadban S. Biomarkers as diagnostic tests for delayed graft function in kidney transplantation. Transpl Int 2021; 34:2431-2441. [PMID: 34626503 DOI: 10.1111/tri.14132] [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: 03/10/2021] [Revised: 08/29/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Delayed graft function (DGF) after kidney transplantation is associated with inferior outcomes and higher healthcare costs. DGF is currently defined as the requirement for dialysis within seven days post-transplant; however, this definition is subjective and nonspecific. Novel biomarkers have potential to improve objectivity and enable earlier diagnosis of DGF. We reviewed the literature to describe the range of novel biomarkers previously studied to predict DGF. We identified marked heterogeneity and low reporting quality of published studies. Among the novel biomarkers, serum NGAL had the greatest potential as a biomarker to predict DGF, but requires further assessment and validation through larger scale studies of diagnostic test performance. Given inadequacies in the dialysis-based definition, coupled with the high incidence and impact of DGF, such studies should be pursued.
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Affiliation(s)
- Christina Lai
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Seow Yeing Yee
- Nephrology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Tracey Ying
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Steve Chadban
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Nalesso F, Cattarin L, Gobbi L, Fragasso A, Garzotto F, Calò LA. Evaluating Nephrocheck ® as a Predictive Tool for Acute Kidney Injury. Int J Nephrol Renovasc Dis 2020; 13:85-96. [PMID: 32425580 PMCID: PMC7189184 DOI: 10.2147/ijnrd.s198222] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/01/2020] [Indexed: 12/31/2022] Open
Abstract
Acute kidney injury (AKI) is a common complication in critically ill patients in the intensive settings with increased risks of short- and long-term complications and mortality. AKI is also associated with an increased length of stay in intensive care units (ICU) and worse kidney function recovery at hospital discharge. The management of AKI is one of the major challenges for nephrologists and intensivists overall for its early diagnosis. The current KDIGO criteria used to define AKI include the serum creatinine and urinary output that are neither sensitive nor specific markers of kidney function, since they can be altered only after hours from the kidney injury. In order to allow an early AKI detection, in the last years, several studies focused on the identification of new biomarkers. Among all these markers, urinary insulin-like growth factor-binding protein (IGFBP-7) and tissue inhibitor of metalloproteinase (TIMP-2) have been proven as the best-performing and have been proposed as a predictive tool for the AKI detection in the critical settings in order to perform an early diagnosis. Patients undergoing major surgery, cardiac surgery, those with hemodynamic instability or those with sepsis are believed to be the top priority patient populations for the biomarker test. In this view, the urinary [TIMP-2] x [IGFBP-7] becomes an important tool for the early detection of patients at high risk for AKI and its integration with the local ICU experience has to provide a multidisciplinary management of AKI with the institution of a rapid response team in order to assess patients and customize AKI management.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Leda Cattarin
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Laura Gobbi
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Antonio Fragasso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Francesco Garzotto
- Healthcare Directorate Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Lorenzo Arcangelo Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
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