Tumour markers and kidney function: a systematic review. Biomed Res Int. 2014;2014:647541. [PMID: 24689048 PMCID: PMC3933284 DOI: 10.1155/2014/647541]

Predictive Value of Serum β2-Microglobulin for 28-Day Mortality in Sepsis Patients in the Emergency Department

Background

Sepsis is an infection-induced systemic inflammatory response syndrome with high morbidity and mortality. β2-microglobulin (β2-MG), a low-molecular-weight protein involved in immune processes, shows potential for predicting the prognosis of various diseases. However, its role in sepsis prognosis remains unclear, necessitating further exploration.

Objective

This study aimed to evaluate the predictive value of serum β2-MG for 28-day mortality in sepsis patients and compare it with traditional indicators such as sequential organ failure assessment (SOFA) scores and lactate (Lac) levels.

Methods

A total of 346 sepsis patients were included in this single-center retrospective study conducted at the emergency department of Beijing Chao-Yang Hospital. Clinical and biochemical indicators, including β2-MG, SOFA scores, and Lac levels, were collected. Predictive ability was assessed using receiver operating characteristic (ROC) curve analysis and binary logistic regression models, and β2-MG was compared to SOFA scores and Lac levels.

Results

β2-MG was significantly correlated with 28-day mortality and identified as an independent risk factor (P<0.001, OR=1.142, 95% CI: 1.083-1.204). The sensitivity of β2-MG was 94%, and its specificity was 77% for predicting 28-day mortality. Combining β2-MG with SOFA scores increased sensitivity to 94%, while combining it with Lac improved specificity to 88.9%. ROC analysis showed that β2-MG's predictive accuracy improved significantly when combined with these indicators.

Conclusion

The serum level of β2-MG is an independent predictor of 28-day mortality in sepsis patients. While less sensitive and specific than SOFA scores and lactate, combining β2-MG with these markers improves predictive accuracy, offering complementary prognostic value.

Predictive Factors of Non-Elevation of Carcinoembryonic Antigen 125 in Acute Heart Failure

This study aims to analyze the factors associated with the lack of carbohydrate antigen 125 (CA-125) elevation in cases of acute heart failure (HF) decompensation. This retrospective study was conducted on 3167 consecutive patients admitted for acute HF in the cardiology department of a referral hospital (June 2019 to June 2024). Admissions from outpatient clinics (n: 1018) and transfers from other hospitals (n: 752) were excluded. The variables of interest included clinical, echocardiographic, therapeutic, and analytical factors. Low CA-125 levels were defined as values ≤ 50 U/mL. A total of 1397 patients were included, of whom 515 had normal CA-125 levels and 882 had elevated levels. Clinically, independent predictors of low CA-125 were sinus rhythm on electrocardiogram (OR: 1.42, 95% CI: 1.12-1.64; p: 0.003) and sleep apnea-hyponpnea syndrome (OR: 1.76, 95% CI: 1.15-2.70; p: 0.009). Echocardiographically, inferior vena cava collapse greater than 50% with inspiration was associated with low CA-125 (OR: 1.78, 95% CI: 1.19-2.69; p = 0.005), as well as with non-severe right ventricular dysfunction. (OR: 2.42; IC95%: 1.39-4.20; p: 0.002). Analytically, elevated NT-proBNP levels were associated with elevated CA-125 levels (OR: 0.99; IC95%: 0.99-0.99; p: 0.006). Survival was higher in the group with CA-125 ≤ 50 U/mL (p: 0.019). Conversely, as CA-125 values increased, mortality also rose. In conclusion, the absence of CA-125 elevation in patients admitted for acute HF is associated with sinus rhythm, sleep apnea-hyponpnea syndrome, low NT-proBNP levels, and inferior vena cava collapse greater than 50% with inspiration.

Innovative laboratory techniques shaping cancer diagnosis and treatment in developing countries

Cancer is a major global health challenge, with approximately 19.3 million new cases and 10 million deaths estimated by 2020. Laboratory advancements in cancer detection have transformed diagnostic capabilities, particularly through the use of biomarkers that play crucial roles in risk assessment, therapy selection, and disease monitoring. Tumor histology, single-cell technology, flow cytometry, molecular imaging, liquid biopsy, immunoassays, and molecular diagnostics have emerged as pivotal tools for cancer detection. The integration of artificial intelligence, particularly deep learning and convolutional neural networks, has enhanced the diagnostic accuracy and data analysis capabilities. However, developing countries face significant challenges including financial constraints, inadequate healthcare infrastructure, and limited access to advanced diagnostic technologies. The impact of COVID-19 has further complicated cancer management in resource-limited settings. Future research should focus on precision medicine and early cancer diagnosis through sophisticated laboratory techniques to improve prognosis and health outcomes. This review examines the evolving landscape of cancer detection, focusing on laboratory research breakthroughs and limitations in developing countries, while providing recommendations for advancing tumor diagnostics in resource-constrained environments.

Factors influencing blood tumor marker concentrations in the absence of neoplasia

BACKGROUND

Tumor markers (TMs) are a heterogeneous group of molecules used in the diagnosis, prognosis and follow-up of cancer patients. During neoplastic differentiation, cells can either directly synthesize or induce the synthesis of TMs, and the release of these molecules into the bloodstream allows their quantification in biological fluids. Although very small concentrations of TMs are usually present in the serum or plasma of healthy subjects, increased concentrations may also be found in the presence of benign diseases or due to technical interference, producing false positive results.

MATERIAL AND METHODS AND RESULTS

Our review analyses the causes of false positives described between January 1970 to February 2023 for the TMs most frequently used in clinical practice: α-fetoprotein (AFP), β2-microglobulin (β2-M), cancer antigen 15-3 (CA 15-3), cancer antigen CA 19-9 (CA 19-9), cancer antigen CA 72-4 (CA 72-4), cancer antigen 125 (CA 125), carcinoembryonic antigen (CEA), chromogranin A (CgA), choriogonadotropin (hCG), cytokeratin 19 fragment (CYFRA 21-1), neuron-specific enolase (NSE), human epididymis protein 4 (HE4), serum HER2 (sHER2), squamous cell carcinoma antigen (SCCA), protein induced by vitamin K absence-II (PIVKA-II), Pro-gastrin-releasing peptide (Pro-GRP), prostate-specific antigen (PSA), Protein S-100 (S-100) and thyroglobulin (Tg). A total of 247 references were included.

CONCLUSIONS

A better understanding of pathophysiological processes and other conditions that affect the concentration of TMs might improve the interpretation of results and their clinical application.

Relationships between squamous cell carcinoma antigen and cytokeratin 19 fragment values and renal function in oral cancer patients

Squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragment (CYFRA) are used to screen and monitor oral cancer patients. However, recent studies have reported that tumour markers become elevated as renal function decreases, regardless of tumour progression. A retrospective study was performed of 423 oral cancer patients who underwent blood testing for these tumour markers and other blood analytes during a 10-year period. The values of SCC-Ag and CYFRA increased significantly with decreasing renal function (P < 0.01), and the values were abnormal at a median 2.6 ng/ml for SCC-Ag and 4.7 ng/ml for CYFRA in the group with estimated glomerular filtration rate (eGFR) values of< 30 ml/min/1.73 m². The factors that were related to the variation in tumour markers were albumin and creatinine. The cut-off values of eGFR were 59.7 ml/min/1.73 m² for SCC-Ag and 63.6 ml/min/1.73 m² for CYFRA, and the cut-off age when the tumour markers might rise due to the effect of renal function were 72 years for SCC-Ag and 73 years for CYFRA. In conclusion, decreased renal function should be taken into account when evaluating tumour markers in oral cancer. In addition, tumour markers are likely to be overestimated in patients over the age of 72-73 years.

CA125: a novel cardiac biomarker for infants with congenital diaphragmatic hernia

BACKGROUND

The carbohydrate antigen 125 (CA125) was proven as a robust biomarker for risk stratification in adults with heart failure. This is the first study analyzing CA125 in a cohort of infants with congenital diaphragmatic hernia (CDH).

METHODS

Sixty-eight infants with CDH, treated at the University Children's Hospital Bonn (Germany), between January 2018 and February 2021, were prospectively enrolled for analysis. CA125 values were measured at the following timepoints: 6,12, 24, 48 h, and during ECMO daily from day 1 to day 7.

RESULTS

In infants not surviving to discharge, CA125 values were significantly higher at day 1 (6, 12, and 24 h). Infants with subsequent need for ECMO presented significantly higher CA125 values at 12 h of life. During ECMO, CA125 values measured at day 1 were significantly higher in infants not surviving to discharge. In the ROC analysis, a CA125 value of ≥10 U/ml was calculated as optimal cut-off for the prediction of ECMO and in-hospital mortality. CA125 values correlated significantly with the severity of PH and ventricular dysfunction.

CONCLUSIONS

CA125 values correlate significantly with echocardiographic markers of PH and ventricular dysfunction and correlate significantly with parameters of disease severity (need for ECMO, mortality).

IMPACT

CA125 was proven as robust cardiac biomarker in adult cohorts. Information about the utility as a biomarker in neonatal cohorts is lacking. This is the first study analyzing CA125 as a cardiac biomarker in a cohort of infants with congenital diaphragmatic hernia (CDH). CA125 correlates significantly with markers of echocardiographic assessment (PH and ventricular dysfunction) in infants with CDH and helps to identify infants at high risk for ECMO and in-hospital mortality. The results underline the need for the inclusion of cardiac biomarkers in the clinical routine in neonates at risk for cardiopulmonary failure.

Changes in lung cancer-related serum tumor markers in patients with chronic kidney disease and determination of upper reference limit

Aims

To investigate the changes in lung cancer-related serum tumor markers in patients with chronic kidney disease (CKD) and determine the upper reference limit for patients with different stages.

Methods

Included inpatients diagnosed with CKD who did not receive dialysis temporarily in our hospital from March to September 2020. Changes in serum CA125, HE4, CYFRA21-1, SCCA, NSE and ProGRP in CKD patients were analyzed. The non-parametric method was used to estimate the upper reference limit of the above indicators in patients with CKD stages 2-5.

Results

The serum levels of HE4, CYFRA21-1, SCCA, and ProGRP in the CKD group were significantly higher than those in the healthy control group; CA125 and NSE levels were not statistically different. The false positives of SCC, CYFRA21-1, ProGRP, and HE4 increased significantly with the CKD stage. Still, NSE and CA125 did not show a significant increasing trend. Both HE4 and ProGRP have independent upper reference limits from CKD2 to CKD5 stage, namely 220.8 pmol/l and 101.4 pg/ml in the CKD2 stage, 496.7 pmol/l and 168.63 pg/ml in CKD3 stage, 4592.4 pmol/l and 272.8 pmol/l for CKD4 stage, CKD5 stage was 4778.2 pmol/l and 491.6 pmol/l.

Conclusion

This study preliminarily determined the upper reference limits of Lung cancer-related tumor markers in patients with different CKD stages and provided laboratory support for the rational use and interpretation of Lung cancer-related tumor markers in special populations.

Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure

BACKGROUND

This study aimed to evaluate whether glomerular filtration rate (eGFR) during admission modifies the predictive value of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) in patients hospitalized for acute heart failure (AHF).

METHODS

We retrospectively evaluated 4595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 2008 through October 2019. To investigate the effect of kidney function on the association of NT-proBNP and CA125 with 1-year mortality (all-cause and cardiovascular mortality), we stratified patients according to four eGFR categories: <30 mL•min^-1•1.73 m^-2, 30-44 mL•min^-1•1.73 m^-2, 44-59 mL•min^-1•1.73 m^-2, and ≥60 mL•min^-1•1.73 m^-2. Biomarkers were assessed within the first 24 hours following admission.

RESULTS

At 1-year follow-up, 748 of 4595 (16.3%) patients died after discharge (of all deaths, 575 [12.5%] were cardiovascular). After multivariate adjustment, both NT-proBNP and CA125 remained independently associated with a higher risk of death when modeled as main effects (P<0.001). However, we found a differential prognostic effect of NT-proBNP across eGFR categories for both endpoints (all-cause mortality, P-value for interaction=0.002; CV mortality, P-value for interaction=0.001). Whereas NT-proBNP was positively and linearly associated with mortality in the subset of patients with normal or mildly reduced eGFR, its predictive ability progressively decreased at the lower extreme of eGFR (<45 mL•min^-1•1.73 m^-2). In contrast, the association between CA125 and survival remained consistent across all eGFR categories (all-cause mortality, P-value for interaction=0.559; CV mortality, P-value for interaction=0.855).

CONCLUSIONS

In patients with AHF and severely reduced eGFR, CA125 outperforms NT-proBNP in predicting 1-year mortality.

Retarding Progression of Chronic Kidney Disease in Autosomal Dominant Polycystic Kidney Disease with Metformin and Other Therapies: An Update of New Insights

Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent single-gene disorder leading to renal failure. Current therapies are aimed to treat renal and extrarenal complications of ADPKD, but improved knowledge of the pathophysiological mechanisms leading to the generation and growth of cysts has permitted the identification of new drug candidates for clinical trials. Among these, in this review, we will examine above all the role of metformin, hypothesized to be able to activate the AMP-activated protein kinase (AMPK) pathway and potentially modulate some mechanisms implicated in the onset and the growth of the cysts.

Cancer Screening in End-Stage Kidney Disease

The incidence of cancer is higher in patients with end-stage kidney disease (ESKD) than among the general population. Despite this, screening for cancer is generally not cost-effective and may worsen quality of life in these patients. This is due to high mortality rates (patients are not living long enough to reap the benefits of screening), the inaccuracy of cancer screening tests, and the increased risks associated with therapy in patients with ESKD. Specific groups of patients with ESKD who have a longer-than-expected life expectancy or higher-than-expected cancer risk may benefit from screening. These groups include patients on peritoneal dialysis, patients on home hemodialysis, Black and Asian-American patients, transplant-eligible patients, and those at higher risk of cancer including patients with acquired cystic kidney disease, those who have been previously exposed to cytotoxic agents or aristolochic acid, and patients with a genetic predisposition to cancer. In this narrative review, we will examine the prevalence of and risk factors for cancer in patients with ESKD and the effectiveness of cancer screening, and discuss specific situations in which cancer screening may be effective.

Low Albumin, Low Bilirubin, and High Alfa-Fetoprotein Are Associated with a Rapid Renal Function Decline in a Large Population Follow-Up Study

A rapid decline in renal function is associated with high cardiovascular morbidity and mortality, and therefore it is important to identify those at high-risk of rapid renal function decline. The relationship between liver function and renal function is unclear. Therefore, in this longitudinal study, we aimed to investigate associations between liver function and rapid renal function decline. A total of 27,116 participants were enrolled from the Taiwan Biobank and followed for 3.8 years. A rapid decline in renal function was defined as a decline in estimated glomerular filtration rate (eGFR) of ≥25%. Binary logistic regression analysis was used to identify associations between liver function parameters (glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase, albumin, α-fetoprotein [AFP], total bilirubin, and gamma-glutamyl transpeptidase) and eGFR decline ≥ 25%. The rate of eGFR decline of ≥25% was 4.7%. Multivariable analysis showed that low albumin (odds ratio [OR], 0.173; p < 0.001), high AFP (OR, 1.006; p = 0.010), and low total bilirubin (OR, 0.588; p < 0.001) were significantly associated with eGFR decline ≥ 25% in all study participants. After excluding abnormal liver function, low albumin (OR, 0.189; p < 0.001), high AFP (OR, 1.007; p = 0.011), and low total bilirubin (OR, 0.569; p = 0.001) were still significantly associated with an eGFR decline of ≥25%. The results of this large population-based cohort study showed associations between low albumin, low bilirubin, and high AFP with a rapid renal function decline. A greater understanding of potential risk factors for a rapid decline in renal function may help to reduce the burden of renal failure in this high-risk population.

Autosomic dominant polycystic kidney disease and metformin: Old knowledge and new insights on retarding progression of chronic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common congenital kidney disorder, generally caused by mutations in the PKD1 and PKD2 genes, coding for polycystins 1 and 2. Its pathogenesis is accompanied by alterations of the cAMP, mTOR, MAPK/ERK, and JAK/STAT pathways. ADPKD is clinically characterized by the formation of many growing cysts with kidney enlargement and a progressive damage to the parenchyma, up to its complete loss of function, and the onset of end-stage renal disease (ESRD). The current aim of ADPKD therapy is the inhibition of cyst development and retardation of chronic kidney disease progression. Several drugs have been recently included as potential therapies for ADPKD including metformin, the drug of choice for the treatment of type 2 diabetes mellitus, according to its potential inhibitory effects on cystogenesis. In this review, we summarize preclinical and clinical evidence endorsing or rejecting metformin administration in ADPKD evolution and pathological mechanisms. We explored the biology of APDKD and the role of metformin in slowing down cystogenesis searching PubMed and Clinical Trials to identify relevant data from the database inception to December 2020. From our research analysis, evidence for metformin as emerging cure for ADPKD mainly arise from preclinical studies. In fact, clinical studies are still scanty and stronger evidence is awaited. Its effects are likely mediated by inhibition of the ERK pathway and increase of AMPK levels, which are both linked to ADPKD pathogenesis.

The Clinical Significance of DJ1 and L1CAM Serum Level Monitoring in Patients with Endometrial Cancer

Circulating tumor markers are not routinely used in patients with endometrial cancer (EC). This pilot study evaluated the role of monitoring new biomarkers DJ1 and L1CAM, in correlation with CA125 and HE4, for the effects of anticancer treatment and preoperative management in EC patients. Serial serum levels of DJ1, L1CAM, CA125 and HE4 were collected in 65 enrolled patients. Serum DJ1, L1CAM, CA125 and HE4 levels were significantly higher at the time of diagnosis compared to those measured during follow-up (FU). In patients with recurrent disease, serum DJ1, CA125 and HE4 levels were significantly higher at the time of recurrence compared to levels in disease-free patients. Serum L1CAM levels were also higher in patients with recurrence but without reaching statistical significance. While DJ1 levels were not affected by any of the observed patient-related characteristics, L1CAM levels were significantly higher in patients with age ≥60 years who were overweight. At the time of EC diagnosis, DJ1 and L1CAM serum levels did not correlate with stage, histological type or risk of recurrence. This is a preliminary description of the potential of serial DJ1 and L1CAM serum level measurement for monitoring the effects of treatment in EC patients.

Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease

Despite hypertension ranks among the leading causes of chronic kidney disease (CKD), the impact of chronic hypertensive nephropathy, the so-called 'nephrosclerosis' (NS), on CKD progression is often unpredictable, particularly in elderly population. We have conducted a prospective, observational study to define renal function patterns and outcomes in elderly CKD individuals with or without NS. Three hundred four individuals with an already established CKD were categorized according to the etiology of CKD. NS was defined as the presence of CKD associated with long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy and minimal proteinuria. Time trajectories in estimated glomerular filtration rate (eGFR) (CKD-Epi) were computed over a 4-year follow-up. In addition, we analyzed the occurrence of a composite outcome of doubling of serum creatinine levels, eGFR reduction ≥25% and/or the need of chronic renal replacement therapy. CKD was secondary to nephrosclerosis (CKD-NS) in 220 (72.3%). In the whole cohort, the average estimated annual GFR slope was 1.8 mL/min/1.73 m² eGFR decline was slower in CKD-NS as compared with others (1.4 vs 3.4 mL/min/1.73 m²; p<0.001). The composite renal outcome during follow-up occurred less frequently among elderly with CKD-NS (16/204 vs 14/70; p=0.01, crude HR 0.43, 95% CI 0.22 to 0.85) and was associated at logistic analyses with the etiology of CKD, background cardiovascular disease, total and low density lipoproteins (LDL) cholesterol, and glycemia levels (p value was ranging from 0.01 to 0.05). Despite being highly prevalent in the elderly, NS is associated with a more favorable renal disease course as compared with other conditions.

Urine phthalate metabolites are associated with urothelial cancer in chronic kidney disease patients

BACKGROUND

Di(2-ethylhexyl) phthalate (DEHP) is one of the most widely used phthalates and is associated with breast cancer. Ths association between DEHP and other types of cancer is not clear. DEHP may increase matrix metalloproteinase-9 that is critical for the development of urothelial cancer (UC). We examined the association between urinary phthalate metabolites and UC. CKD patients were selected as a control group because CKD patients are more at risk of UC than the general population.

METHODS

In this cross-sectional study, we measured seven urinary phthalate metabolites that are abundant and can be measured using HPLC-MS/MS in Taiwan CKD patients between Jul 2013 and Dec 2015. MiBP (a urinary metabolite of Dibutyl phthalates[DBP]) and MEHHP (a urinary metabolite of DEHP) were described because they are the most abundant phthalate metabolites. The association of phthalate (log-transformed) and UC were analyzed using logistic regression with adjustments for age, gender, renal function, use of traditional Chinese medicine, toxins (dye, organic solvent), and non-steroidal anti-inflammatory drugs.

RESULTS

We measured the urinary MEHHP and MiBP of 496 patients (224 UC and 272 CKD patients). The urinary MEHHP was associated with UC but MiBP was not. Medical history including the use of non-steroid anti-inflammatory drugs, exposure to environmental toxins (dye, paint, and organic solvent), and the use of traditional Chinese medicine was independently associated with UC. The adjusted odds ratio of MEHHP was 1.42 (95% confidence interval: 1.21-1.68).

CONCLUSION

Phthalate urinary metabolite(MEHHP) may be associated with UC in CKD patients and the association is independent of well-known risk factors of UC.

Prostate-Specific Antigen: From Promising to Disappointment Tool for Diagnosis of Chronic Renal Failure in Predialysis Patients

Introduction Prostate-specific antigen (PSA) is a biomarker commonly used for detection of prostate cancer. Its viability as a marker for diagnosis of chronic renal failure (CRF) in predialysis patients was investigated.

Methods Sera from 230 patients with CRF were analyzed by enzyme-linked immunosorbent assay (ELISA) for determining total PSA (tPSA) levels before hemodialysis.

Results Of the patients investigated, 98.69% had a normal PSA level with a value less than 4 ng/mL. Three elderly men with both kidney failure showed a moderate elevation of PSA level.

Conclusion PSA is considered a nonsignificant indicator for diagnosis of CRF.

Factors Associated With Postoperative Voiding Dysfunction Post Renal Transplantation

INTRODUCTION

Renal transplantation offers a better quality of life and survival rate for patients with end-stage renal disease. However, voiding dysfunction may have results such as decreased bladder capacity that have been observed in patients with prolonged oliguria or anuria, impacting a patient's quality of life. This study aimed to investigate preoperative factors associated with the occurrence of voiding dysfunction after renal transplantation.

METHODS

Seventy-one patients' data who had undergone successful renal transplantation at Cipto Mangunkusumo General Hospital in Jakarta were collected. Preoperative characteristics including age, sex, history of hypertension, diabetes mellitus, preoperative anuria, and duration of renal substitution therapy were obtained. Multivariate analysis were performed examining the correlation of preoperative characteristics with postoperative voiding dysfunction measured by International Prostate Symptom Score storage (IPSS-s) sub-score > 5, overactive bladder symptom score (OABSS) > 5, maximum flow rate (Qmax) > 15 mL/cc, and postvoid residual volume (PVR) > 50 mL.

RESULTS

A significant correlation of IPSS-s score suggesting storage problem with duration of preoperative dialysis was observed (odds ratio [OR] 1.052; 95% confidence interval [CI] 1.006-1.1001, P = .027). Older age and preoperative anuria were positively correlated with OABSS score > 5 (OR 1.104 and 33.567, P value .004 and .002, respectively). Negative correlation was observed between male sex and Qmax > 15mL/s (OR 1.73; 95% CI 0.033-1.907, P = .038). Male sex was negatively correlated with PVR > 50 mL (OR 0.231; P = .043) but positively correlated with the presence history of diabetes mellitus (OR 8.146; 95% CI 1.548-42.864, P = .013).

CONCLUSION

This study demonstrated that assessment of patient age, sex, and past medical history could help determine patients' risk for developing voiding dysfunction after renal transplantation.

Antiproteinuric effect of DPP-IV inhibitors in diabetic and non-diabetic kidney diseases

Diabetes Mellitus (DM) is a chronic and severe metabolic disease, characterized by chronic hyperglycemia due to insulin resistance and/or reduced insulin secretion. Concerning the non-insulin glucose-lowering therapy for diabetes, Dipeptidyl-peptidase-4 (DPP-4) inhibitors, members of the incretin family, represent new agents, capable of a glycemic control improvement with an advantageous safety profile, given the absence of weight gain, the low incidence of hypoglycemia and the good renal tolerance in patients suffering from chronic renal failure. In addition to demonstrating efficacy in glycemic control through inhibition of GLP-1 degradation, DPP-4 inhibitors (DPP-4is) seem to demonstrate pleiotropic effects, which also make them interesting in both diabetic and non-diabetic nephropathies, especially for their capacity of reducing proteinuria. Several studies about diabetic nephropathy on patients' cohorts and murine models have demonstrated a solid direct relationship between DPP-4 activity and urinary albumin excretion (UAE), thus confirming the capacity of DPP-4is to reduce proteinuria; the mechanism responsible for that effect was studied to assess if it was the result of a direct action on renal impairment or a secondary consequence of the better glycemic control related to these agents. As a result of these more in-depth studies, DPP-4is have demonstrated an improvement of renal inflammation markers and consequent proteinuria reduction, regardless of glucose concentrations. Considering the nephroprotective effects of DPP-4is might be glycemic independent, several studies were conducted to prove the validity of the same effects in non-diabetic nephropathies. Among these studies, DPP-4is demonstrated an improvement of various renal inflammatory markers on several models of non-diabetes dependent renal impairment, confirming their capacity to reduce proteinuria, independently from the action on glucose metabolism. The objective of this review is to present and discuss the so far demonstrated antiproteinuric effect of DPP-4is and their effects on diabetic and non-diabetic nephropathies.

Iron Infusion and Induced Hypophosphatemia: The Role of Fibroblast Growth Factor-23

The mechanism of action of fibroblast growth factor-23 (FGF23) is becoming increasingly clearer as a result of studies that have defined its structure and pleiotropic effects. Furthermore, data are emerging on the effects exerted on this hormone by iron administration. Ten main iron formulations are recognized (with clear differences in composition and possible reactions of intolerance and anaphylaxis), which are indicated for iron deficiency anemia, including nephropathic subjects, as suggested by medical guidelines. With some types of iron formulation (especially iron carboxymaltose) a particular side effect has been observed: hypophosphatemia, mediated by FGF23. This review aims to draw attention to this correlation and the contradiction represented by the presence of both positive and negative modulation by FGF23, with the effects induced by its increase even after long-term treatment with iron formulation. However, more evidence is needed to understand the reasons for this differential stimulation.

Normalization of Elevated Tumor Marker CA27-29 After Bilateral Lung Transplantation in a Patient With Breast Cancer and Idiopathic Pulmonary Fibrosis

Solid tumors involving glandular organs express mucin glycoprotein that is eventually shed into the circulation. As a result, these proteins can easily be measured in the serum and be used as potential tumor markers. The most commonly used tumor markers for breast cancer are CA27-29 and CA15-3, which both measure the glycoprotein product of the mucin-1 (MUC1) gene. CA27-29 has been approved by the US Food and Drug Administration for monitoring disease activity in breast cancer patients. Most oncology clinical practice guidelines do not recommend the use of tumor markers for routine surveillance of early stage disease but recognize their utility in the metastatic setting. We present a patient with stage IIIA breast cancer and preexisting hypersensitivity pneumonitis who was found to have an elevated serum tumor marker CA27-29. After successful curative intent treatment of her early stage breast cancer, she developed gradual and progressive worsening of her lung disease with eventual development of severe pulmonary fibrosis requiring bilateral lung transplantation. As part of the pretransplant evaluation, she was found to have an elevation of serum tumor marker CA27-29. While the diagnostic evaluation, including imaging studies, was negative for the presence of recurrent disease, the serial serum tumor marker CA27-29 levels remained persistently elevated. The decision was made for her to undergo bilateral lung transplantation. Shortly after surgery, her CA27-29 tumor marker level returned to normal range, and it has continued to remain in the normal range with no evidence of breast cancer recurrence.

Adjustment of serum HE4 to reduced glomerular filtration and its use in biomarker-based prediction of deep myometrial invasion in endometrial cancer

Background

We investigated the efficacy of circulating biomarkers together with histological grade and age to predict deep myometrial invasion (dMI) in endometrial cancer patients.

Methods

HE4ren was developed adjusting HE4 serum levels towards decreased glomerular filtration rate as quantified by the eGFR-EPI formula. Preoperative HE4, HE4ren, CA125, age, and grade were evaluated in the context of perioperative depth of myometrial invasion in endometrial cancer (EC) patients. Continuous and categorized models were developed by binary logistic regression for any-grade and for G1-or-G2 patients based on single-institution data from 120 EC patients and validated against multicentric data from 379 EC patients.

Results

In non-cancer individuals, serum HE4 levels increase log-linearly with reduced glomerular filtration of eGFR ≤ 90 ml/min/1.73 m². HE4ren, adjusting HE4 serum levels to decreased eGFR, was calculated as follows: HE4ren = exp[ln(HE4) + 2.182 × (eGFR-90) × 10^-2]. Serum HE4 but not HE4ren is correlated with age. Model with continuous HE4ren, age, and grade predicted dMI in G1-or-G2 EC patients with AUC = 0.833 and AUC = 0.715, respectively, in two validation sets. In a simplified categorical model for G1-or-G2 patients, risk factors were determined as grade 2, HE4ren ≥ 45 pmol/l, CA125 ≥ 35 U/ml, and age ≥ 60. Cumulation of weighted risk factors enabled classification of EC patients to low-risk or high-risk for dMI.

Conclusions

We have introduced the HE4ren formula, adjusting serum HE4 levels to reduced eGFR that enables quantification of time-dependent changes in HE4 production and elimination irrespective of age and renal function in women. Utilizing HE4ren improves performance of biomarker-based models for prediction of dMI in endometrial cancer patients.

Screening for prostate cancer in renal transplant candidates: Single-centre experience over 10 years

Objectives:

The purpose of this article is to report 10 years of single-centre experience with prostate cancer screening in renal transplant candidates.

Patients and methods:

This is a single-centre retrospective analysis of results of prostate cancer screening as a part of renal pre-transplant workup. We included all male patients suitable for transplant workup over 10 years. Patients with persistently elevated prostate specific antigen were considered for prostate biopsy. Biopsy results, treatment data and short-term outcomes for patients diagnosed with prostate cancer were collected.

Results:

We identified 542 patients with a mean age of 52 years. Thirty-one (5.7%) patients were referred to a urologist. Twenty-three (74%) of those referred were biopsied. Histological findings for 10 biopsies (44%) were normal, three (13%) had prostatic intraepithelial neoplasm and nine patients (39%) had invasive adenocarcinoma. One case (4%) was inconclusive. All patients with a normal biopsy proceeded with pre-transplant workup. Out of nine patients diagnosed with prostate cancer, five were transplant listed, two were receiving treatment and two were subsequently deceased.

Conclusion:

Prostate specific antigen screening with repeat testing and the use of age-adjusted normal values led to the diagnosis of prostate cancer that had major implications for transplant listing. For the majority of cancers the diagnosis did not deny transplant surgery to patients but only delayed listing for transplant.

Analysis of serum level of HE4 and CA125 considering selected risk factors among patients with endometrioid endometrial cancer

The aim of the study

To assess the difference of serum level of HE4 and CA125 among patients with endometrioid endometrial cancer, considering the presence or absence of selected risk factors.

Material and methods

A retrospective study of 46 patients, whose serum level of HE4 and CA125 level was documented, admitted to our Clinic because of endometrioid endometrial cancer. The statistical difference of both markers was analyzed considering certain risk factors.

Results

In the examined group of patients there was no significant statistical difference of HE4 and CA125 levels among patients with and without the following risk factors: older age, menopausal status, overweight and obesity, hypertension, diabetes, early menarche, and family history of certain cancers. Similar results were obtained within the subgroup of patients with stage I endometrial cancer. Both HE4 and CA125 were significantly higher in premenopausal patients than in those after menopause in the more advanced stages of the disease. The same results were obtained within group of patients with advanced histological grading G2 and G3. In this group, higher levels of CA125 were observed among patients without hypertension. Among patients with histological grade G1 the serum level of HE4 was higher in the group of patients older than 60 years than it was in younger patients.

Conclusions

In the examined group of patients serum levels of tumour markers may not be affected by the selected risk factors. Higher HE4 and CA125 levels among premenopausal patients may be an alarming sign of advanced stages and classes of histological grading.

Elevated Squamous Cell Carcinoma Antigen, Cytokeratin 19 Fragment, and Carcinoembryonic Antigen Levels in Diabetic Nephropathy

OBJECTIVE

We aimed to explore whether squamous cell carcinoma antigen (SCC), cytokeratin 19 fragment (Cyfra21-1), neuron-specific enolase (NSE), and carcinoembryonic antigen (CEA) are elevated in diabetic nephropathy (DN) and the association between urinary albumin-to-creatinine ratio (UACR) and tumor markers in diabetic patients.

METHODS

Nondialysis patients with diabetes (n = 261) and 90 healthy controls were enrolled. DN was defined as an UACR ≥ 30 mg/g in the absence of a urinary tract infection or other renal abnormalities.

RESULTS

Patients with DN had significantly higher serum SCC, Cyfra21-1, and CEA levels than those with normoalbuminuria and healthy controls. The rates of positive SCC, Cyfra21-1, and CEA significantly increased with increasing urinary albumin excretion (all P for trend < 0.001). In contrast, NSE was not affected by DN. SCC, Cyfra21-1, and CEA were significantly and positively correlated with UACR. In logistic regression, after multivariable adjustment, increased UACR was associated with increased odds ratio of elevated tumor marker levels (all P for trend < 0.05).

CONCLUSIONS

Serum levels of SCC, Cyfra21-1, and CEA are markedly increased with increasing urinary albumin excretion, which affects the specificity for diagnosis for lung cancer. Appropriate interpretation of tumor markers in diabetic patients is mandatory to avoid unnecessary and even hazardous biopsies.

[Not Available]

Zusammenfassung. Konventionelle Tumormarker sind Proteine, Peptide oder andere biologische Substanzen, die von Tumorzellen selber oder vom Körper als Reaktion auf einen Tumor gebildet werden. Einflussfaktoren, die zu falsch positiven oder falsch negativen Werten führen sind häufig wenig bekannt. Der klinische Nutzen eines Tumormarkes hängt von seiner Spezifität und Sensitivität ab. Beide Parameter sind in der Regel zu wenig hoch, weshalb sich Tumormarker für ein Tumorscreening nicht eignen. Der Hauptnutzen von Tumormarkern liegt in Therapieverlaufskontrollen oder in der Nachsorge von Tumoren. In Zukunft werden präzisere, DNA-basierte Marker die Tumorbehandlung unterstützen.

Reference range determination for gastrointestinal tumor markers in patients on maintenance dialysis

AIM: To identify the reference range of carcinoembryonic antigen (CEA), α-fetoprotein (AFP), carbohydrate antigen 199 (CA199) and carbohydrate antigen 72-4 (CA72-4) in patients on maintenance hemodialysis.

METHODS: A total of 397 patients (203 males and 194 females) on maintenance hemodialysis were recruited at the Second Hospital of Tianjin Medical University between January 2014 and February 2016. Meanwhile, 272 healthy adult volunteers (139 males and 133 females) were included in a control group. Serum levels of CEA, CA199 and AFP were detected by chemiluminescence assay. Serum level of CA72-4 was detected by electrochemiluminescence assay. The reference ranges of CEA, CA199, AFP and CA72-4 were evaluated by Wilcoxon Mann-Whitney test and Chi-squared test.

RESULTS: Serum levels of CEA, CA199 and CA72-4 in patients on maintenance hemodialysis were significantly higher than those in the healthy control group (P < 0.05). Positive rates of the above three markers were also higher in patients on maintenance hemodialysis compared to the normal control group. Serum AFP levels did not differ significantly between patients on maintenance hemodialysis and the control group. The 95th percentile for CEA, CA199 and CA72-4 was identified to be 8.1 ng/mL, 135.8 U/mL and 11.2 ng/mL, respectively.

CONCLUSION: We identified the 95^th percentile values of CEA, CA199 and CA72-4 in patients on maintenance hemodialysis, which were higher than those of the control group.

Serum tumor markers in chronic kidney disease: as clinical tool in diagnosis, treatment and prognosis of cancers

Cancer is singled out as the biggest cause of death in the world, predicted to reach 13.1 million cancer-related deaths by the year 2030. Although there are no specific tumor markers used in cancer screening, some markers can be used to assist in making a diagnosis and determining a prognosis. They can be used to follow in cases where the diagnosis is cancer through monitoring of the disease recurrence and/or evaluating the response to therapy. These markers are not specific as the number increases in multiple cases of cancer. Some markers are positive in a single type of cancer; others are detectable in more than one type. An ideal tumor marker should be highly sensitive, specific, and reliable with high prognostic value. Other characteristics of an ideal tumor marker are organ specificity and correlation of it with tumor stages. However, none of the tumor markers reported to date has all these characteristics. Influence of different stages of chronic kidney function on serum tumor markers is variable. Furthermore, hemodialysis, peritoneal dialysis, and kidney transplantation affect on tumor markers differently. Sometimes, no study has been found in the literature review. Combined serum tumor markers may also be valuable. This literature review points the role of serum tumor markers in screening, diagnosis, and follow-up of cancer patients in chronic kidney disease patients and renal allograft recipients. In addition, impact of chronic kidney disease and kidney transplantation on different serum tumor markers is briefly explored.

Kinetics and binding geometries of the complex between β2-microglobulin and its antibody: An AFM and SPR study

β2-Microglobulin (B2M) is a human protein involved in the regulation of immune response and represents a useful biomarker for several diseases. Recently, anti-B2M monoclonal antibodies have been introduced as innovative therapeutic agents. A deeper understanding of the molecular interaction between the two partners could be of utmost relevance for both designing array-based analytical devices and improving current immunotherapies. A visualization at the nanoscale performed by Atomic Force Microscopy revealed that binding of B2M to the antibody occurred according to two preferred interaction geometries. Additionally, Atomic Force Spectroscopy and Surface Plasmon Resonance provided us with detailed information on the binding kinetics and the energy landscape of the complex, both at the single molecule level and in bulk conditions. Combination of these complementary techniques contributed to highlight subtle differences in the kinetics behaviour characterizing the complexes. Collectively, the results may deserve significant interest for designing, development and optimization of novel generations of nanobiosensor platforms.

Nephro-oncology: a link in evolution

A multidisciplinary approach represents the best method to interact with patients. Neoplastic and renal diseases are closely related to each other because of an increased risk of cancer among individuals with end-stage renal disease and because of the high prevalence of renal failure in cancer patients. Physicians should be able to know how to prevent and treat the possible complications which may appear during the course of neoplastic disease that may lead to kidney damage such as the Acute Tumor Lysis Syndrome, disorders of hydroelectrolitic balance, metabolic alterations in the calcium-phosphorus, anemia, interstitial and glomerular impairment due to chemotherapy. It is very important to know patients' renal function and directly monitor it, before and during treatment, using formulas for estimating glomerular filtration rate (GFR) and above all, specific biomarkers are more early and sensitive than the increase of creatinine, like neutrophil gelatinase-associated lipocalin. Additionally, physician should consider that alteration of GFR or substitutive renal treatments severely influence dosage of tumor markers and it could lead to wrong diagnosis of cancer. The aim of this article is to provide a review of problems related to cancer relevant in the development of renal failure and try to define the best therapeutic strategies to cope with possible kidney imbalances induced by cancer or its treatment.

The role of epigenetics in kidney malignancies

Introduction

Renal cell carcinomas (RCC) are collectively the third most common type of genitourinary neoplasms, surpassed only by prostate and bladder cancer. Cure rates for renal cell carcinoma are related to tumor grade and stage; therefore, diagnostic methods for early detection and new therapeutic modalities are of paramount importance. Epigenetics can be defined as inherited modifications in gene expression that are not encoded in the DNA sequence itself. Epigenetics may play an important role in the pursuit of early diagnosis, accurate prognostication and identification of new therapeutic targets.

Material and methods

We used PubMed to conduct a comprehensive search of the English medical literature using search terms including epigenetics, DNA methylation, histone modification, microRNA regulation (miRNA) and RCC. In this review, we discuss the potential application of epigenetics in the diagnosis, prognosis and treatment of kidney cancer.

Results

During the last decade, many different types of epigenetic alterations of DNA have been found to be associated with malignant renal tumors. This has led to the research of the diagnostic and prognostic implications of these changes in renal malignancies as well as to the development of novel drugs to target these changes, with the aim of achieving a survival benefit.

Conclusions

Epigenetics has become a promising field in cancer research. The potential to achieve early detection and accurate prognostication in kidney cancer might be feasible through the application of epigenetics. The possibility to reverse these epigenetic changes with new therapeutic agents motivates researchers to continue pursuing better treatment options for kidney cancer and other malignancies.

Role of β2-microglobulin in uremic patients may be greater than originally suspected

The role of beta2-microglobulin (β₂M) in dialysis-related amyloidosis as a specific amyloid precursor was defined in the 1980s. Studies in those years were largely related to β₂M amyloidosis. In 2005, for what was probably the first time in the available literature, we provided data about the association between β₂M and early-onset atherosclerosis in hemodialysis patients without co-morbidities. In recent years, the role of uremic toxins in uremic atherosclerosis and the interest in β₂M as a marker of cardiovascular (CV) and/or mortality risk have grown. In the current literature, clinical studies suggest that β₂M is an independent, significant predictor of mortality, not only in dialysis patients, but also in predialysis patients and in the high-risk portion of the general population, and it seems to be a factor strongly linked to the presence and severity of CV disease. It is still unknown whether β₂M is only a uremic toxin marker or if it also has an active role in vascular damage, but data support that it may reflect an increased burden of systemic atherosclerosis in a setting of underlying chronic kidney disease. Thus, although there have been some inconsistencies among the various analyses relating to β₂M, it promises to be a novel risk marker of kidney function in the awareness and detection of high-risk patients. However, more research is required to establish the pathophysiological relationships between retained uremic toxins and further biochemical modifications in the uremic milieu to get answers to the questions of why and how. In this review, the recent literature about the changing role of β₂M in uremic patients will be examined.