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Abramavicius S, Galaune V, Tunaityte A, Vitkauskiene A, Gumbrevicius G, Radzeviciene A, Maciulaitis R. The Glomerular Filtration Rate Estimators in the Pharmacokinetic Modelling in Acute Kidney Injury: An Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10020158. [PMID: 33557261 PMCID: PMC7915939 DOI: 10.3390/antibiotics10020158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/29/2022] Open
Abstract
The glomerular filtration rate (GFR), according to which the drug dose for patients with chronic kidney disease (CKD) is adjusted, is computed with estimators (eGFR) that are developed specifically for CKD. These particular types of estimators are also used in population pharmacokinetic (pop PK) modelling in drug development. Similar approaches without scientific validation have been proposed for patients with acute kidney injury (AKI), yet it is uncertain which specific eGFR should be used for drug dosing or in pop PK models in patients with AKI. In our study, we included 34 patients with AKI and vancomycin (VCM) treatment, and we built both individual PK and pop PK (non-linear mixed-effects, one-compartment) models to see which eGFR estimator is the best covariate. In these models different eGFRs (Cockcroft-Gault, MDRD, CKD-EPI 2009, Jelliffe and Jelliffe, Chen et al., and Yashiro et al. 2013) were used. We included six additional patients to validate the final pop PK model. All eGFRs underrate the true renal clearance in the AKI, so we created pop PK models for VCM dosing in AKI with all eGFRs, to discover that the most accurate model was the one with the Cockcroft-Gault estimator. Since the eGFRs underestimate the true renal clearance in AKI, they are inaccurate for clinical drug dosing decisions, with the exception of the Cockcroft-Gault one, which is appropriate for the pop PK models intended for drug development purposes in AKI.
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Affiliation(s)
- Silvijus Abramavicius
- Laboratory of Preclinical Drug, Investigation Institute of Cardiology, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania; (S.A.); (V.G.); (G.G.); (A.R.); (R.M.)
| | - Vaidotas Galaune
- Laboratory of Preclinical Drug, Investigation Institute of Cardiology, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania; (S.A.); (V.G.); (G.G.); (A.R.); (R.M.)
| | - Agile Tunaityte
- Laboratory of Preclinical Drug, Investigation Institute of Cardiology, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania; (S.A.); (V.G.); (G.G.); (A.R.); (R.M.)
- Correspondence:
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania;
| | - Gintautas Gumbrevicius
- Laboratory of Preclinical Drug, Investigation Institute of Cardiology, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania; (S.A.); (V.G.); (G.G.); (A.R.); (R.M.)
| | - Aurelija Radzeviciene
- Laboratory of Preclinical Drug, Investigation Institute of Cardiology, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania; (S.A.); (V.G.); (G.G.); (A.R.); (R.M.)
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Romaldas Maciulaitis
- Laboratory of Preclinical Drug, Investigation Institute of Cardiology, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania; (S.A.); (V.G.); (G.G.); (A.R.); (R.M.)
- Nephrology Department, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania
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Rates, predictors, and mortality of sepsis-associated acute kidney injury: a systematic review and meta-analysis. BMC Nephrol 2020; 21:318. [PMID: 32736541 PMCID: PMC7393862 DOI: 10.1186/s12882-020-01974-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Due to the high incidence and mortality of sepsis-associated acute kidney injury, a significant number of studies have explored the causes of sepsis-associated acute kidney injury (AKI). However, the opinions on relevant predictive risk factors remain inconclusive. This study aimed to provide a systematic review and meta-analysis to determine the predisposing factors for sepsis-associated AKI. METHOD A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed, and Web of Science, databases, with an end-date of 25th May 2019. Valid data were retrieved in compliance with specific inclusion and exclusion criteria. RESULT Forty-seven observational studies were included for analysis, achieving a cumulative patient number of 55,911. The highest incidence of AKI was caused by septic shock. Thirty-one potential risk factors were included in the meta-analysis. Analysis showed that 20 factors were statistically significant. The odds ratio (OR) and 95% confidence interval (CI), as well as the prevalence of the most frequently-seen predisposing factors for sepsis-associated AKI, were as follows: septic shock [2.88 (2.36-3.52), 60.47%], hypertension [1.43 (1.20-1.70), 38.39%], diabetes mellitus [1.59 (1.47-1.71), 27.57%], abdominal infection [1.44 (1.32-1.58), 30.87%], the administration of vasopressors [2.95 (1.67-5.22), 64.61%], the administration of vasoactive drugs [3.85 (1.89-7.87), 63.22%], mechanical ventilation [1.64 (1.24-2.16), 68.00%], positive results from blood culture [1.60 (1.35-1.89), 41.19%], and a history of smoking [1.60 (1.09-2.36), 43.09%]. Other risk factors included cardiovascular diseases, coronary artery diseases, liver diseases, unknown infections, the administration of diuretics and ACEI/ARB, the infection caused by gram-negative bacteria, and organ transplantation. CONCLUSION Risk factors of S-AKI arise from a wide range of sources, making it difficult to predict and prevent this condition. Comorbidities, and certain drugs, are the main risk factors for S-AKI. Our review can provide guidance on the application of interventions to reduce the risks associated with sepsis-associated acute kidney injury and can also be used to tailor patient-specific treatment plans and management strategies in clinical practice.
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Wajda J, Dumnicka P, Kolber W, Sporek M, Maziarz B, Ceranowicz P, Kuźniewski M, Kuśnierz-Cabala B. The Marker of Tubular Injury, Kidney Injury Molecule-1 (KIM-1), in Acute Kidney Injury Complicating Acute Pancreatitis: A Preliminary Study. J Clin Med 2020; 9:jcm9051463. [PMID: 32414176 PMCID: PMC7290845 DOI: 10.3390/jcm9051463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) may be associated with severe inflammation and hypovolemia leading to organ complications including acute kidney injury (AKI). According to current guidelines, AKI diagnosis is based on dynamic increase in serum creatinine, however, creatinine increase may be influenced by nonrenal factor and appears late following kidney injury. Kidney injury molecule-1 (KIM-1) is a promising marker of renal tubular injury and it has not been studied in AP. Our aim was to assess if urinary KIM-1 may be used to diagnose AKI complicating the early stage of AP. We recruited 69 patients with mild to severe AP admitted to a secondary care hospital during the first 24 h from initial symptoms of AP. KIM-1 was measured in urine samples collected on the day of admission and two subsequent days of hospital stay. AKI was diagnosed based on creatinine increase according to Kidney Disease: Improving Global Outcomes 2012 guidelines. Urinary KIM-1 on study days 1 to 3 was not significantly higher in 10 patients who developed AKI as compared to those without AKI and did not correlate with serum creatinine or urea. On days 2 and 3, urinary KIM-1 correlated positively with urinary liver-type fatty acid-binding protein, another marker of tubular injury. On days 2 and 3, urinary KIM-1 was higher among patients with systemic inflammatory response syndrome, and several correlations between KIM-1 and inflammatory markers (procalcitonin, urokinase-type plasminogen activator receptor, C-reactive protein) were observed on days 1 to 3. With a limited number of patients, our study cannot exclude the diagnostic utility of KIM-1 in AP, however, our results do not support it. We hypothesize that the increase of KIM-1 in AKI complicating AP lasts a short time, and it may only be observed with more frequent monitoring of the marker. Moreover, urinary KIM-1 concentrations in AP are associated with inflammation severity.
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Affiliation(s)
- Justyna Wajda
- Jagiellonian University Medical College, Faculty of Medicine, Department of Anatomy, 31-034 Kraków, Poland; (J.W.); (M.S.)
| | - Paulina Dumnicka
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Medical Diagnostics, 30-688 Kraków, Poland;
| | - Witold Kolber
- Department of Surgery, Complex of Health Care Centers in Wadowice, 34-100 Wadowice, Poland;
| | - Mateusz Sporek
- Jagiellonian University Medical College, Faculty of Medicine, Department of Anatomy, 31-034 Kraków, Poland; (J.W.); (M.S.)
| | - Barbara Maziarz
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Clinical Biochemistry, Department of Diagnostics, 31-501 Kraków, Poland;
| | - Piotr Ceranowicz
- Jagiellonian University Medical College, Faculty of Medicine, Department of Physiology, 31-531 Kraków, Poland
- Correspondence: (P.C.); (B.K.-C.); Tel.: +48-12-4211006 (P.C.); +48-12-4248365 (B.K-C.)
| | - Marek Kuźniewski
- Jagiellonian University Medical College, Faculty of Medicine, Department of Nephrology, 30-688 Kraków, Poland;
| | - Beata Kuśnierz-Cabala
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Clinical Biochemistry, Department of Diagnostics, 31-501 Kraków, Poland;
- Correspondence: (P.C.); (B.K.-C.); Tel.: +48-12-4211006 (P.C.); +48-12-4248365 (B.K-C.)
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Hall PS, Mitchell ED, Smith AF, Cairns DA, Messenger M, Hutchinson M, Wright J, Vinall-Collier K, Corps C, Hamilton P, Meads D, Lewington A. The future for diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritisation. Health Technol Assess 2019; 22:1-274. [PMID: 29862965 DOI: 10.3310/hta22320] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is highly prevalent in hospital inpatient populations, leading to significant mortality and morbidity, reduced quality of life and high short- and long-term health-care costs for the NHS. New diagnostic tests may offer an earlier diagnosis or improved care, but evidence of benefit to patients and of value to the NHS is required before national adoption. OBJECTIVES To evaluate the potential for AKI in vitro diagnostic tests to enhance the NHS care of patients admitted to the intensive care unit (ICU) and identify an efficient supporting research strategy. DATA SOURCES We searched ClinicalTrials.gov, The Cochrane Library databases, Embase, Health Management Information Consortium, International Clinical Trials Registry Platform, MEDLINE, metaRegister of Current Controlled Trials, PubMed and Web of Science databases from their inception dates until September 2014 (review 1), November 2015 (review 2) and July 2015 (economic model). Details of databases used for each review and coverage dates are listed in the main report. REVIEW METHODS The AKI-Diagnostics project included horizon scanning, systematic reviewing, meta-analysis of sensitivity and specificity, appraisal of analytical validity, care pathway analysis, model-based lifetime economic evaluation from a UK NHS perspective and value of information (VOI) analysis. RESULTS The horizon-scanning search identified 152 potential tests and biomarkers. Three tests, Nephrocheck® (Astute Medical, Inc., San Diego, CA, USA), NGAL and cystatin C, were subjected to detailed review. The meta-analysis was limited by variable reporting standards, study quality and heterogeneity, but sensitivity was between 0.54 and 0.92 and specificity was between 0.49 and 0.95 depending on the test. A bespoke critical appraisal framework demonstrated that analytical validity was also poorly reported in many instances. In the economic model the incremental cost-effectiveness ratios ranged from £11,476 to £19,324 per quality-adjusted life-year (QALY), with a probability of cost-effectiveness between 48% and 54% when tests were compared with current standard care. LIMITATIONS The major limitation in the evidence on tests was the heterogeneity between studies in the definitions of AKI and the timing of testing. CONCLUSIONS Diagnostic tests for AKI in the ICU offer the potential to improve patient care and add value to the NHS, but cost-effectiveness remains highly uncertain. Further research should focus on the mechanisms by which a new test might change current care processes in the ICU and the subsequent cost and QALY implications. The VOI analysis suggested that further observational research to better define the prevalence of AKI developing in the ICU would be worthwhile. A formal randomised controlled trial of biomarker use linked to a standardised AKI care pathway is necessary to provide definitive evidence on whether or not adoption of tests by the NHS would be of value. STUDY REGISTRATION The systematic review within this study is registered as PROSPERO CRD42014013919. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - Alison F Smith
- Academy of Primary Care, Hull York Medical School, Hull, UK.,National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Messenger
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | | | - Judy Wright
- Academy of Primary Care, Hull York Medical School, Hull, UK
| | | | | | - Patrick Hamilton
- Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Meads
- Academy of Primary Care, Hull York Medical School, Hull, UK
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Córdova-Sánchez BM, Ruiz-García EB, López-Yañez A, Barragan-Dessavre M, Bautista-Ocampo AR, Meneses-García A, Herrera-Gómez A, Ñamendys-Silva SA. Plasma neutrophil gelatinase-associated lipocalin and factors related to acute kidney injury and mortality in critically ill cancer patients. Ecancermedicalscience 2019; 13:903. [PMID: 30915161 PMCID: PMC6411412 DOI: 10.3332/ecancer.2019.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 11/30/2022] Open
Abstract
Rationale Acute kidney injury (AKI) is a frequent complication in critically ill cancer patients. Objectives To assess plasma neutrophil gelatinase-associated lipocalin (NGAL) levels and risks factors associated with AKI and mortality. Methods We recruited 96 critically ill cancer patients and followed them prospectively. Plasma NGAL levels were determined at intensive care unit (ICU) admission and at 48 hours. We generated receiver operating characteristic curves to assess the ability of NGAL to predict AKI. Logistic regression analysis was performed to determine risks factors associated with AKI. Cox-regression analysis was performed to evaluate 6-month mortality. Measurements and main results From 96 patients, 60 (63%) developed AKI and 33 (55%) were classified as stages 2 and 3. In patients without AKI at admission, plasma NGAL levels revealed an area under the curve (AUC) = 0.522 for all AKI stages and an AUC = 0.573 for stages 2 and 3 AKI (85% sensitivity and 67% specificity for a 50.66 ng/mL cutoff). We identified sequential organ failure assessment (SOFA) score (without renal parameters) at admission as an independent factor for developing stages 2 and 3 AKI, and haemoglobin as a protective factor. We observed that metastatic disease, dobutamine use and stage 3 AKI were independent factors associated with 6-month mortality. Conclusions In our cohort of critically ill cancer patients, NGAL did not predict AKI. SOFA score was a risk factor for developing AKI, and haemoglobin level was a protective factor for developing AKI. The independent factors associated with 6-month mortality included metastatic disease, dobutamine use, lactate and stage 3 AKI.
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Affiliation(s)
- Bertha M Córdova-Sánchez
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Erika B Ruiz-García
- Translational Medicine Research Laboratory, Instituto Nacional de Cancerologia, Ciudad de Mexico 14080, Mexico
| | - Alicia López-Yañez
- Translational Medicine Research Laboratory, Instituto Nacional de Cancerologia, Ciudad de Mexico 14080, Mexico
| | - Mireya Barragan-Dessavre
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | | | - Abelardo Meneses-García
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Angel Herrera-Gómez
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Silvio A Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.,Department of Critical Care Medicine, Fundación Clínica Médica Sur, Mexico City 14050, Mexico.,Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico
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6
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Abstract
Sepsis is defined as organ dysfunction resulting from the host's deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.
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Affiliation(s)
- Jason T Poston
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago
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7
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Morozov D, Morozova O, Pervouchine D, Severgina L, Tsyplakov A, Zakharova N, Sushentsev N, Maltseva L, Budnik I. Hypoxic renal injury in newborns with abdominal compartment syndrome (clinical and experimental study). Pediatr Res 2018; 83:520-526. [PMID: 29053704 DOI: 10.1038/pr.2017.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/29/2017] [Indexed: 12/13/2022]
Abstract
BackgroundSurgical treatment for gastroschisis and congenital diaphragmatic hernia (CDH) commonly leads to abdominal compartment syndrome (ACS) associated with hypoxic renal injury. We hypothesized that measurement of urinary and serum concentrations of vascular endothelial growth factor (VEGF), π-glutathione S-transferase (π-GST), and monocyte chemoattractant protein-1 (MCP-1) may serve for noninvasive detection of hypoxic renal injury in such patients.MethodsIntra-abdominal pressure (IAP), renal excretory function, and the biomarker levels were analyzed before, 4, and 10 days after surgery. Association between the biomarker levels and renal histology was investigated using an original model of ACS in newborn rats.ResultsFour days after surgery, IAP increased, renal excretory function decreased, and the levels of VEGF, π-GST, and MCP-1 increased, indicating renal injury. Ten days after surgery, IAP partially decreased, renal excretory function completely restored, but the biomarker levels remained elevated, suggesting the ongoing kidney injury. In the model of ACS, increase in the biomarker levels was associated with progressing kidney morphological alteration.ConclusionSurgical treatment for gastroschisis and CDH is associated with prolonged hypoxic kidney injury despite complete restoration of renal excretory function. Follow-up measurement of VEGF, π-GST, and MCP-1 levels may provide a better tool for noninvasive assessment of renal parenchyma in newborns with ACS.
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Affiliation(s)
- Dmitry Morozov
- Department of Pediatric Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Olga Morozova
- Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Dmitri Pervouchine
- Center for Data-Intensive Biomedicine and Biotechnology, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Lubov Severgina
- Department of Pathological Anatomy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexei Tsyplakov
- Research Institute for Fundamental and Clinical Uronephrology, Saratov State Medical University n. a. V. I. Razumovsky, Saratov, Russia
| | - Natalya Zakharova
- Research Institute for Fundamental and Clinical Uronephrology, Saratov State Medical University n. a. V. I. Razumovsky, Saratov, Russia
| | - Nikita Sushentsev
- Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Larisa Maltseva
- Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ivan Budnik
- Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia
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Ohno K, Kuno A, Murase H, Muratsubaki S, Miki T, Tanno M, Yano T, Ishikawa S, Yamashita T, Miura T. Diabetes increases the susceptibility to acute kidney injury after myocardial infarction through augmented activation of renal Toll-like receptors in rats. Am J Physiol Heart Circ Physiol 2017; 313:H1130-H1142. [PMID: 28822965 DOI: 10.1152/ajpheart.00205.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) after acute myocardial infarction (MI) worsens the prognosis of MI patients. Although type 2 diabetes mellitus (DM) is a major risk factor of AKI after MI, the underlying mechanism remains unclear. Here, we examined the roles of renal Toll-like receptors (TLRs) in the impact of DM on AKI after MI. MI was induced by coronary artery ligation in Otsuka-Long-Evans-Tokushima fatty (OLETF) rats, a rat DM model, and Long-Evans-Tokushima-Otsuka (LETO) rats, nondiabetic controls. Sham-operated rats served as no-MI controls. Renal mRNA levels of TLR2 and myeloid differentiation factor 88 (MyD88) were significantly higher in sham-operated OLETF rats than in sham-operated LETO rats, although levels of TLR1, TLR3, and TLR4 were similar. At 12 h after MI, protein levels of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in the kidney were elevated by 5.3- and 4.0-fold, respectively, and their mRNA levels were increased in OLETF but not LETO rats. The increased KIM-1 and NGAL expression levels after MI in the OLETF kidney were associated with upregulated expression of TLR1, TLR2, TLR4, MyD88, IL-6, TNF-α, chemokine (C-C motif) ligand 2, and transforming growth factor-β1 and also with activation of p38 MAPK, JNK, and NF-κB. Cu-CPT22, a TLR1/TLR2 antagonist, administered before MI significantly suppressed MI-induced upregulation of KIM-1, TLR2, TLR4, MyD88, and chemokine (C-C motif) ligand 2 levels and activation of NF-κB, whereas NGAL levels and IL-6 and TNF-α expression levels were unchanged. The results suggest that DM increases the susceptibility to AKI after acute MI by augmented activation of renal TLRs and that TLR1/TLR2-mediated signaling mediates KIM-1 upregulation after MI.NEW & NOTEWORTHY This is the first report to demonstrate the involvement of Toll-like recpetors (TLRs) in diabetes-induced susceptibility to acute kidney injury after acute myocardial infarction. We propose that the TLR1/TLR2 heterodimer may be a new therapeutic target for the prevention of acute kidney injury in diabetic patients.
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Affiliation(s)
- Kouhei Ohno
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Atsushi Kuno
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and.,Department of Pharmacology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Murase
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Shingo Muratsubaki
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Takayuki Miki
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Masaya Tanno
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Satoko Ishikawa
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Tomohisa Yamashita
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
| | - Tetsuji Miura
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and
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9
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Shu KH, Wang CH, Wu CH, Huang TM, Wu PC, Lai CH, Tseng LJ, Tsai PR, Connolly R, Wu VC. Urinary π-glutathione S-transferase Predicts Advanced Acute Kidney Injury Following Cardiovascular Surgery. Sci Rep 2016; 6:26335. [PMID: 27527370 PMCID: PMC4985825 DOI: 10.1038/srep26335] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/27/2016] [Indexed: 02/08/2023] Open
Abstract
Urinary biomarkers augment the diagnosis of acute kidney injury (AKI), with AKI after cardiovascular surgeries being a prototype of prognosis scenario. Glutathione S-transferases (GST) were evaluated as biomarkers of AKI. Urine samples were collected in 141 cardiovascular surgical patients and analyzed for urinary alpha-(α-) and pi-(π-) GSTs. The outcomes of advanced AKI (KDIGO stage 2, 3) and all-cause in-patient mortality, as composite outcome, were recorded. Areas under the receiver operator characteristic (ROC) curves and multivariate generalized additive model (GAM) were applied to predict outcomes. Thirty-eight (26.9%) patients had AKI, while 12 (8.5%) were with advanced AKI. Urinary π-GST differentiated patients with/without advanced AKI or composite outcome after surgery (p < 0.05 by generalized estimating equation). Urinary π-GST predicted advanced AKI at 3 hrs post-surgery (p = 0.033) and composite outcome (p = 0.009), while the corresponding ROC curve had AUC of 0.784 and 0.783. Using GAM, the cutoff value of 14.7 μg/L for π-GST showed the best performance to predict composite outcome. The addition of π-GST to the SOFA score improved risk stratification (total net reclassification index = 0.47). Thus, urinary π-GST levels predict advanced AKI or hospital mortality after cardiovascular surgery and improve in SOFA outcome assessment specific to AKI.
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Affiliation(s)
- Kai-Hsiang Shu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Hsien Wang
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Che-Hsiung Wu
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Tao-Min Huang
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan
| | - Pei-Chen Wu
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chien-Heng Lai
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Jung Tseng
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Pi-Ru Tsai
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan
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10
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Lameire N, Vanmassenhove J, Van Biesen W, Vanholder R. The cell cycle biomarkers: promising research, but do not oversell them. Clin Kidney J 2016; 9:353-8. [PMID: 27274818 PMCID: PMC4886923 DOI: 10.1093/ckj/sfw033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 12/14/2022] Open
Abstract
This review focuses on the most recent scientific and clinical information on the development and clinical applicability of the cell cycle biomarkers TIMP-2 and IGFBP-7 in the diagnosis and prognosis of patients at risk for and suffering from acute kidney injury (AKI). A number of evaluation studies have demonstrated that compared with existing biomarkers, urinary excretion of the product of both biomarkers, [TIMP-2]•[IGFBP-7], improved diagnostic performance in assessing the risk for AKI, predicting the need for renal replacement therapy, AKI-related complications and short- and long-term prognoses. The reference intervals for these biomarkers, measured by the recently approved NephroCheck test, have been determined in apparently healthy adults and those with stable chronic morbid conditions without AKI. This review recognizes that the combination of these two cell cycle arrest markers for the early detection of AKI is promising but concludes that its clinical impact is still unproved. Clinicians should understand the utility and limitations of this test before deciding whether to make it available at their institution.
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Affiliation(s)
- Norbert Lameire
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
| | - Jill Vanmassenhove
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
| | - Wim Van Biesen
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
| | - Raymond Vanholder
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
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11
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Abstract
Acute kidney injury (AKI) is a common and often lethal complication that is also associated with severe morbidity in hospitalized patients. During the last decade, the standardization of AKI diagnostic criteria has helped to facilitate several large-scale investigations of biomarkers of AKI. These studies have led to the international clinical implementation of several biomarkers of renal injury. This review summarizes the results of many of these multicenter investigations and discusses the clinical utility and interpretation of several of these new clinical tests. The merits of combining biomarkers of kidney function is also discussed.
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12
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Zwiers AJM, de Wildt SN, van Rosmalen J, de Rijke YB, Buijs EAB, Tibboel D, Cransberg K. Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: a prospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:181. [PMID: 25895828 PMCID: PMC4422047 DOI: 10.1186/s13054-015-0910-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/02/2015] [Indexed: 01/01/2023]
Abstract
Introduction Children admitted to a pediatric intensive care unit (ICU) are at high risk of developing acute kidney injury (AKI). Although serum creatinine (SCr) levels are used in clinical practice, they are insensitive for early diagnosis of AKI. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are novel AKI biomarkers whose performance in pediatric ICU patients is largely unknown. In this study, we aimed to characterize uNGAL and KIM-1 patterns in children following ICU admission and to assess their properties in relation to identifying children at risk for AKI development. Methods From June 2010 until January 2014, we conducted a prospective observational cohort study of term-born children ages 1 day to 1 year on mechanical ventilation. Blood and urine samples were obtained every 6 to 12 hours up to 72 hours post-admission. Blood samples were assayed for SCr, and urine samples were assayed for uNGAL and KIM-1. The RIFLE (risk, injury, failure, loss, end-stage renal disease) classification as 150%, 200% or 300% of median SCr reference values was used to define AKI. Results A total of 100 children were included (80 survived). Their median age at admission was 27.7 days (interquartile range (IQR), 1.5 to 85.5). The median duration of mechanical ventilation was 5.8 days (IQR, 3.1 to 11.4). Thirty-five patients had evidence of AKI within the first 48 hours post-admission, of whom 24 (69%) already had AKI when they entered the ICU. uNGAL and KIM-1 concentrations in AKI peaked between 6 to 12 hours and between 12 to 24 hours post-admission, respectively. The maximal area under the receiver operating characteristic curve (AUC) for uNGAL was 0.815 (95% confidence interval (CI), 0.685 to 0.945, P <0.001) at 0 to 6 hours post-admission. The discriminative ability of KIM-1 was moderate, with a largest AUC of 0.737 (95% CI, 0.628 to 0.847; P <0.001) at 12 to 24 hours post-admission. At the optimal cutoff point (126 ng/ml), uNGAL concentration predicted AKI development correctly in 16 (84%) of 19 children, up to 24 hours before a rise in SCr became apparent. Conclusions Levels of uNGAL and KIM-1 increase in patients with AKI following ICU admission and peak at 6 to 12 hours and 12 to 24 hours post-admission, respectively. uNGAL seems to be a reliable marker for identifying children who will develop AKI 24 hours later.
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Affiliation(s)
- Alexandra J M Zwiers
- Intensive Care and Department of Pediatric Surgery, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands. .,Department of Pediatric Nephrology, Erasmus Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Saskia N de Wildt
- Intensive Care and Department of Pediatric Surgery, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands. .,Department of Pediatric Nephrology, Erasmus Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands. .,Department of Internal Medicine, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Erik A B Buijs
- Intensive Care and Department of Pediatric Surgery, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands. .,Department of Pediatric Nephrology, Erasmus Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands. .,Department of Pediatric Nephrology, Erasmus Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Karlien Cransberg
- Department of Pediatric Nephrology, Erasmus Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
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13
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Prowle JR. Measurement of AKI biomarkers in the ICU: still striving for appropriate clinical indications. Intensive Care Med 2015; 41:541-3. [PMID: 25608925 DOI: 10.1007/s00134-015-3662-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/11/2015] [Indexed: 11/25/2022]
Affiliation(s)
- John R Prowle
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK,
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14
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Mårtensson J, Bellomo R. The rise and fall of NGAL in acute kidney injury. Blood Purif 2014; 37:304-10. [PMID: 25170751 DOI: 10.1159/000364937] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
Abstract
For many years, neutrophil gelatinase-associated lipocalin (NGAL) has been considered the most promising biomarker of acute kidney injury (AKI). Commercial assays and point-of-care instruments, now available in many hospitals, allow rapid NGAL measurements intended to guide the clinician in the management of patients with or at risk of AKI. However, these assays likely measure a mixture of different NGAL forms originating from different tissues. Systemic inflammation, commonly seen in critically ill patients, and several comorbidities contribute to the release of NGAL from haematopoietic and non-haematopoietic cells. The unpredictable release and complex nature of the molecule and the inability to specifically measure NGAL released by tubular cells have hampered its use a specific marker of AKI in heterogeneous critically ill populations. In this review, we describe the nature and cellular sources of NGAL, its biological role and diagnostic ability in AKI and the increasing concerns surrounding its diagnostic and clinical value.
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Affiliation(s)
- Johan Mårtensson
- Department of Intensive Care, Austin Hospital, Monash University, Melbourne, Vic., Australia
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16
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Spasovski D. Renal markers for assessment of renal tubular and glomerular dysfunction. J Nephropharmacol 2013; 2:23-25. [PMID: 28197440 PMCID: PMC5297548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/21/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dejan Spasovski
- Corresponding author: Dr. Dejan Spasovski, Department of Rheumatology, University Clinical Centre, Skopje, Republic of Macedonia.
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