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Dimitriadis K, Damianaki A, Bletsa E, Pyrpyris N, Tsioufis P, Theofilis P, Beneki E, Tatakis F, Kasiakogias A, Oikonomou E, Petras D, Siasos G, Aggeli K, Tsioufis K. Renal Congestion in Heart Failure: Insights in Novel Diagnostic Modalities. Cardiol Rev 2024:00045415-990000000-00224. [PMID: 38427026 DOI: 10.1097/crd.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Heart failure is increasingly prevalent and is estimated to increase its burden in the following years. A well-reported comorbidity of heart failure is renal dysfunction, where predominantly changes in the patient's volume status, tubular necrosis or other mechanical and neurohormonal mechanisms seem to drive this impairment. Currently, there are established biomarkers evaluating the patient's clinical status solely regarding the cardiovascular or renal system. However, as the coexistence of heart and renal failure is common and related to increased mortality and hospitalization for heart failure, it is of major importance to establish novel diagnostic techniques, which could identify patients with or at risk for cardiorenal syndrome and assist in selecting the appropriate management for these patients. Such techniques include biomarkers and imaging. In regards to biomarkers, several peptides and miRNAs indicative of renal or tubular dysfunction seem to properly identify patients with cardiorenal syndrome early on in the course of the disease, while changes in their serum levels can also be helpful in identifying response to diuretic treatment. Current and novel imaging techniques can also identify heart failure patients with early renal insufficiency and assess the volume status and the effect of treatment of each patient. Furthermore, by assessing the renal morphology, these techniques could also help identify those at risk of kidney impairment. This review aims to present all relevant clinical and trial data available in order to provide an up-to-date summary of the modalities available to properly assess cardiorenal syndrome.
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Affiliation(s)
- Kyriakos Dimitriadis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Evanthia Bletsa
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | - Nikolaos Pyrpyris
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Theofilis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Fotis Tatakis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | | | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | - Konstantina Aggeli
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Garganeeva AA, Kuzheleva EA, Fediunina VA, Tukish OV, Mareev YV, Fudim M, Popov SV. Low Level Of Neutrophil Gelatinase-Associated Lipocalin (NGAL) In Patients With Chronic Heart Failure And Multivessel Coronary Atherosclerosis. Russ Open Med J 2022. [DOI: 10.15275/rusomj.2022.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rationale — Several biomarkers are used to determine the prognosis of patients with heart failure (HF), including neutrophil gelatinase-associated lipocalin (NGAL, Lipocalin-2). We investigated NGAL serum levels in patients with HF and coronary artery disease (CAD). Methods — Fifty-three patients with chronic HF and stable multivessel CAD were included in the study. Patients were grouped on the basis of the NGAL level: low NGAL group (NGAL<37 ng/mL, n=19) and normal NGAL group (NGAL ≥37 ng/mL, n=34). Results and Discussion — The main findings from our study of patients with HF and multivessel CAD were: 1) Plasma NGAL levels were below reference values in 35.8% of cases. 2) We detected a strong positive correlation between neutrophil count and NGAL level (0.573, р<0.001). 3) Neutropenia was present in 15.8% of patients in the low NGAL group and in none in the group with a normal NGAL level (p=0.041). 4) Postinfarction left ventricular aneurysms were more often diagnosed in patients of the first group (15.8%) and in none of patients in the second group (p=0.041). Conclusion — Low NGAL has been associated with neutropenia in patients with heart failure and multivessel atherosclerotic CAD. Left ventricular aneurysms were diagnosed in 15.8% (n=3) patients with low NGAL and in none with normal NGAL levels. These changes may be due to maladaptive remodeling of the heart after myocardial infarction, but further research is needed.
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Affiliation(s)
| | | | | | | | - Yuri V. Mareev
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia; Robertson Center For Biostatistics, Glasgow, United Kingdom
| | - Marat Fudim
- uke University Medical Center, Division of Cardiology, Durham, NC, USA
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Lorenzo-Gómez MF, Flores-Fraile MC, Márquez-Sánchez M, Flores-Fraile J, González-Casado I, Padilla-Fernández B, Valverde-Martínez S, Hernández Sánchez T, Muller-Arteaga C, García-Cenador MB. Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections. Ther Adv Urol 2020; 12:1756287220974133. [PMID: 33335564 PMCID: PMC7724260 DOI: 10.1177/1756287220974133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/25/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: To characterize the impact on kidney injury of recurrent urinary tract
infections (RUTI) in the frail elderly. Methods: Prospective observational study in 200 frail elderly subjects for 1 year.
Groups: GA (n = 100): subjects without RUTI, GB
(n = 100): subjects with RUTI. Variables: age,
concomitant diseases, glomerular filtration rate (GFR), urine neutrophil
gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end
(NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning
(NAG-1) and the end (NAG-2) of the study, urine transforming growth
factor-beta 1 (TGFβ-1). Descriptive statistics, Mann–Whitney test,
Chi-squared test, Fisher’s exact test, and multivariate analysis were
used. Results: Mean age was 84.33 (65–99) years old, with no difference between GA and GB.
Mean NGAL-1 was 1.29 ng/ml (0.04–8). There was lower in GA than in GB. Mean
NGAL-2 was 1.41 ng/ml (0.02–9.22). NGAL-2 was lower in GA than in GB. Mean
NAG-1 was 0.38 UU.II/ml (0.01–2.63. NAG-1 in GA was lower than in GB. Mean
NAG-2 was 0.44 UU.II/ml (0–3.41). NAG-2 was lower in GA compared with GB.
Mean TGFβ-1 was 23.43 pg/ml (0.02–103.76). TGFβ-1 was lower in GA than GB.
There were no differences in the presence of secondary diagnoses between GA
and GB. NAG-2 and NGAL-1 were the most determining factors of renal
function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1,
followed by NAG-2. Conclusion: Frail elderly with RUTI have higher urinary levels of renal injury markers,
specifically NGAL, NAG, and TGFβ-1, chronically in periods between urinary
tract infection (UTI). Urinary markers of renal injury, specifically NGAL,
NAG, and TGFβ-1, identify early deterioration of renal function, compared
with serum creatinine, or albuminuria, in frail elderly with recurrent
urinary infections.
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Affiliation(s)
- María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, Salamanca, Spain Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain Urology Service of the University Hospital of Salamanca, Salamanca, Spain
| | | | - Magaly Márquez-Sánchez
- Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, Alfonso X el sabio Campus Miguel de Unamuno, Salamanca, 37008, Spain
| | - Ignacio González-Casado
- Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain
| | | | - Sebastián Valverde-Martínez
- Department of Surgery, University of Salamanca, Salamanca, Spain Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain Department of Urology of University Hospital of Avila, Spain
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Li D, Yan Sun W, Fu B, Xu A, Wang Y. Lipocalin-2-The myth of its expression and function. Basic Clin Pharmacol Toxicol 2019; 127:142-151. [PMID: 31597008 DOI: 10.1111/bcpt.13332] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/19/2019] [Indexed: 01/01/2023]
Abstract
Lipocalin-2 is a functional biomarker for acute and chronic kidney diseases, heart failure and obesity-related medical complications. It is rapidly induced in epithelial cells under stress conditions, but constitutively produced from pre-adipocytes and mature adipocytes. Measuring the lipocalin-2 levels represents an effective approach for risk prediction, patient stratification and disease management. Nevertheless, due to ligand-binding, post-translational modification and protein-protein interaction, lipocalin-2 exists as multiple variants that elicit different pathophysiological functions. To characterize the specific structure-functional relationships of lipocalin-2 variants is critical for the development of biomarker assays with sufficient precision and reliability. Moreover, identifying the pathological forms of lipocalin-2 will provide new therapeutic targets and treatment approaches for obesity-related complications.
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Affiliation(s)
- Dahui Li
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Yan Sun
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Bowen Fu
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Aimin Xu
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Yu Wang
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
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