Therapeutic and predictive targets of AKI.

Acute kidney injury (AKI) is a very common condition encountered in a hospital setting. AKI is an independent risk factor for in-hospital mortality. In this review, we discuss in detail about the tubular, inflammatory and vascular molecular targets of AKI which may result in therapies to improve mortality and biomarkers for earlier diagnosis of AKI.

HIV-associated nephropathy in Caucasians: case report and review of literature.

HIV-associated nephropathy (HIVAN) is almost exclusively seen in African-Americans (AA) and is rare in Caucasians. The mechanisms responsible for the predilection of HIVAN in AA are not well understood. In transgenic mouse studies, genetic background plays a vital role in the development of the HIVAN phenotype. Larger studies in humans have been initiated to study genetic polymorphisms responsible for HIVAN. As our case illustrates, HIVAN should be considered in Caucasian patients with HIV infection complicated by nephrotic syndrome and renal failure.

Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review.

The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, but such measurements are a poor marker of acute deterioration in kidney function. We performed a systematic review of publications that evaluated the accuracy and reliability of serum and urinary biomarkers in human subjects when used for the diagnosis of established AKI or early AKI, or to risk stratify patients with AKI. Two reviewers independently searched the MEDLINE and EMBASE databases (January 2000-March 2007) for studies pertaining to biomarkers for AKI. Studies were assessed for methodologic quality. In total, 31 studies evaluated 21 unique serum and urine biomarkers. Twenty-five of the 31 studies were scored as having 'good' quality. The results of the studies indicated that serum cystatin C, urine interleukin-18 (IL-18), and urine kidney injury molecule-1 (KIM-1) performed best for the differential diagnosis of established AKI. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin, IL-18, glutathione-S-transferase-pi, and gamma-glutathione-S-transferase performed best for early diagnosis of AKI. Urine N-acetyl-beta-D-glucosaminidase, KIM-1, and IL-18 performed the best for mortality risk prediction after AKI. In conclusion, published data from studies of serum and urinary biomarkers suggest that biomarkers may have great potential to advance the fields of nephrology and critical care. These biomarkers need validation in larger studies, and the generalizability of biomarkers to different types of AKI as well as the incremental prognostic value over traditional clinical variables needs to be determined.

Obesity as an independent predictor of posttransplant diabetes mellitus.

BACKGROUND: In the general population, there is a clear association between obesity and type 2 diabetes mellitus. However, the evidence of relationship between body mass index (BMI: weight/height(2)) and the risk of posttransplant diabetes mellitus (PTDM) is inconsistent when studied at a level of single center. The aim of our study was to determine if pretransplant BMI is an independent risk factor for PTDM at our center and to demonstrate the pattern of weight gain in patients who develop PTDM. METHODS: This is a retrospective analysis of renal allograft recipients at University of Colorado Hospital. The medical records of patients who received a kidney transplant from January 1998 to March 2001 were screened to identify the cases of PTDM. Controls were matched for immunosuppressive regimen, gender, and type of donor. A total of 18 cases and 36 controls were identified. RESULTS: The incidence of PTDM in our transplant population was 10%. Of these cases, 72% developed PTDM in the first 2 months after transplant, and 38% of them required insulin. On multivariate analysis, BMI was significantly associated with PTDM (adjusted odds ratio 1.22, 95% confidence interval 1.04-1.42) while controlling for number of rejections, age, and other factors. We also noticed that weight gain was significantly lower in patients who developed PTDM after transplantation. CONCLUSIONS: We conclude that obesity is an independent predictor of PTDM. The weight gain was significantly poor among patients who developed PTDM. Among all the risk factors for PTDM, obesity is the only modifiable risk factor before transplantation. Obese patients should be treated with a less diabetogenic immunosuppressive regimen and be counseled to lose weight before transplant.