SerpinA3 in the Early Recognition of Acute Kidney Injury to Chronic Kidney Disease (CKD) transition in the rat and its Potentiality in the Recognition of Patients with CKD.

Recognizing patients at early phases of chronic kidney disease (CKD) is difficult, and it is even more challenging to predict acute kidney injury (AKI) and its transition to CKD. The gold standard to timely identify renal fibrosis is the kidney biopsy, an invasive procedure not usually performed for this purpose in clinical practice. SerpinA3 was identified by high-resolution-mass-spectrometry in urines from animals with CKD. An early and progressive elevation of urinary SerpinA3 (uSerpinA3) was observed during the AKI to CKD transition together with SerpinA3 relocation from the cytoplasm to the apical tubular membrane in the rat kidney. uSerpinA3/alpha-1-antichymotrypsin was significantly increased in patients with CKD secondary to focal and segmental glomerulosclerosis (FSGS), ANCA associated vasculitis (AAV) and proliferative class III and IV lupus nephritis (LN). uSerpinA3 levels were independently and positively associated with renal fibrosis. In patients with class V LN, uSerpinA3 levels were not different from healthy volunteers. uSerpinA3 was not found in patients with systemic inflammatory diseases without renal dysfunction. Our observations suggest that uSerpinA3 can detect renal fibrosis and inflammation, with a particular potential for the early detection of AKI to CKD transition and for the differentiation among lupus nephritis classes III/IV and V.

Crossed-immunoelectrophoresis analysis of the urinary excretion of alpha 1-acid glycoprotein, alpha 1-antitrypsin, albumin, and transferrin in normal subjects and in patients with renal disease.

Urinary excretion of four plasma proteins having molecular weights between 44,100 and 90,000 daltons was studied by two-dimensional immunoelectrophoresis in normal individuals and in patients with different kinds of renal pathology. The proteins studied were: alpha 1-acid glycoprotein, 44,100 molecular weight (MW) and pH 2.7 isoelectric point (IP); alpha 1-antitrypsin, 54,000 MW and 4.0 IP; albumin, 69,000 MW and 4.9 IP; and transferrin, 90,000 MW and 5.6 IP. The proteins were measured in urine with an oligospecific serum produced by the immunization of rabbits with the 4S fraction obtained from normal human plasma by gel filtration on Sephadex G-200. The increase in urinary excretion of these proteins observed both among glomerulopathic and tubulopathic patients did not correlate with MW. Mean renal albumin excretion was 2.9 mg/24 h among normal individuals, 87.38 mg/24 h among patients with tubulopathy, and 3,228 mg/24 among patients with glomerulopathy. Among patients with glomerulopathy, there was a direct correlation between the increased excretion of these proteins and their IP, except for alpha 1-acid glycoprotein.