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1.
Environ Pollut ; 256: 113334, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31677874

RESUMO

The goal of this study was to assess biomarkers of exposure to glyphosate and assess potential associations with renal function in children. Glyphosate is used ubiquitously in agriculture worldwide. While previous studies have indicated that glyphosate may have nephrotoxic effects, few have examined potential effects on kidney function in children. We leveraged three cohorts across different phases of child development and measured urinary levels of glyphosate. We evaluated associations of glyphosate with three biomarkers of kidney injury: albuminuria (ACR), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury marker 1 (KIM-1). Multivariable regression analyses examined associations of glyphosate with kidney injury biomarkers controlling for covariates. We identified glyphosate in 11.1% of the total participants. The herbicide was detected more frequently in the neonate population (30%). Multivariable regression models failed to identify significant associations of log-transformed glyphosate with any of the kidney injury biomarkers, controlling for covariates age, sex, and maternal education. While we confirm detectability of glyphosate in children's urine at various ages and stages of life, there is no evidence in this study for renal injury in children exposed to low levels of glyphosate. Further studies of larger sample size are indicated to better understand putative deleterious effects of the herbicide after different levels of exposure.


Assuntos
Exposição Ambiental/análise , Poluentes Ambientais/urina , Glicina/análogos & derivados , Nefropatias/urina , Biomarcadores/urina , Criança , Pré-Escolar , Estudos de Coortes , Creatinina/urina , Estudos Transversais , Feminino , Glicina/urina , Receptor Celular 1 do Vírus da Hepatite A/análise , Humanos , Lactente , Recém-Nascido , Nefropatias/epidemiologia , Lipocalina-2/urina , Estudos Longitudinais , Masculino , Prevalência , Albumina Sérica Humana/urina
2.
Ann Lab Med ; 40(2): 131-141, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31650729

RESUMO

BACKGROUND: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. METHODS: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. RESULTS: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01-1.14]), Interleukin-6 (1.51 [1.01-2.26]), midkine (1.01 [1.00-1.02]), 1-hepcidin-25 (1.08 [1.00-1.17]), and NGAL/hepcidin-ratio (2.91 [1.30-6.49]) were independent predictors of MAKE and AKI (1.38 [1.03-1.85], 1.08 [1.01-1.15], 1.01 [1.00-1.02], 1.09 [1.01-1.18], and 3.45 [1.54-7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. CONCLUSIONS: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The combination of biomarkers with hepcidin-25 may further improve diagnostic discrimination.


Assuntos
Lesão Renal Aguda/diagnóstico , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Lipocalina-2/urina , Lesão Renal Aguda/etiologia , Idoso , Área Sob a Curva , Feminino , Humanos , Interleucina-6/urina , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença
3.
J Immunol Res ; 2019: 5063089, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637265

RESUMO

Objectives: As a screening index of diabetic kidney disease (DKD), urinary albumin/creatine ratio (UACR) is commonly used. However, approximately 23.3%-56.6% of DKD patients with estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2 are normoalbuminuric. Thus, urinary biomarkers of nonalbuminuric renal insufficiency in type 2 diabetes mellitus (T2DM) patients are urgently needed. Methods: This cross-sectional study enrolled 209 T2DM patients with normoalbuminuria whose diabetes duration was more than 5 years. The patients were classified into two groups, NO-CKD (eGFR ≥ 60 ml/min per 1.73 m2, n = 165) and NA-DKD (eGFR < 60 ml/min per 1.73 m2, n = 44). Levels of urinary neutrophil gelatinase-associated lipocalin (NGAL), retinol-binding protein (RBP), plasminogen activator inhibitor-1 (PAI-1), vascular cell adhesion molecule-1 (VCAM-1), and E-cadherin were detected, and their correlations with eGFR, plasma TNF-α, IL-6, endothelin-1 (ET-1), and 8-hydroxydeoxyguanosine (8-OHdG) were assessed. Results: Among patients with renal insufficiency, 26.0% was normoalbuminuric. Compared to the NO-CKD group, the NA-DKD group was older with lower hemoglobin (HB) levels and higher systolic blood pressure (SBP), plasma TNF-α, IL-6, and 8-OHdG levels. Logistic regression analysis suggested that age, TNF-α, and 8-OHdG were independent risk factors for nonalbuminuric renal insufficiency. Compared to the NO-CKD group, the NA-DKD group exhibited significant increases in urinary NGAL and RBP levels but not PAI-1, VCAM-1, and E-cadherin. Urinary NGAL and RBP both correlated negatively with eGFR and positively with plasma IL-6 and 8-OHdG. Multiple linear regression indicated NGAL (ß = -0.287, p = 0.008) and RBP (ß = -44.545, p < 0.001) were independently correlated with eGFR. Conclusion: Age, plasma TNF-α, and 8-OHdG are independent risk factors for renal insufficiency in T2DM patients with normoalbuminuria. Urinary NGAL and RBP can serve as noninvasive biomarkers of normoalbuminuric renal insufficiency in T2DM.


Assuntos
Albuminúria/metabolismo , Biomarcadores/urina , Diabetes Mellitus Tipo 2/fisiopatologia , Lipocalina-2/urina , Insuficiência Renal/urina , Proteínas de Ligação ao Retinol/urina , Idoso , Nefropatias Diabéticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Ann Hematol ; 98(12): 2653-2660, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31641850

RESUMO

Sickle cell disease (SCD) is a hereditary condition characterized by homozygosis of the hemoglobin S (HbS) gene. Marked morbimortality is observed due to chronic hemolysis, endothelial injury, and episodes of vaso-occlusion, which leads to multi-organ damage. Renal impairment is common and may have different presentations, such as deficiency in urinary acidification or concentration, glomerulopathies, proteinuria, and hematuria, frequently resulting in end-stage renal disease (ESRD). Novel biomarkers of renal function, such as kidney injury molecule 1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein 1 (MCP-1) are being studied in order to enable early diagnosis of kidney damage in SCD.


Assuntos
Anemia Falciforme/urina , Quimiocina CCL2/urina , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Falência Renal Crônica/urina , Rim/metabolismo , Lipocalina-2/urina , Anemia Falciforme/complicações , Biomarcadores/urina , Humanos , Falência Renal Crônica/etiologia
5.
Top Spinal Cord Inj Rehabil ; 25(3): 214-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548788

RESUMO

Objective: To evaluate whether urinary antimicrobial peptides (AMPs) can discriminate between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in pediatric patients with neurogenic bladder (NGB). Design/Methods: Bladder urine was collected from pediatric patients (≤18 years old) with NGB without augmentation cystoplasty. Patients were divided into the following groups based on symptomatology and results of urinalysis/urine culture: (a) UTI, (b) ASB, and (c) sterile. Urine AMPs ß defense 1 (BD-1), neutrophil gelatinase-associated lipocalin (NGAL), cathelicidin (LL-37), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), and human α defensin 5 (HD-5) were compared between groups by enzyme-linked immunosorbent assays. In addition, urines from pediatric controls without NGB or UTI were also analyzed. Significance was determined using Student's t test for parametric or Mann-Whitney U test for nonparametric data. A p value of <.05 was considered significant. Results: Thirty-six patients with NGB from a spinal dysraphism were evaluated: UTI, n = 6; ASB, n = 18; sterile, n = 12. These groups did not differ significantly by age but did significantly differ by gender (p = .0139). NGAL significantly differed between UTI and ASB groups (median 38.5 ng/mg vs 15.5 ng/mg, respectively; p = .0197) with a sensitivity and specificity of 82.4% and 83.3%, respectively. HIP/PAP, BD-1, HD-5, LL-37, and NGAL levels were all significantly higher in sterile NGB urines compared to 17 non-NGB pediatric controls (p < .0001, p = .0020, p = .0035, p = .0006, and p = .0339, respectively). Conclusion: All five urinary AMPs evaluated were significantly elevated in NGB patients compared to controls. NGAL levels may help differentiate between UTI and ASB in pediatric NGB patients.


Assuntos
Infecções Assintomáticas , Bacteriúria/diagnóstico , Biomarcadores/urina , Lipocalina-2/urina , Bexiga Urinaria Neurogênica/diagnóstico , Infecções Urinárias/urina , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino
7.
BMC Vet Res ; 15(1): 306, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455336

RESUMO

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), a promising renal biomarker, can exists as a monomer, a dimer and/or in a NGAL/matrix metalloproteinase-9 (MMP-9) complex form when associated with different urinary diseases in humans and dogs. In this study, the presence of the various different molecular forms of NGAL in cat urine (uNGAL) was examined and whether these forms are correlated with different urinary diseases was explored. RESULTS: One hundred and fifty-nine urine samples from cats with various different diseases, including acute kidney injury (AKI, 22 cats), chronic kidney disease (CKD, 55 cats), pyuria (44 cats) and other non-renal and non-pyuria diseases (non-RP, 26 cats), as well as healthy animals (12 cats), were collected. The molecular forms of and concentrations of urinary NGAL in these cats were analyzed, and their uNGAL-to-creatinine ratio (UNCR) were determined. The cats with AKI had the highest UNCR (median: 2.92 × 10- 6), which was followed by pyuria (median: 1.43 × 10- 6) and CKD (median: 0.56 × 10- 6); all of the above were significantly higher than the healthy controls (median: 0.17 × 10- 6) (p < 0.05). Three different NGAL molecular forms as well as the MMP-9 monomer were able to be detected in the cat urine samples. Moreover, the cases where urine NGAL monomer were present also had significantly higher levels of BUN (median: 18.9 vs 9.6 mmol/L) and creatinine (327.1 vs 168 umol/L). The presence of dimeric NGAL was found to be associated with urinary tract infections. Most cats in the present study (126/159, 79.2%) and more than half of healthy cats (7/12, 58.3%) had detectable NGAL/MMP-9 complex present in their urine. CONCLUSIONS: The monomeric and dimeric molecular forms of uNGAL suggest upper and lower urinary tract origins of disease, respectively, whereas the presence of the uNGAL/MMP-9 complex is able to be detected in most cats, including seemingly healthy ones.


Assuntos
Doenças do Gato/urina , Lipocalina-2/urina , Doenças Urológicas/veterinária , Animais , Biomarcadores/urina , Gatos , Lipocalina-2/química , Lipocalina-2/classificação , Isoformas de Proteínas/urina , Doenças Urológicas/urina
8.
Int J Mol Sci ; 20(15)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366007

RESUMO

Acute kidney injury (AKI) is a serious complication of acute pancreatitis (AP), which occurs in up to 70% of patients with severe AP and significantly increases the risk of mortality. At present, AKI is diagnosed based on dynamic increase in serum creatinine and decreased urine output; however, there is a need for earlier and more accurate biomarkers. The aim of the study was to review current evidence on the laboratory tests that were studied as the potential biomarkers of AKI in AP. We also briefly summarized the knowledge coming from the studies including sepsis or ICU patients since severe acute pancreatitis is associated with systemic inflammation and organ failure. Serum cystatin C and serum or urine NGAL have been shown to predict or diagnose AKI in AP; however, this evidence come from the single center studies of low number of patients. Other markers, such as urinary kidney injury molecule-1, cell cycle arrest biomarkers (tissue inhibitor metalloproteinase-2 and urine insulin-like growth factor-binding protein 7), interleukin-18, liver-type fatty acid-binding protein, or calprotectin have been studied in other populations suffering from systemic inflammatory states. In AP, the potential markers of AKI may be significantly influenced by either dehydration or inflammation, and the impact of these factors may be difficult to distinguish from kidney injury. The subject of AKI complicating AP is understudied. More studies are needed, for both exploratory (to choose the best markers) and clinical (to evaluate the diagnostic accuracy of the chosen markers in real clinical settings).


Assuntos
Lesão Renal Aguda/sangue , Pancreatite/sangue , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Biomarcadores/sangue , Biomarcadores/urina , Cistatina C/sangue , Humanos , Complexo Antígeno L1 Leucocitário/sangue , Lipocalina-2/sangue , Lipocalina-2/urina , Pancreatite/complicações , Pancreatite/urina , Inibidor Tecidual de Metaloproteinase-2/sangue
9.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266271

RESUMO

OBJECTIVES: Acute kidney injury (AKI) secondary to nephron-sparing surgery represents a significant problem in order to preserve renal function. Since serum creatinine alone underestimates the early detection of AKI several biomarker have been investigated. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is considered a good biomarker for AKI. MATERIALS AND METHODS: We report our experience in 28 patients affected by localized renal cell carcinoma and submitted to robot-assisted partial nephrectomy (RAPN). In each patient selective urinary NGAL levels were dosed before surgery, then 2 and 48 hours after the procedure, through a ureteral catheter inserted into the excretory axis of the operated kidney. Moreover, we evaluated split renal function of the preserved renal parenchyma by a 99mTC-DTPA renal scintigraphy, performed before surgery and three months later. RESULTS: AKI was diagnosed, according to internationally criteria, in 3 patients (10.7%). The baseline selective urinary NGAL level was 20.02 ng/ml. This level significantly increased after surgery with a selective urinary NGAL level that reached 56.36 ng/ml (p < 0.0001). Moreover, a significant reduction in 99mTC-DTPA clearance of the operated kidneys after three months was detected (p < 0.0001). CONCLUSIONS: Selective urinary NGAL assay represent a sensitive biomarker of acute kidney injury after robotic nephron sparing surgery, capable of predicting the functional outcome of the operated kidney.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Feminino , Humanos , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Blood Purif ; 48(3): 243-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31330511

RESUMO

BACKGROUND: Restart of renal replacement therapy (RRT) after initial discontinuation of continuous RRT (CRRT) is frequently needed. The aim of the present study was to evaluate whether renal markers after discontinuation of CRRT can predict restart of RRT within 90 days. METHODS: Prospective multicenter observational study in 90 patients, alive, still on the intensive care unit at day 2 after discontinuation of CRRT for expected recovery with urinary neutrophil gelatinase-associated lipocalin (NGAL) available. The endpoint was restart of RRT within 90 days. Baseline and renal characteristics were compared between outcome groups no restart or restart of RRT. Logistic regression and receiver operator characteristic curve analysis were performed to determine the best predictive and discriminative variables. RESULTS: Restart of RRT was needed in 32/90 (36%) patients. Compared to patients not restarting, patients restarting RRT demonstrated a higher day 2 urinary NGAL, lower day 2 urine output, and higher incremental creatinine ratio (day 2/0). In multivariate analysis, only incremental creatinine ratio (day 2/0) remained independently associated with restart of RRT (OR 5.28, 95% CI 1.45-19.31, p = 0.012). The area under curve for incremental creatinine ratio to discriminate for restart of RRT was 0.76 (95% CI 0.64-0.88). The optimal cutoff was 1.49 (95% CI 1.44-1.62). CONCLUSION: In this prospective multicenter study, incremental creatinine ratio (day 2/0) was the best predictor for restart of RRT. Patients with an incremental creatinine ratio at day 2 of 1.5 times creatinine at discontinuation are likely to need RRT within 90 days. These patients might benefit from nephrological follow-up.


Assuntos
/métodos , Terapia de Substituição Renal/métodos , Idoso , Biomarcadores/urina , Creatinina/análise , Feminino , Humanos , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Suspensão de Tratamento
11.
J Cardiothorac Surg ; 14(1): 107, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196131

RESUMO

BACKGROUND: Acute kidney injury after cardiac surgery is common and associated with increased mortality. It is unknown whether an intended higher arterial pressure during cardiopulmonary bypass reduces the incidence of acute and chronic kidney injury. METHODS: Patients were randomised either to a control group or a high pressure group (arterial pressure > 60 mmHg). The inclusion criteria were age > 70 years, combined cardiac surgery and serum creatinine < 200 µmol/L. Glomerular filtration rate using the Cr-EDTA clearance method was measured the day before surgery and 4 months postoperatively. The RIFLE criteria were used to define the presence of acute kidney injury. In addition, the ratio between urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and creatinine was measured. RESULTS: Ninety patients were included. Mean age was 76 ± 4 years and 76% were male. Mean arterial pressure was 47 ± 5 mmHg in the control group and 61 ± 4 mmHg in the high pressure group (p < 0.0001). The change in glomerular filtration rate at follow-up was - 9 ± 12 ml/min in the control group and - 5 ± 16 ml/min in the high pressure group (p = 0.288, 95% CI - 13 to 4). According to the RIFLE criteria 38% in the control group and 46% in the high pressure group developed acute kidney injury (p = 0.447). The postoperative urinary NGAL/creatinine ratio was comparable between the groups. CONCLUSIONS: An intended increase in arterial pressure during cardiopulmonary bypass to > 60 mmHg did not decrease the incidence of acute or chronic kidney injury after cardiac surgery. TRIAL REGISTRATION: Clinicaltrials.gov, identifier: NCT01408420 . Registered 3rd of August 2011.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Pressão Arterial , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Creatinina/urina , Feminino , Taxa de Filtração Glomerular , Humanos , Lipocalina-2/urina , Masculino , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes
12.
Ren Fail ; 41(1): 446-454, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31162999

RESUMO

Objectives: Urine neutrophil gelatinase-associated lipocalin (NGAL) was found to increase in diabetic kidney disease (DKD). However, the clinical value of urine NGAL as diagnostic indicators in DKD remains to be clarified. Methods: Relevant studies were systematically retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. Stratified analyses and regression analyses were performed. Results: Fourteen studies with 1561 individuals were included in our analysis, including 1204 cross-sectional participants and 357 cohort participants. For the cross-sectional studies, the pooled sensitivity and specificity of NGAL in the diagnosis of DKD were 0.82 (95% confidence interval (CI): 0.75-0.87) and 0.81 (95% CI: 0.68-0.90), respectively. The pooled diagnostic odds ratio was 19 (95% CI: 11-33), and the overall area under the curve was 0.88 (95% CI: 0.84-0.90). For the cohort studies, the pooled sensitivity and specificity of NGAL in the diagnosis of DKD were 0.96 (95% CI: 0.91-0.98) and 0.89 (95% CI: 0.84-0.92), respectively. The overall area under the curve was 0.98, indicating good discriminative ability of NGAL as biomarkers for DKD. Conclusions: Urine NGAL, as the early diagnostic marker of DKD, might have the high diagnostic value, especially in cohort studies.


Assuntos
Nefropatias Diabéticas/diagnóstico , Lipocalina-2/urina , Adolescente , Adulto , Idoso , Biomarcadores/urina , Criança , Estudos de Coortes , Estudos Transversais , Nefropatias Diabéticas/urina , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Sensibilidade e Especificidade
13.
J Obstet Gynaecol ; 39(7): 991-995, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31177884

RESUMO

This study was designed to explore matrix metalloproteinase-9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) levels and MMP-9/NGAL ratio in women with and without endometriosis diagnosed surgically and/or histopathologically. The correlation between biomarkers and the severity of the disease is analysed. The revised American Fertility Society classification system was used to determine the severity of endometriosis. Serum MMP-9 and Ca125, urine NGAL levels were measured in all participants. Serum MMP-9 levels were significantly higher in the study group (n = 60) compared to controls (n = 31) (15.0 pg/mL (6.0-143.0) vs. 12.0 (4.0-18.0), respectively; p=.002). MMP-9 levels were significantly higher in severe endometriosis compared to mild endometriosis subgroups (p<.001). No significant difference was found between NGAL levels in study and control groups (p>.05). The diagnostic value of MMP-9 and NGAL is not superior than CA-125 for endometriosis. Nevertheless, MMP-9 might be a potential predictive marker for advanced stage of the disease. Impact Statement What is already known on this subject? The gold standard diagnostic test for diagnosis of endometriosis is laparoscopy combined with histopathological confirmation of eutopic endometrial glands and/or stroma. Both invasiveness and possible accompanying complications limit the preference regarding the surgical approach. Among non-invasive markers none has been accepted as gold standard neither for diagnosis nor for determining the severity of the disease. MMPs are extracellular endopeptidases, which have a significant role in degradation and remodelling of extracellular matrix for cellular migration and invasion. Among these, MMP-9 has been shown to be higher in eutopic/ectopic endometrial tissue in women with endometriosis and has been suggested to have a role in pathogenesis of endometriosis by promoting invasion of the endometriotic lesions. NGAL is an acute phase protein, which is involved in a variety of physiological and pathophysiological processes. The molecule has also been revealed to correlate with endometriosis pathophysiology through the epithelial-mesenchymal transition process which is the basis for the onset of endometriosis. But also, NGAL which composes a complex with MMP-9 (MMP-9 and NGAL complex), has been shown to protect MMP-9 from autodegradation in vitro which might be a contributing factor for endometriosis pathophysiology. What the results of this study add? MMP-9 cut-off level for prediction of severe endometriosis is a novel finding obtained from this study with acceptable sensitivity and specificity. On the other hand, NGAL seems to have no significant value either for diagnosis of for determining severity of the disease. After all, MMP-9 might be an easy use acceptable biomarker for endometriosis but further studies on larger populations are needed. What the implications are of these findings for clinical practice and/or further research? MMP might be a potential non-invasive predictive marker for advanced stage disease.


Assuntos
Endometriose/enzimologia , Lipocalina-2/urina , Metaloproteinase 9 da Matriz/sangue , Adulto , Biomarcadores/sangue , Biomarcadores/urina , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos
14.
Iran J Kidney Dis ; 13(3): 191-197, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31209192

RESUMO

INTRODUCTION: Contrast-induced Acute Kidney Injury (CI-AKI) is a prevalent complication of chronic kidney disease (CKD) patients. The aim of this study was to evaluate the effects of periprocedural administration of trimetazidine as an anti-oxidant agent on the incidence of CI-AKI in CKD patients based on changes of Neutrophil Gelatinase-Associated Lipocalin (uNGAL) level, which has recently been introduced as an early predictor of CI-AKI. METHODS: One hundred CKD patients with a mean GFR of 50 ± 7 cc/min who were candidate for coronary angiography assigned randomly to receive (50 patients, intervention group) or not receive (50 patients, control group) trimetazidine (70mg/d) for 72 hours. CI-AKI was defined as 0.5 mg or 25% increase in serum creatinine. We also checked uNGAL before and 12h after angiography. RESULTS: Serum creatinine, showed a trend of less increment in the case group, although could not achieve a significant difference, there was a significant difference in urinary NGAL rise between two groups. CI-AKI was defined as 1.7 times increase in uNGAL level (12h after angiography to pre-procedurally uNGAL level ratio) according to the ROC curves. The incidence of CI-AKI according to urinary NGAL definition was 8% in the Trimetazidine group and 24% in the control group (P < .05). CONCLUSION: We concluded that Trimetazidine treatment before angiography may be effective in CI-AKI prevention. Moreover, it is shown that 1.7 times increase in urine NGAL after angiography is a valuable cut off point for clinicians to discriminate high risk patients for contrast nephropathy.


Assuntos
Lesão Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Lipocalina-2/urina , Insuficiência Renal Crônica/complicações , Trimetazidina/uso terapêutico , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/urina , Angiografia Coronária/efeitos adversos , Creatinina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Método Simples-Cego
15.
Clin Chim Acta ; 495: 552-555, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31175848

RESUMO

BACKGROUND: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for predicting acute kidney injury (AKI). The purpose of this study was to evaluate the diagnostic performance of urinary NGAL in predicting AKI in sepsis patients in the emergency department. METHODS: A total of 140 patients were enrolled. We compared serum procalcitonin and urinary NGAL concentrations between patients with local infection, sepsis, and septic shock, and between patients who did and did not develop AKI with sepsis. Receiver-operating characteristic curve analysis was used to evaluate the ability to predict AKI in sepsis patients. RESULTS: Both serum procalcitonin and urinary NGAL concentrations were significantly higher in the sepsis and septic shock groups than in the local infection group (both p < 0.001). In sepsis patients, serum procalcitonin and urinary NGAL concentrations were higher in AKI patients than in those without AKI (p = 0.006, p < 0.001, respectively). The area under the curve for predicting of AKI was higher for a urinary NGAL of 0.820 (95% confidence interval (CI) 0.721-0.895) than for a serum procalcitonin concentration of 0.76 (95% CI 0.597-0.800). CONCLUSION: Urinary NGAL concentration may predict AKI in patients with sepsis in the emergency department.


Assuntos
Lesão Renal Aguda/complicações , Lesão Renal Aguda/urina , Serviço Hospitalar de Emergência , Lipocalina-2/urina , Sepse/complicações , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Prognóstico , Curva ROC
16.
Ann Transplant ; 24: 291-297, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31110167

RESUMO

Acute kidney injury (AKI) is a frequent and serious complication of orthotopic liver transplantation (OLT), with a significant impact on mortality, graft survival, and chronic kidney disease. Currently, the diagnosis of AKI is based on changes in serum creatinine, which is a late marker, usually rising when there is already significant damage to the renal parenchyma. During the last 2 decades, various biomarkers have been studied in many clinical situations, mostly after cardiac surgery, in drug-induced AKI, or in sepsis. The present article summarizes the data on those biomarkers that have been evaluated for the prediction of AKI in patients undergoing OLT.


Assuntos
Lesão Renal Aguda/diagnóstico , Proteínas de Ligação a Ácido Graxo/metabolismo , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Interleucina-18/metabolismo , Lipocalina-2/metabolismo , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Biomarcadores/sangue , Biomarcadores/urina , Proteínas de Ligação a Ácido Graxo/sangue , Proteínas de Ligação a Ácido Graxo/urina , Humanos , Interleucina-18/sangue , Interleucina-18/urina , Lipocalina-2/sangue , Lipocalina-2/urina , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina , Fatores de Risco
17.
Hypertens Pregnancy ; 38(3): 157-162, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31140344

RESUMO

Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis. Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA). Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively. Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.


Assuntos
Lipocalina-2/urina , Pré-Eclâmpsia/diagnóstico , Adulto , Biomarcadores/urina , Estudos de Casos e Controles , Feminino , Humanos , Pré-Eclâmpsia/urina , Gravidez , Turquia
18.
J Clin Lab Anal ; 33(6): e22907, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062866

RESUMO

BACKGROUND: Acute kidney injury (AKI) has become a common complication of acute ischemic stroke (AIS) and may have a significant impact on the clinical outcomes. Neutrophil gelatinase-associated lipocalin (NGAL), an acute phase protein, has been identified as a novel biomarker for acute kidney impairment. Here, we studied the early expression of NGAL in AIS patients with AKI and its clinic value in predicting and diagnosis of AKI after stroke. METHODS: A total of 205 subjects diagnosed as first-ever AIS were recruited in this study, including 40 AIS with AKI and 165 AIS without AKI defined using the KDIGO guidelines. The serum and urine levels of NGAL were measured with ELISA. To evaluate the clinic value of NGAL, we also detected creatinine, urea nitrogen and cystatin C and microalbumin (mALB) in serum or urine using chemiluminescence or immunoturbidimetry method, and then the receiver operating characteristic (ROC) curve and correlation was analyzed. The severity of AIS patients was evaluated based on the National Institutes of Health Stroke Scale (NIHSS) score. RESULTS: The serum and urine NGAL levels were significantly increased in AIS patients with AKI, and line regression analysis indicated that there was a positive correlation between the serum NGAL and creatinine level in AIS patients accompanied AKI. Additionally, the concentration of serum NGAL in AIS patients with AKI increased with the severity of stroke. CONCLUSION: The increased serum NGAL may be used as a valuable complementary marker for the diagnoses and prediction of AKI in the early stage of AIS patients.


Assuntos
Lesão Renal Aguda/etiologia , Isquemia Encefálica/complicações , Lipocalina-2/sangue , Lipocalina-2/urina , Acidente Vascular Cerebral/complicações , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Idoso , Biomarcadores/sangue , Isquemia Encefálica/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/sangue
19.
Curr Pharm Des ; 25(10): 1122-1133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096894

RESUMO

BACKGROUND: High global incidence of acute kidney injury (AKI) is an observable complication in critically ill patients. Long-term disease and medication complexity contribute to devastating chronic kidney disease (CKD), diminishing quality of life. OBJECTIVES: To establish new biomarkers to guide patient care and facilitate novel therapeutics development. METHODS: Serum and urinary levels of creatinine, CysC, and NGAL were estimated in 86 renal patients and compared with healthy controls for AKI and CKD categorization. Creatinine and CysC measurements were used to estimate GFR. Kidney biopsies were prepared for light microscopy for further characterization. Patients' demographic data were used in group association studies. RESULTS: Thirty-six patients met the criteria for AKI and 50 for CKD. Both mean serum and urine creatinine levels were significantly elevated by 2.8 and 2.6, respectively, from baseline in 48 h in the AKI group but not CKD group. Mean serum Cystatin C (CysC) values were higher than controls but similar in both disease states, while urine levels were slightly higher in CKD patients, and remained steady by the end of the follow-up (EF-Up). Further, a significant 2.9-fold and 5.5-fold (p=0.001) increase in serum NGAL in AKI and CKD, respectively, and a dramatic 7.1-factor reduction in AKI group, but no appreciable change in the CKD group from admission to EF-Up were observed. Similarly, urine NGAL level for AKI and CKD increased 3.2-fold and 6-fold respectively, on admission, which decreased moderately with the AKI group (2.5-fold) but increased by a factor of 1-8 (10.7- fold; p=0.001) at EF-Up. ROC assessment curve revealed relatively higher NGAL performance at good predictive values than CysC (p < 0.009). CONCLUSION: Our data demonstrated creatinine elevation by a factor > 2 in 48 h in AKI group but not CKD group, which returned close to normal levels by the EF-Up, an indication of abrupt renal injury in AKI, compared with a persistent effect in the CKD group. Both serum and urine NGAL sensitivity and specificity provided powerful discriminative tool between AKI and CKD by reduction in the AKI group and an increase in the CKD group by the EF-UP, thus, contributing in establishing the basis for AKI and CKD classification. CysC, however, displayed less sensitivity than NGAL, indicating effects by enigmatic non-specific factors.


Assuntos
Lesão Renal Aguda/diagnóstico , Cistatina C/sangue , Cistatina C/urina , Lipocalina-2/sangue , Lipocalina-2/urina , Insuficiência Renal Crônica/diagnóstico , Biomarcadores/sangue , Biomarcadores/urina , Estudos de Casos e Controles , Humanos
20.
Med Sci Monit ; 25: 3668-3675, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31100058

RESUMO

BACKGROUND Neutrophil gelatinase-associated lipocalin plays an important role in renal dysfunctions. The objective of this study was to test the hypothesis that indomethacin used in treating patent ductus arteriosus protects infants from renal dysfunction. MATERIAL AND METHODS This prospective cohort study assessed data on urine prostaglandin metabolites, urinary neutrophil gelatinase-associated lipocalin, and the renal functions of preterm infants with confirmed patent ductus arteriosus who had been injected with indomethacin (n=144, ID group) or acetaminophen (n=144, AP group). RESULTS A reduction of neutrophil gelatinase-associated lipocalin in urine samples was found in the ID group (993±48 µG/L vs. 103±5 µG/L, p<0.0001). The reduction in prostaglandin (673±32 pg/mL vs. 139±7 pg/mL, p<0.0001) and the closure of ductus (2.64±0.89 mm vs. 2.31±0.81 mm, p=0.001) were found in the ID group after the first dose of indomethacin, but the closure of ductus (2.47±0.54 mm vs. 2.32±0.55 mm, p=0.02) and prostaglandin reduction (667±31 pg/mL vs. 129±7 pg/mL, p<0.0001) were found after the second dose of acetaminophen. Indomethacin had greater effect in reducing the risk of acute kidney injury than did acetaminophen (p=0.042). CONCLUSIONS Indomethacin treatment used in treating patent ductus arteriosus protects infants from renal dysfunction.


Assuntos
Lesão Renal Aguda/prevenção & controle , Permeabilidade do Canal Arterial/tratamento farmacológico , Indometacina/uso terapêutico , Acetaminofen/uso terapêutico , China , Estudos de Coortes , Feminino , Humanos , Indometacina/farmacologia , Recém-Nascido , Recém-Nascido Prematuro/metabolismo , Doenças do Prematuro/tratamento farmacológico , Lipocalina-2/análise , Lipocalina-2/urina , Masculino , Estudos Prospectivos , Prostaglandinas/análise , Prostaglandinas/urina , Resultado do Tratamento
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