Kidney international
-
Kidney international · Apr 2015
Necroptosis and parthanatos are involved in remote lung injury after receiving ischemic renal allografts in rats.
Early renal graft injury could result in remote pulmonary injury due to kidney-lung cross talk. Here we studied the possible role of regulated necrosis in remote lung injury in a rat allogeneic transplantation model. In vitro, human lung epithelial cell A549 was challenged with TNF-α and conditioned medium from human kidney proximal tubular cells (HK-2) after hypothermia-hypoxia insults. ⋯ Acute immune rejection exacerbated the remote lung injury and 3-AB or/and Nec-1 combined with cyclosporine A conferred optimal lung protection. Thus, renal graft injury triggered remote lung injury, likely through regulated necrosis. This study could provide the molecular basis for combination therapy targeting both pathways of regulated necrosis to treat such complications after renal transplantation.
-
Kidney international · Mar 2015
Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.
Biomarker studies for early detection of acute kidney injury (AKI) have been limited by nonselective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. ⋯ The category-free net reclassification index improved with urine L-FABP (total net reclassification index for nonevents 31.0%) and urine NGAL (total net reclassification index for events 33.3%). However, only urine L-FABP significantly improved the integrated discrimination index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP, providing independent and additive prognostic information when combined with clinical predictors.
-
Kidney international · Feb 2015
Randomized Controlled TrialRemote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery.
Acute kidney injury (AKI) is a frequent complication of cardiac surgery and usually occurs in patients with preexisting chronic kidney disease (CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal ischemia-reperfusion injury associated with cardiac surgery and may be a preventive strategy for postsurgical AKI. We undertook a randomized controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated glomerular filtration rate under 60 ml/min per 1.73 m(2)) undergoing coronary artery bypass graft (CABG) surgery. ⋯ AKI developed in 12 patients in both groups within 48 h of CABG. There were no significant differences between the two groups in the concentrations of any of the serum or urinary biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by forearm ischemia-reperfusion had no effect on the frequency of AKI after CABG in patients with CKD.
-
Kidney international · Jan 2015
ReviewThe definition of acute kidney injury and its use in practice.
Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. ⋯ Novel biomarkers may further refine the definition of AKI, but their use will need to produce tangible improvements in outcomes and cost effectiveness. Further developments in AKI definitions should be informed by research into their practical application across health-care providers. This review will discuss the definition of AKI and its use in practice for clinicians and laboratory scientists.
-
Kidney international · Jan 2015
Observational StudySoluble urokinase receptor is a biomarker of cardiovascular disease in chronic kidney disease.
Soluble urokinase-type plasminogen activator receptor (suPAR) accumulates in patients with chronic kidney disease (CKD). In various non-CKD populations, suPAR has been proposed as a prognostic marker for mortality and cardiovascular disease. However, it is not known whether suPAR holds prognostic information in patients with mild-to-moderate CKD. ⋯ Higher suPAR was directly and significantly associated with both overall mortality (univariate hazard ratio 5.35) and cardiovascular events (univariate hazard ratio 5.06). In multivariate analysis, suPAR remained significantly associated with cardiovascular events (full model, hazard ratio 3.05). Thus, in patients with mild-to-moderate CKD, suPAR concentrations show a clear, direct, and graded association with a higher risk for new-onset cardiovascular disease.