Mild elevation of urinary biomarkers in prerenal acute kidney injury.

Doi K, Katagiri D, Negishi K, Hasegawa S, Hamasaki Y, Fujita T, Matsubara T, Ishii T, Yahagi N, Sugaya T, Noiri E
Kidney Int. 2012 82 (10): 1114-20

PMID: 22854644 · DOI:10.1038/ki.2012.266

Prerenal acute kidney injury (AKI) is thought to be a reversible loss of renal function without structural damage. Although prerenal and intrinsic AKI frequently coexist in clinical situations, serum creatinine and urine output provide no information to support their differentiation. Recently developed biomarkers reflect tubular epithelial injury; therefore, we evaluated urinary biomarker levels in an adult mixed intensive care unit (ICU) cohort of patients who had been clinically evaluated as having prerenal AKI. Urinary L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), N-acetyl-β-D-glucosaminidase (NAG), and albumin in patients with prerenal AKI showed modest but significantly higher concentrations than in patients with non-AKI. We also conducted a proof-of-concept experiment to measure urinary biomarker excretion in prerenal AKI caused by volume depletion. Compared with cisplatinum and ischemia-reperfusion models in mice, volume depletion in mice caused a modest secretion of L-FABP and NGAL into urine with more sensitive response of L-FABP than that of NGAL. Although no histological evidence of structural damage was identified by light microscopy, partial kidney hypoxia was found by pimonidazole incorporation in the volume depletion model. Thus, our study suggests that new AKI biomarkers can detect mild renal tubular damage in prerenal acute kidney injury.

MeSH Terms (27)

Acetylglucosaminidase Acute-Phase Proteins Acute Kidney Injury Aged Albuminuria Animals Biomarkers Cisplatin Disease Models, Animal Fatty Acid-Binding Proteins Female Humans Intensive Care Units Interleukin-18 Lipocalin-2 Lipocalins Male Mice Mice, Inbred C57BL Mice, Inbred ICR Mice, Transgenic Middle Aged Oncogene Proteins Prospective Studies Proto-Oncogene Proteins Reperfusion Injury Up-Regulation

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