scholarly journals Serum and Urinary Biomarkers Determination and Their Significance in Diagnosis of Kidney Diseases

2010 ◽  
Vol 29 (4) ◽  
pp. 288-297 ◽  
Author(s):  
Višnja Ležaić
Keyword(s):  
Cystatin C ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Urinary Biomarkers ◽  
Clinical Samples ◽  
Major Public Health Problem ◽  
Lower Urinary Tract Infection ◽  
Fatty Acid Binding ◽  
Cardiovascular Morbidity And Mortality

Serum and Urinary Biomarkers Determination and Their Significance in Diagnosis of Kidney DiseasesChronic kidney disease (CKD) is becoming a major public health problem worldwide due to the epidemic increase of patients on renal replacement therapy and their high cardiovascular morbidity and mortality. The only effective approach to this problem is prevention and early detection of CKD. In addition, despite significant improvements in therapeutics, the mortality and morbidity associated with acute kidney injury (AKI) remain high. A major reason for this is the lack of early markers for AKI, and hence an unacceptable delay in initiating therapy. Therefore, there is a pressing need to develop biomarkers (proteins and other molecules in the blood or urine) for renal disease, which might assist in diagnosis and prognosis and might provide endpoints for clinical trials of drugs designed to slow the progression of renal insufficiency. Besides serum creatinine, promising novel biomarkers for AKI include a plasma panel (neutrophil gelatinase-associated lipocalin-NGAL and cystatin C) and a urine panel (NGAL, kidney injury molecule-1, interleukin-18, cystatin C, alpha 1-microglobulin, Fetuin-A, Gro-alpha, and meprin). For CKD, these include a similar plasma panel and a urine panel (NGAL, asymmetric dimethylarginine, and liver-type fatty acid-binding protein). Increased plasma and urinary TGF-β1 levels might contribute to the development of chronic tubulointerstitial disease, indicating the possible therapeutic implications. Furthermore, to differentiate lower urinary tract infection and pyelonephritis interleukin-6 and serum procalcitonin levels were introduced. It will be important in future studies to validate the sensitivity and specificity of these biomarker panels in clinical samples from large cohorts and in multiple clinical situations.

Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness

2021 ◽  
Author(s):  
Stephen Duff ◽  
Ruairi Irwin ◽  
Jean Maxime Cote ◽  
Lynn Redahan ◽  
Blaithin A McMahon ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Urinary Biomarkers ◽  
High Morbidity ◽  
Diagnostic Analysis ◽  
Prognostic Analysis ◽  
Stage 1

Abstract Background Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. Methods The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. Results In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. Conclusions Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.

OP116 Cost-Effectiveness Of Sacubitril/Valsartan In Heart Failure

2017 ◽  
Vol 33 (S1) ◽  
pp. 52-53
Author(s):  
Liang Lin ◽  
Mohamed Ismail Abdul Aziz ◽  
David Bin-Chia Wu ◽  
Kwong Ng
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Public Health Problem ◽  
Cardiovascular Death ◽  
Sensitivity Analyses ◽  
Major Public Health Problem ◽  
Old Patients ◽  
Asian Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
The Cost

INTRODUCTION:Heart failure (HF) is a major public health problem worldwide and in Asia. Sacubitril/valsartan reduces cardiovascular death and hospitalizations for HF. However, decision makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of current standard of care.METHODS:Using a Markov model, we projected lifetime clinical and economic outcomes of sacubitril/valsartan versus enalapril for 66-year-old patients with HF in Singapore. Key health states included New York Heart Association (NYHA) classes; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Probabilities of events were based on the PARADIGM-HF trial. The uncertain treatment effect of sacubtril/valsartan in Asian patients was modelled using a hazard ratio (HR) of 1 as upper limit in sensitivity analyses. Utilities were obtained from published literature. Local national epidemiological and cost data were applied. Analyses were conducted from the Singapore healthcare payer's perspective. Both one-way and Probabilistic Sensitivity Analyses (PSA) based on 10,000 Monte Carlo simulations were performed.RESULTS:Compared to enalapril, sacubitril/valsartan was associated with an incremental cost-effectiveness ratio (ICER) of SGD74k (USD52k) per quality-adjusted life year (QALY) gained. The cost-effectiveness of sacubitril/valsartan was highly dependent on its effectiveness in reducing the risk of cardiovascular death. However, this was uncertain, particularly in the Asian subgroup, where results were not statistically significant. In sensitivity analyses using results from Asian patients, the ICERs ranged from SGD41k (USD30k) to SGD1.3 million (USD 0.94 million) per QALY gained. PSA showed the probability of sacubitril/valsartan being cost-effective was below 1 percent, 12 percent and 71 percent at thresholds of SGD20k (USD14k), SGD50k (USD36k) and SGD100k (USD 72k) per QALY gained, respectively.CONCLUSIONS:Given the uncertain ICER, sacubtril/valsartan may not provide good value for money compared to enalapril in reducing cardiovascular morbidity and mortality in patients with HF at the current daily cost. Our study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering HF therapy.

scholarly journals Simple and Feasible Detection of Hepatitis B Virus via Combination of Multienzyme Isothermal Rapid Amplification and Lateral Flow Dipstick Strip

2021 ◽  
Vol 8 ◽  
Author(s):  
Mao-Ling Sun ◽  
Hai-Yun Lai ◽  
Na-Yu Chong ◽  
Dong-Fan Liu ◽  
Zhen-Yi Zhang ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Public Health Problem ◽  
Lateral Flow ◽  
Detection Sensitivity ◽  
Clinical Samples ◽  
Major Public Health Problem ◽  
Lateral Flow Dipstick ◽  
B Virus ◽  
Rapid Amplification

Hepatitis B virus infection is not only a huge burden in the field of social health but also a major public health problem that affects the lives and health of the people. Simple, rapid, feasible detection of HBV is critical for its prevention and spread, especially in the developing countries with low-resource laboratories. To this end, we combined multienzyme isothermal rapid amplification (MIRA) and lateral flow dipstick (LFD) strip to detect HBV. A pair of primers targeting the conserved region of HBV genome was designed and used in MIRA-LFD assay. Our results found that the entire amplification of MIRA-LFD only takes 10 min at 37°C and the dilution of the amplification products was added in the LFD strip and observed by the naked eye after 10 min. The detection sensitivity of this method can reach 10 pg. The 45 clinical samples were detected by MIRA-LFD and real-time PCR. The accuracy rate of MIRA-LFD was 100%. Therefore, these characteristics of our newly developed MIRA-LFD assay make it particularly useful and suitable for detecting HBV in the resource-limited condition.

scholarly journals Association of Urinary Biomarkers of Kidney Injury with Estimated GFR Decline in HIV-Infected Individuals following Tenofovir Disoproxil Fumarate Initiation

2018 ◽  
Vol 13 (9) ◽  
pp. 1321-1329 ◽  
Author(s):  
Simon B. Ascher ◽  
Rebecca Scherzer ◽  
Michelle M. Estrella ◽  
William R. Zhang ◽  
Anthony N. Muiru ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Cystatin C ◽  
Tenofovir Disoproxil Fumarate ◽  
Disease Risk ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
First Year ◽  
Mixed Effect ◽  
Monocyte Chemoattractant Protein 1

Background and objectivesTenofovir disoproxil fumarate (tenofovir) is associated with elevated concentrations of biomarkers of kidney damage and dysfunction in individuals with HIV. The relationship of these kidney biomarkers with longitudinal kidney function decline is unknown.Design, setting, participants, & measurementsWe evaluated associations of 14 urinary biomarkers of kidney injury with changes in eGFR among 198 men and women with HIV who initiated tenofovir between 2009 and 2015 in the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study. Urinary biomarkers included albumin-to-creatinine ratio, α-1-microglobulin, β-2-microglobulin, cystatin C, kidney injury molecule-1 (KIM-1), IL-18, neutrophil gelatinase–associated lipocalin (NGAL), clusterin, osteopontin, uromodulin, monocyte chemoattractant protein-1, EGF, trefoil factor 3, and chitinase 3-like protein 1. We used multivariable linear mixed-effect models controlling for demographics, traditional kidney disease risk factors, and HIV-related risk factors to evaluate associations of baseline biomarkers with first-year changes in eGFR, and associations of year 1 and first-year change in biomarkers with changes in eGFR from year 1 to year 3. We used the least absolute shrinkage and selection operator method to identify a parsimonious set of biomarkers jointly associated with changes in eGFR.ResultsMedian eGFR before tenofovir initiation was 103 (interquartile range, 88–116) ml/min per 1.73 m2. During the first year of tenofovir use, eGFR decreased on average by 9.2 (95% confidence interval, 6.5 to 11.9) ml/min per 1.73 m2 and was stable afterward (decrease of 0.62; 95% confidence interval, −0.85 to 2.1 ml/min per 1.73 m2 per year). After multivariable adjustment, higher baseline β-2-microglobulin, KIM-1, and clusterin were associated with larger first-year eGFR declines, whereas higher baseline uromodulin was associated with a smaller eGFR decline. First-year increase in urinary cystatin C and higher year 1 IL-18 were associated with larger annual eGFR declines from year 1 to year 3. The parsimonious models identified higher pre-tenofovir clusterin and KIM-1, lower pre-tenofovir uromodulin, and higher year 1 IL-18 as jointly associated with larger eGFR declines.ConclusionsUrinary biomarkers of kidney injury measured before and after tenofovir initiation are associated with subsequent changes in eGFR in individuals with HIV.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_28_CJASNPodcast_18_9_S.mp3

scholarly journals Urinary fatty acid-binding protein 1: an early predictive biomarker of kidney injury

2009 ◽  
Vol 296 (4) ◽  
pp. F669-F679 ◽  
Author(s):  
Eisei Noiri ◽  
Kent Doi ◽  
Kousuke Negishi ◽  
Tamami Tanaka ◽  
Yoshifumi Hamasaki ◽  
...  
Keyword(s):  
Fatty Acid ◽  
Kidney Disease ◽  
Transgenic Mice ◽  
Fatty Acid Binding Protein ◽  
Binding Protein ◽  
Kidney Injury ◽  
Predictive Biomarker ◽  
Clinical Samples ◽  
Fatty Acid Binding ◽  
Acid Binding Protein

In the development of novel therapeutic strategies for kidney disease, new renal biomarkers for early detection and accurate evaluation of renal injury are urgently required for both acute kidney injury (AKI) and chronic kidney disease (CKD). Fatty acid-binding protein 1 (FABP1) is expressed in renal proximal tubule cells and shed into urine in response to hypoxia caused by decreased peritubular capillary blood flow. To clarify the role of urinary FABP1 in kidney disease, we established human FABP1 transgenic mice and evaluated the responses of FABP1 to several AKI and CKD models. Moreover, there are accumulating clinical data that urinary FABP1 can detect human AKI earlier than serum creatinine and can distinguish the risk population for AKI. Investigation with “humanized” FABP1 transgenic mice and measurement of clinical samples allowed us to develop urinary FABP1 as a new renal biomarker. Further clinical studies are necessary to confirm the potential of urinary FABP1 for clinical application.

scholarly journals Prevalence, risk-inducing lifestyle, and perceived susceptibility to kidney diseases by gender among Nigerians residents in South Western Nigeria

2020 ◽  
Vol 20 (2) ◽  
pp. 860-870
Author(s):  
Monica Ewomazino Akokuwebe ◽  
Clifford Odimegwu ◽  
Femi Omololu
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Kidney Disease ◽  
Lifestyle Modification ◽  
Disease Risk ◽  
Kidney Diseases ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Perceived Susceptibility ◽  
Female Ratio

Background: Kidney disease (KD) is increasingly recognized as a major public health problem worldwide with rising inci- dence and prevalence. Early identification of KD risk factors will slow down progression to kidney failure and death. Objective: To determine the prevalence, risk-inducing lifestyle and perceived susceptibility among Nigerians in South-west- ern Nigeria. Methods: A pretested structured questionnaire was employed to draw information on socio-demographic, knowledge, risk-inducing lifestyle and perceived susceptibility to conventional risk factors of KD from 1757 residents aged ≥15 years. Results: The mean age of the respondents was 47.61±13.0 years with a male-female ratio of 1.13:1. Knowledge of KD was low (mean score 2.29; 95% CI: 2.18, 2.32). The prevalence of some established KD risk factors was regular use of herbal medications, 26.8% and physical inactivity, 70.0%. Females with factors such as use of herbal drink [RRR: 1.56; CI=1.06- 2.30; p=0.02] and smoking [RRR: 2.72; CI=1.37-5.37; p=0.00] predicted increased odds of perceived susceptibility to KD than their male counterparts. Conclusion: The prevalence of KD risk-inducing lifestyles was high. More emphasis should be placed on effective public health programmes towards behavioural change in order to adopt lifestyle modification as well as to reduce the tendency to develop KD. Keywords: Kidney disease; risk-inducing lifestyles; perceived susceptibility.

scholarly journals A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases

2019 ◽  
Vol 6 (3) ◽  
pp. 911
Author(s):  
Siddharth Pugalendhi ◽  
Tarun Kumar Dutta ◽  
Hemachandar R. ◽  
Lokesh S.
Keyword(s):  
Urinary Tract ◽  
Urine Analysis ◽  
Kidney Diseases ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Blood Analysis ◽  
Resistance Pattern ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Tract Infections

Background: Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.Methods: It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.Results: Among 65 CKD participants with UTI who were studied, E. coli (47.7%) and K. pneumoniae (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.Conclusions: The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area.

Implications of Klotho Protein for Managing Kidney Disease - an Emerging Role in Therapeutics and Molecular Medicine

2020 ◽  
Vol 20 ◽  
Author(s):  
Suman K Ray ◽  
Neha Masarkar ◽  
Sukhes Mukherjee
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
Fibroblast Growth Factor 23 ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Molecular Medicine ◽  
Klotho Protein ◽  
Parenchymal Injury ◽  
Fgf 23 ◽  
Pleiotropic Actions

: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are a growing public health problem. There is a paucity of sensitive biomarkers to detect AKI, early CKD, and ameliorate extra-renal complications. Klotho protein, detected mainly in the kidneys, regulates renal health and functions as a co-receptor for fibroblast growth factor 23 (FGF-23) signaling. It is now coming to be known for its extreme pleiotropic actions. These include cytoprotection via anti-oxidation, anti-senescence, anti-apoptosis, renoprotective effects, promotion of angiogenesis and vascularisation, inhibition of fibrogenesis, and stem cell preservation. Emerging clinical studies suggest kidney damage to be a perpetual state of renal Klotho deficiency. In AKI, Klotho levels in plasma and/or urine possibly will serve as an initial biomarker for kidney parenchymal injury. In CKD, Klotho levels may also be an indicator of early disease as well as predict the rate of progression. Earlier studies using ELISA as a technique, reveal a correlation between plasma Klotho, eGFR, serum creatine, and Blood Urea Nitrogen (BUN) levels. Thereby, preventing the decline of Klotho levels by various mechanisms that can retard CKD advancement and advance renal function. Substantial data indicate Klotho can be therapeutically included as an individualized regimen for managing CKD patients. Considerable research is required in investigating the role of soluble Klotho as a biomarker in patients with different types and severity of kidney diseases, which will be highlighted in our review.

A CASE OF PARAQUAT POISONING PRESENTING WITH MULTIORGAN DYSFUNCTION

2021 ◽  
pp. 59-60
Author(s):  
Venkata sai suhas Yadlapati ◽  
Nirmala Devi ◽  
V.R.Mohan Rao
Keyword(s):  
Public Health ◽  
Acute Kidney Injury ◽  
Developing Countries ◽  
Liver Disease ◽  
Early Diagnosis ◽  
Fatal Case ◽  
Case Fatality ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Major Public Health Problem

Ÿ Self-poisoning with pesticides is a major public health problem in developing countries with an estimated 300 000 deaths each year.Very high case fatality (>50%) - due both to its inherent toxicity and the lack of early diagnosis and effective treatment.Though it is easily availabile, poisoning with this toxin is not common. Fatal dose of paraquat is so trivial that >10 ml poison can damage lungs permanently. Ÿ In this context we present a fatal case of 30 yr old male patient who have consumed paraquat and presented with extensive complication of acute kidney injury, and lung injury and liver disease.

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