Plomo y nefropatía: biomarcadores urinarios en la detección de daño renal precoz / Blood lead levels and markers of renal dysfunction among mechanical workshop workers

The role of lead (Pb) as an environmental cause of nephropathy is difficult to ascertain due to the difficulty to determine clinically its exposure. Aim: To assess lead levels and renal function in a group of males working in mechanical workshops. Material and Methods: Blood and urine samples were obtained from 100 mechanical workshop workers aged 38 ± 16 years and 95 non-exposed office clerks aged 37 ± 17 years. Blood lead and creatinine levels were determined. In exposed workers, urinary excretion of intestinal alkaline phosphatases (IAP) and N-acetyl-glucosaminidase (NAG) were measured as early markers of renal failure. Results: Blood lead levels were 66.4 ± 43 and 33.6 ± 18 µg/L among mechanical workshop workers and non-exposed controls, respectively, p < 0.01. The figures for serum creatinine were 0.9 ± 0.1 and 0.9 ± 0.1 respectively, p = NS. Among exposed workers urinary excretion of IAP was 0.47 ± 0.6 U/L and of NAG, 0.92 ± 1.1 U/L. There was a positive correlation between blood lead levels and NAG excretion (r = 0.284) and IAP excretion (r = 0.346). Conclusions: Exposed workers had higher blood lead levels and there was a weak positive association between these levels and the urinary excretion of NAG and IAP.

Renal biomarkers of male and female Wistar rats (Rattus norvegicus) undergoing renal ischemia and reperfusion

PURPOSE: To investigate biomarkers of acute renal injury in Wistar rats, subjected to left renal ischemia for 10 minutes, and then compare reperfusion at 24 hours, and at 5, 7, 14 and 21 days after the procedure. METHODS: Eight female and male rats between 60 and 81 days old were used in the Central Animal Facility of the UFMS. Assessed biomarkers included urine protein, urea, creatinine, glucose, sodium, potassium, urine alkaline phosphatase and gamma-glutamyl transferase activities, and protein-to-creatinine ratio; and in serum: urea, creatinine, sodium and potassium, fractional excretion of sodium, potassium, urine flow and creatinine clearance. RESULTS: Greater variance was observed in the parameters at 24 hours and at five days (p<0.05) after reperfusion. On the 21st day, these parameters approximated those obtained for the control group. CONCLUSIONS: Renal ischemia for 10 minutes was sufficient to raise urine levels of protein, glucose, fractional excretion of potassium, urea, creatinine clearance, urine activity of gamma-glutamyltransferase and alkaline phosphatase enzymes in the first 24 hours, up to five days after reperfusion, which may indicate risk of acute kidney injury, according to the RIFLE classification. .

Effects of repeated extracorporeal shock wave in urinary biochemical markers of rats / Avaliação dos fatores bioquímicos urinários de risco para nefrolitíase em ratos submetidos à aplicação repetida de ondas de choque eletro-hidráulicas

PURPOSE: To access the effect of repeated extracorporeal shock wave (ESW) on urinary biochemical markers METHODS: 20 rats were assigned for ESW (Direx Tripter X1® - 14 KV) to one of two groups: G1 (n=10) one ESW; G2 (n=10) two ESWs within a 14-day interval. Within the twenty-four hour period before and after the application of shock waves, the animals were placed in metabolic cages for 24 hour urine collection. The ph, creatinine, sodium, potassium, chlorides, calcium, magnesium, phosphorus, oxalates, alkaline phosphatase and citrates were measured. Twenty-four hours after the material was collected for urinary determination, the animals underwent nephrectomy of the kidney submitted to the ESW applications and were, then, sacrificed. The kidneys were processed for hispatological examination. RESULTS: Small variations in the biochemical markers were found in both groups, with no significant differences between the values obtained either prior to or following the ESW applications, except for citrate and alkaline phosphatase. Citraturia decreased significantly in group 2, following the second ESWL application (24.8 ± 3.0 mg/day after the first ESWL vs. 15.3 ± 2.2 mg/day after the second ESWL; p < 0.05). Alkaline phosphatase increased significantly following ESWL in group I (0.57 ± 0.02 vs. 0.79 ± 0.04 µmol/mg creatinine; p < 0.01) and also in group 2 (0.69 ± 0.05 vs. 0.83 ± 0.03 µmol/mg creatinine; p < 0.05). Glomerular, interstitial and sub-capsular hemorrhage with perivascular edema was found in the animals in both groups studied. CONCLUSIONS: A significant increase in urinary alkaline phosphatase was found in both groups studied, suggesting a proximal tubule lesion. In the group of rats undergoing more than one ESWL application, a smaller urinary citrate excretion was noticed, which may be a factor contributing for the formation of new calculi.

OBJETIVO: Avaliar os efeitos renais das ondas de choque eletro-hidráulicas (OCEH), utilizando como parâmetros marcadores bioquímicos urinários. MÉTODOS: Foram utilizados 20 ratos machos, EPM - Wistar, distribuídos aleatoriamente em dois grupos: G1 (n=10) Animais submetidos a uma sessão de OCEH. G2 (n=10) Animais submetidos a duas sessões de OCEH separadas por um intervalo de 14 dias. Para coleta da urina os animais foram mantidos em gaiolas metabólicas 24 horas antes e depois da aplicação das OCEH. Foram medidos o pH, a creatinina, sódio, potássio, cloretos, cálcio, magnésio, fósforo, oxalato, fosfatase alcalina e citrato. Vinte e quatro horas após a coleta da urina os animais foram submetidos à nefrectomia do rim envolvido no experimento e, em seguida, sacrificados. Os rins foram então submetidos aos procedimentos de fixação e coloração histológica com hematoxilina e eosina. RESULTADOS: Pequenas variações nos marcadores bioquímicos foram detectadas nos dois grupos, sem diferenças significantes nos valores obtidos antes e após a aplicação das OCEH, exceto para os valores urinários de citrato e fosfatase alcalina. A citratúria diminuiu significantemente nos animais do Grupo 2 após a segunda aplicação das OCEH( 24,8 ± 3,0 mg/dia após a primeira sessão de OCEH e 15,3 ± 2,2 mg/dia após a segunda sessão de OCEH; p < 0.05). A fosfatase alcalina urinária aumentou de forma significante no grupo 1 após a sessão de OCEH (0,57 ± 0,02 vs. 0,79 ± 0,04 µmol/mg de creatinina; p < 0,01) e também no grupo 2 (0,69 ± 0,05 vs. 0,83 ± 0,03 µmol/mg de creatinina; p < 0,05). Os achados histológicos observados nos animais dos dois grupos foram: hemorragia glomerular, intersticial e subcapsular, acompanhada de edema perivascular. CONCLUSÕES: Observou-se um aumento significante da fosfatase alcalina urinária nos dois grupos estudados, sugerindo uma lesão dos túbulos proximais causada pelas ondas de choque eletro-hidráulicas. Nos animais submetidos a mais de uma ...

Effect of Roux-en Y gastric bypass on bone metabolism in patients with morbid obesity: [Mansoura experiences]

Roux-en-Y gastric bypass [RYGBP] has been found to be the most efficient way to lose weight and maintain the weight loss in morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant changes on bone metabolism .The objectives of this study were to evaluate effects of weight loss on bone metabolism after Roux-en Y gastric bypass in patients with morbid obesity. Our study included 70 patients with morbid obesity, RYGBP was done for all patients. Daily postoperative oral supplementation with 1000 mg of calcium and 800 IU of vitamin D was done for each patient Body weight, BMJ, also Total body fat, Total lean tissue mass, Bone Mineral content [BMC], Bone Mineral density [BMD], Total bone area [TBA] [using DEXA], also, serum calcium, parathyroid hormone [PTH], 25-OH vitamin D, 24 hours urinary calcium and bone specific Alkaline phos-phatase [BSAP] were assessed preoperatively and one year after surgery. In our study: females comprised 70% of cases. The mean age was 35 +/- 8.8 years. One year after RYGB: Body weight [BW] decreased significantly from 132.8 +/- 26.5 to 90.3 +/- 17.3 kg [P=0.001]. Body Mass Index [BMI] decreased significantly from 48 +/- 7.3 to 32.6 +/- 4.1 kg/m2 [P= 0.001]. BMC decreased significantly from 2968.6 +/- 71.4 to 2700.8 +/- 45.4 gm [p = 0.001] BMD decreased significantly from 1.026 +/- 0.03 to 1.22 +/- 0.015 gm/cm[2] [P=0.001]. TBA decreased significantly from 2356.2 +/- 35.4 to 2216.3 +/- 43.5 cm2 [P=0.001]. Serum calcium, 24 hours urinary calcium and BSAP were non significantly decreased while 25 OH-vitamin D and PTH were non significantly increased after surgery. From this study, it is shown that Roux-en-Y gastric bypass operation gives very good results as regards reduction of body weight in morbidly obese patients. Postoperative supplementation with calcium and vitamin D partially correct osteoporosis. So, These patients need periodic follow up for Bone Mineral Density [BMD], PTH, calcium, serum vitamin D and markers of bone resorption and formation specially postmenopausal female

Study of serum activin a and follistatin in post renal transplant patients: correlation with renal hemodynamics, graft function and survival

Chronic allograft nephropathy [CAN] is a devasting long-term complication of kidney transplantation that is responsible for a significant proportion of graft loss. Activin A, a member of the transforming growth factor-beta [TGF- beta] superfamily of proteins, has a pro-fibrotic activity. The biologic effects of activin A are countered by follistatin, which is a high affinity extracellular binding protein for activin A. To study serum activin A and follistatin levels in the post-renal transplant patients and their correlation to renal hemodynamics, graft function and survival. The study included 20 post-renal transplant patients [Group I] and 20 age and sex matched healthy subjects [Group II] as controls. Serum activin A and serum follistatin were measured by enzyme linked immunosorbent assay [ELISA]. Serum C-reactive protein [S.CRP] was measured by turbidimetry. Serum and urinary alkaline phosphatase [S.ALP, U.ALP] were measured by spectrophotometry. Renal henwdynamics were evaluated by duplex Doppler ultrasonography; resistive and pulsatility indices [RI, PI] were calculated. Ten patients were categorized as chronic allograft nephropathy [CAN; group Ia]. The other ten patients had a stable renal function [non-CAN; group Ib]. There was a statistically significant increase in serum activin A [S.activin A], S.ALP, S.CRP, RI and PI and a statistically significant decrease in U.ALP and follistarin/activin ratio in patients with CAN than healthy controls, versus a statistically significant difference only in S. activin A and follistatin/activin ratio between non-CAN and controls. There was no statistically significant differences in S. follistatin between the studied groups. In post-renal transplant patients, S.activin A showed a statistically significant positive correlation with S. creatinine, S.CRP, RI and PI versus a statistically significant negative correlation with creatinine clearance, U.ALP and follistatin/Activin ratio. U.ALP showed a statistically significant positive correlation with creatinine clearance versus a statistically significant negative correlation with S. creatinine, S. activin A, S.CRP, RI and PI. Enhanced activin A activity together with normal follistatin level and the decrease in follistatin/activin ratio in post-renal transplant patients, showed that there is a dysregulation of activin-follistatin axis with the increase of the unbound biologically active activin A with deterioration of renal function. Also, there is an increased activity of ongoing inflammation accompanied by impaired renal function among renal allograft recipients that led to enhanced renal fibrosis and a degree of tubular dysfunction

Utilidad de la fosfatasa alcalina urinaria como marcador precoz de lesión tubular renal / Utility of urinary alkaline phosphatase as early marker of renal tubular failure

El objetivo de este estudio fue determinar la actividad de la fosfatasa alcalina urinaria (FALur) para evaluar precozmente lesión tubular y su utilidad diagnóstica. Los pacientes estudiados fueron: 20 Controles (C), 11 hipertensos (HTA), 23 diabéticos (DBT) y 34 con insuficiencia renal de diverso origen (IRDO). Se realizaron las determinaciones de: creatinina, clearence de creatinina (Jaffé cinético), FAL sérica y urinaria (cinético DGKC), microalbuminuria (inmunoturbidimétrico), proteiunuria (turbidimétrico), uroproteinograma, SDS-PAGE (al 12,5%) e isoenzimograma de FAL. La FAL sérica hallada fue normal, sin diferencia entre grupos y sin relación con el aumento de la FALur. El valor de corte recomendado para FALur fue de 8 UI/L. La FALur estuvo elevada en HTA e IRDO y normal en individuos con DBT. Los aumentos de FALur en IRDO se relacionaron con la lesión tubular estructural y en pacientes con HTA podrían relacionarse con alteración tubular precoz. Se propone la determinación de FALur para la detección temprana de lesión tubular ante falla renal establecida o en individuos con riesgo de desarrollarla, y se establece su utilidad en pacientes: - con DBT y HTA para seguimiento (junto a microalbuminuria y clearence de creatinina), - internados en riesgo de insuficiencia renal aguda: para orientar tratamientos, - con insuficiencia renal crónica: como indicador de lesión y pronóstico.

The objective of this study was to determine the activity of urinary Alkaline Phosphatase (ALPur) to evaluate early tubular failure and its diagnostic usefulness. The patients studied were: 20 Controls (C), 11 with Hipertensión (HTA), 23 Diabetic (DBT) and 34 with renal Insufficiency of diverse origin (IRDO). The creatinine, creatinine clearence (kinetic Jaffé) serum and urinary ALP (kinetic DGKC), microalbuminuria (Immunoturbidimetric), proteiunuria (Turbidimetric), uroproteinogram, SDS-PAGE (12.5%) and ALP isoenzymes determinations were made. The results indicate that serum ALP was normal, without difference between groups, and no relation with the increase in ALPur. Recommended cut-off value of ALPur was 8 UI/L. ALPur was elevated in HTA and IRDO, and normal in DBT. Increases in ALPur in IRDO were related to the structural tubular injury, and those in HTA could be related to early tubular alteration. Determination of ALPur is proposed for early detection of tubular injury, before renal failure is established or when there is risk of developing it, establishing its usefulness in: - DBT and HTA patients: screening (together with microalbuminuria and creatinine clearence). - Hospitalized patients in risk of acute renal insufficiency: in order to orient treatments. - Patients with chronic renal insufficiency: as an indicator of injury and prognosis.

Renal tubular dysfunction in patients with type 2 diabetes mellitus

It is well established that the detection of microalbuminuria in patients with diabetes mellitus indicates the presence of glomerular involvement in early renal damage. Recent studies have demonstrated that there iso also a tubular component of renal complications in diabetes, as shown by the detection of renal tubular proteins and enzymes in urine. So, the objective of this study was to determine the activity of urinary enzymes [N-aceiyl-beta-D-glucosaminidase [NAG], a lysosomal enzyme, gamma-glutamyltranspeptidase [GGT], alkaline phosphalase [ALP], brush border enzymes and /32 microglobulin [beta 2MG,] as one of the tubular proteins] as markers of tubular damage which may reflect early stage of diabetic nephropathy [DN] and to clarify the importance of estimation of these enzymes as noninvasive cheap tools in monitoring the course of DN [degree of proteinuria]. Also we studied the serum level of angiolensine converting enzyme [ACE] to evaluate the endothelial disorder in diabetic patients. Patients and Methods: 3 groups of non smoker type 2 diabetic patients were studied, 1[st] group was 20 normo-albuminuric diabetic patients, 2[nd] group was 20 patients with microalbuminurea [urinary albumin is >30 mg - <300 mg/day], and the 3[rd] group was 20 patie!ts with macroalbuminuria [: 300 mg/day]. Another 15 healthy age and sex matched subjects were recruited as a control group. For each patient and control subject the followings were estimated: [1] urinary glucose, 2 hours postprandial blood glucose, and glycated haemoglohin as parameters of gl, vcaemic control [2] blood urea, serum creatinine, 24-hour urinary protein and microalbuminuria to detect DN, ['3,] Serum ACE, urinary NAG. ALP, GGT and beta 2 microglobulin. The serum urinary NAG, ALP, beta 2MG, HbA[1c] and 2-hour postprandial blood glucose were significantly higher in the diabetic groups compared to controls. While GGT was significantly lower in the diabetic groups compared to controls. Also the increase in serum ACE, urinary NAG, ALP and beta 2MG positively correlated with the degree of albuminuria, HbA[1c] and 2-hour postprandial blood glucose while urinary GGT negatively correlated with the previous parameters. The significant progressive increase in ACE activity in the studied groups supports the hypothesis of ACE activity being an essential partner in the development of DN The elevation of the levels of NAG, ALP and beta 2 microglobulin, and the decrease in the level of GGT in the first group and the progressive change in their levels with the pathological increase in the level of urinary albumin, suggest that these changes are useful in the diagnosis of early stage of DN before the development of microalbuminuria. GGT and NAG appear more simple and readily available compared with others

Urinary enzyme concentrations and urinalysis in healthy horses

The tubules of the kidneys are metabolically very active being responsible for the absorption or excretion of a wide range of substances. The transport of these compounds is facilitated by a variety of enzymes which can generally be found in large amounts in tubular cells. The regular turnover of these cells results in the presence of their enzymes in urine [enzymuria]. Measurement of the changes in the content of these enzymes in urine can be a good aid in detection of early kidney diseases. In this study the normal values of the following enzymes ALP [alkaline phosphatase] AST [aspartate aminotransfrase] ALT [Alanine amino transfrase] and creatinine in Iranian crossbreed horses were measured, the subjects were divided into two groups of males and females. The sex of the horses did not influence urinary enzymes activity [p>0.05]. Normal values of ALP, AST, ALT were found to be 3.99 +/- 1.23 Iu/L, 4.34 +/- 1.17 Iu/L 1.78 +/- 0.54 Iu/L respectively and creatinine was 3.70 +/- 0.69 g/L in males and 1.46 +/- 0.17 g/L in females