Diagnostic value of combined detection of NGAL,L-FABP and KIM-1 in urine for early acute kidney injury in children / 国际检验医学杂志

Objective To investigate the diagnostic value of combined detection of NGAL,L-FABP and KIM-1 in urine for early acute kidney injury in children.Methods 128 cases sepsis patients in our hospital during ICU from September 2015 to September 2016 were enrolled in the study,according to the occurrence of acute renal injury(AIK)were divided into observation group and control group,the incidence of AKI in 26 ca-ses as the observation group,102 cases without AKI as control group;the content of urine collected from two groups of children,NGAL L-FABP,KIM-1.Results In AKI group 6 h NGAL,L-FABP,Kim-1 in urine in-creased significantly higher than that of the other time points and non AKI group level,significant difference was statistically significant;6h NGAL,L-FABP,Kim-1 in urine combined detection efficiency is highest,sen-sitivity,specificity and positive pre detection value and negative predictive value were measured 86.7%,97. 8%,78.3% a,98.7% a,was significantly higher than the diagnostic efficacy of urinary NGAL,L-FABP,Kim-1;6h,L-FABP,NGAL in the urine level of KIM-1 and 48h in patients with creatinine and GFR levels of correla-tion analysis found that in children with early urinary NGAL,L-FABP,KIM-1 and 48h in children with creati-nine and GFR levels were positive related.Conclusion The detection of NGAL,L-FABP and KIM-1 in urine is of great significance in the diagnosis of AKI in children,which is worthy of clinical application.

Effect of the ioversol on early renal function in patients undergoing cerebral vascular intervention / 中国医师杂志

Objective To investigate the effect of different doses of ioversol on renal function,and to explore early renal injury biomarkers on contrast induced kidney injury and safe ioversol dosage.Methods A total of 158 cases (98 males and 60 females) undergoing cerebral vascular intervention (CVI) in our department was selected with age ranging from 23 to 81 years old (average age 59.70 ± 12.02).Based on ioversol dosage in surgery,patients were divided into three groups:low dose group (≤ 150 ml,n =49),middle dose group (151-200 ml,n =74),and high dose group (＞200 ml,n =35).U-κ,U-λ,urinary transferrin (UTRF),urine microalbumin (UMA),urinary immunoglobulin IgG (UIgG),urine beta2-microglobulin (Uβ2-MG),Uα1-MG,urinary N-acetyl-beta-D-glucosaminidase (UNAG),plasma cystatin C (CysC) and Scr were detected by scattering turbidimetry,immune turbidimetry and fully automatic biochemical analysis pre-surgery 24 h and post-surgery 72 h.Contrast-induced acute kidney injury (CI-AKI) was defined as laboratory increase of Scr value≥44.2 μmol/L or ≥25％ from baseline measurement at 48 hours after surgery.The relationship in ioversol dosage and various factors was assessed by Single and multiple factors binary logistic regression analysis.Results According to the criterion that Scr increase value were ≥44.2 μmol/L,of 158 cases,3 cases occurred CI-AKI,the AKI incidence was 1.90％.Based on the criterion that Scr increase value was ≥25％,33 cases occurred CI-AKI,the incidence was 20.89％.The concentration of U-κ,UTRF,Uα1-MG,UNAG and plasma CysC were significantly different in high dose group compared to low ioversol dose group (P ＜ 0.05),while the other biomarkers had no significant difference (P ＞ 0.05).Conclusions The contrast media-ioversol could lead to CI-AKI;when the dosage of ioversol was more than 200 ml one-time,the concentration of U-κ,UTRF,Uα1-MG,UNAG and plasma CysC increased significantly.U-κ,UTRF,Uα1-MG,UNAG and plasma CysC could predict the early renal injury in patients who undergoing CVI.The rise of U-κ,UTRF,Uα1-MG,UNAG and plasma CysC are related to the dosage of ioversol.Furthermore,possibility of kidney injury is significantly high when ioversol dosage is more than 200 ml one-time.

Predictive value of NGAL and renal injury molecule 1 in 28-day mortality of neonatal sepsis with re-nal injury / 中国医师杂志

Objective To investigate the prognostic value of serum neutrophil gelatinase-associated lipid transport protein (NGAL) and renal injury molecule 1 (KIM-1) in assessing neonatal sepsis with a-cute renal injury. Methods A total of 63 cases of renal injury with neonatal sepsis was collected from De-partment of Pediatrics, Affiliated Children's Hospital of Capital Institute of Pediatrics. The general condition of the patients, and neonatal critical case score ( NCIS) were recorded. The expressions of NGAL and KIM-1 in serum of all children were measured by venous blood and urine. Each case was followed up for 28 days to track the death of newborns. Pearson correlation analysis was used to test the correlation among NGAL, KIM-1, and NCIS;Multivariate regression analysis was used for NGAL, KIM-1, and other risk factors asso-ciated with neonatal sepsis kidney injury 28 days mortality. Receiver operating characteristic ( ROC) curve was used to compare the value of NGAL and KIM-1 in the prognosis of neonatal sepsis renal injury. The val-ues of NGAL and KIM-1 in the prognosis of neonatal sepsis renal injury were analyzed by ROC curve. Re-sults ⑴ After 28 days of follow-up, 63 cases of neonatal sepsis, and 22 died were found, which was ac-counted for 34. 92 percent of the total. ⑵ Compared to the survival group, the expressions of NGAL and KIM-1 in the death group were increased ( P<0. 01 ) . ⑶ Pearson correlation analysis showed that NGAL and KIM-1 expressions in peripheral blood were negatively correlated with NCIS. ⑷Multivariate regression analysis showed that NGAL and KIM-1 were independent risk factors for neonatal sepsis kidney injury ( P<0. 01). ⑸ ROC curve analysis showed that the area under the curve of NGAL and KIM-1 was 0. 79 (95％CI:0. 75-0. 93), and 0. 84 (95％ CI:0. 71-0. 90), NGAL and KIM-1 were better than single detection with NGAL, or KIM-1, area under curve (AUC) was 0. 89 (95％ CI:0. 78-0. 94) (P<0. 01). Sensitiv-ity of KIM-1 was superior to that of NGAL, and specificity of NGAL was superior to KIM-1. The sensitivity and specificity of both were better than single detection with NGAL and KIM-1. Conclusions NGAL and KIM-1 have good predictive value in assessing neonatal sepsis kidney injury mortality.

Advances of adult stem cell repair in renal injury / 中国医师杂志

Acute and chronic kidney injury are still lack of good treatments now.Although human renal histological structure is complex,it also can be regenerated by new renal tubular epithelial cells replacing injured cells.With the study deepening,it supports a new way for treating kidney injury with characteristics of proliferation and differentiation of stem cells.This article will discuss the features of some kinds of the adult stem cells in the kidney regeneration,and those functions in the pathological situation briefly.

The significance of urinary NGAL and KIM-1 in predicting the kidney injury in children with congenital heart disease / 国际检验医学杂志

Objective To investigate the significance of urine neutrophil gelatinase associated lipocalin (NGAL ) and renal injury molecule-1 (KIM-1) in predicting the acute kidney injury (AKI) in children with congenital heart disease after operation .Methods From April 2014 to December 2015 ,67 cases of cardiopulmonary bypass in children with congenital heart disease were studied in our hospital ,all patients were divided into AKI group (n=24) and non AKI group (n=43) by pRIFLE standard .Serum creatinine , urine NGAL and urine KIM-1 levels were compared between the two groups before and after the operation ,the receiver operating characteristic curve (ROC curve) and the area under the curve (AUC) were used to evaluate the value of NGAL and KIM-1 in pre-dicting the postoperative AKI in children with congenital heart disease .Results There was no significant difference between the two groups in preoperative and postoperative 2 h and 4 h creatinine (P>0 .05) ,but the levels of postoperative 12 ,24 ,48 h creati-nine in the non AKI group were significantly lower than those in the AKI group (P<0 .05) .The NGAL level of postoperative 2 ,4 , 6 ,12 h in non AKI group was significantly lower than that in AKI group (P<0 .05) ,but there was no significant difference in the level of postoperative 24 h urine NGAL between the two groups (P>0 .05) .There was no significant difference between the two groups of patients with postoperative 2 h urinary KIM-1 (P>0 .05) ,postoperative 4 ,6 ,12 ,24 h urinary KIM-1 levels in the non AKI group were significantly lower than those in the AKI group (P<0 .05) .The optimal time point separate detection of urinary NGAL levels to assist in diagnosis of AKI after 12 h ,AUC was 0 .834 (95% CI:0 .631-0 .912);the best time point separately to detect the level of KIM-1 AKI to assist in the diagnosis of AKI after 24 h ,AUC was 0 .871 (95% CI:0 .665-0 .933);combined de-tection of urinary NGAL and KIM-1 levels to assist the best time for the diagnosis of AKI after 24 h ,AUC was 0 .913(95% CI:0 .745-0 .968) .Conclusion Urine NGAL and urine KIM-1 in children with congenital heart disease after operation have important clinical significance in predicting the occurrence of AKI .

The significance of urinary NGAL and KIM-1 in predicting the kidney injury in children with congenital heart disease / 国际检验医学杂志

Objective To investigate the significance of urine neutrophil gelatinase associated lipocalin (NGAL ) and renal injury molecule-1 (KIM-1) in predicting the acute kidney injury (AKI) in children with congenital heart disease after operation .Methods From April 2014 to December 2015 ,67 cases of cardiopulmonary bypass in children with congenital heart disease were studied in our hospital ,all patients were divided into AKI group (n=24) and non AKI group (n=43) by pRIFLE standard .Serum creatinine , urine NGAL and urine KIM-1 levels were compared between the two groups before and after the operation ,the receiver operating characteristic curve (ROC curve) and the area under the curve (AUC) were used to evaluate the value of NGAL and KIM-1 in pre-dicting the postoperative AKI in children with congenital heart disease .Results There was no significant difference between the two groups in preoperative and postoperative 2 h and 4 h creatinine (P>0 .05) ,but the levels of postoperative 12 ,24 ,48 h creati-nine in the non AKI group were significantly lower than those in the AKI group (P<0 .05) .The NGAL level of postoperative 2 ,4 , 6 ,12 h in non AKI group was significantly lower than that in AKI group (P<0 .05) ,but there was no significant difference in the level of postoperative 24 h urine NGAL between the two groups (P>0 .05) .There was no significant difference between the two groups of patients with postoperative 2 h urinary KIM-1 (P>0 .05) ,postoperative 4 ,6 ,12 ,24 h urinary KIM-1 levels in the non AKI group were significantly lower than those in the AKI group (P<0 .05) .The optimal time point separate detection of urinary NGAL levels to assist in diagnosis of AKI after 12 h ,AUC was 0 .834 (95% CI:0 .631-0 .912);the best time point separately to detect the level of KIM-1 AKI to assist in the diagnosis of AKI after 24 h ,AUC was 0 .871 (95% CI:0 .665-0 .933);combined de-tection of urinary NGAL and KIM-1 levels to assist the best time for the diagnosis of AKI after 24 h ,AUC was 0 .913(95% CI:0 .745-0 .968) .Conclusion Urine NGAL and urine KIM-1 in children with congenital heart disease after operation have important clinical significance in predicting the occurrence of AKI .

Research of timing of hemopurification therapy for sepsis patients according to KDIGO AKI classification / 中国医师杂志

Objective To investigate the prognosis of sepesis patients whose timing of hemopurification therapy was classified according to kidney disease:improving global outcomes acute kidney injury (KDIGO AKI) classification.Methods The clinic data of sepsis patients,who were treated with hemopurification therapy in Xiangya Hospital intensive care unit (ICU) during January 1,2014 to June 1,2014,were retrospectively analyzed.According to KGIDO AKI classification as their timing of hemopurification therapy,103 patients were divided to 2 groups,AKI Ⅰ group (n =34),AKI Ⅱ,Ⅲ group (n =69).Acute physiology and chronic health evaluation Ⅱ (APACHE-Ⅱ),sequential organ failure assessment (SOFA),rate of multiple organ injury 7-,28-,90-days mortality rate of 2 groups were analyzed.For 90 days survivors,the length of ICU stay,hospital stay,the frequency and time of hemopurification were analyzed,respectively.Results APACHE-Ⅱ,SOFA of KDIGO AKI Ⅰ group was less than KDIGO AKI Ⅱ,Ⅲ group.KDIGO AKI I group was less on rate of 3 and ≥4 organ injury than KDIGO AKI Ⅱ,Ⅲ group.7-,28-,90-days mortality rate of KDIGO AKI I group were less than AKI Ⅱ,Ⅲ group.In 90 days survivors,length of ICU stay,hospital stay,frequency and time of hemopurification of KDIGO AKI Ⅰ group were less than AKI Ⅱ,Ⅲ group.Conclusions KDIGO AKI classification is an effective indicator to sepsis patients for hemopurification therapy.Compared to KDIGO AKI Ⅱ,Ⅲ,sepsis patients with KDIGO AKI Ⅰ were less severity and multiple organ injuries.To start hemopurification during AKI Ⅰ,it could decrease mortality rate,length of ICU stay,hospital stay,and frequency and time of hemopurification therapy.

Progress in treatment of acute kidney injure with adipose-derived mesenchymal stem cells / 中国医师杂志

Cell-based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing tissue or organ damage.Recently,many authors have focused their atte(n)tion on adipose-derived mesenchymal stem cells (ADMSCs) for their capacity to differentiate into many cell lineages.Acute kidney injury (AKI),as a common emergency,has high morbidity rate and relatively limited treatment.This review will summarize the mechanism of ADMSCs in treatment of acute kidney injury,and hope to lay a foundation for future research.

Diagnostic value of serum cystatin C in the PICU children with septic acute kidney injury / 中国医师杂志

Objective To evaluate the early diagnosis value of serum cystatin C in the pediatric intensive care unit (PICU) children with septic acute kidney injury.Methods A total of 196 children in PICU confirmed with sepsis in Hunan Province Children's Hospital was enrolled in this study.Patients were divided into acute kidney injury (AKI) and non-AKI group according to whether accompanied with acute kidney injury.The serum cystatin C and serum creatinine were collected in 2 h,48 h,and 96 h after admission,and the clinical data were collected.The serum Cys C was drawn in receiver operating characteristic (ROC) curve.The sensitivity and specificity of Cys C were evaluated in diagnosis of septic AKI.Results The incidence of septic AKI was 35.20％,higher Cys C levels were risk factors for the onset of AKI,and OR was 26.218 (95％ CI:6.235 ～ 110.232).In AKI group,the serum Cys C level in 2 hours after admission was (2.05 ± 0.90)mg/L,which was higher than 48 hours (1.72 ± 0.72)mg/L and 96 hours (1.62 ±0.95) mg/L(Z =2.169,P =0.030; Z =2.789,P =0.005).In the septic AKI group,cystatin C and creatinine were positive correlation (r =0.582,P =0.000).The area under the ROC curve at 2hours after admission for serum cystatin C in diagnosis of AKI was 0.831.A cutoff point of 1.325 mg/L for 2 hours after admission was identified for cystatin C in the diagnosis of septic AKI,with a sensitivity of 87.1％and specificity of 78.9％.Conclusions Higher level of Cys C was risk factor for the onset of AKI.Compare to creatinine,cystatin C was earlier increased in children with septic AKI and positively correlated with it.It might be a biomarker for early diagnosis of septic AKI in PICU critical ill children.

The effect of intensive atorvastatin treatment on kidney function in patients after percutaneous coronary intervention / 安徽医科大学学报

Objective To investigate whether intensive atorvastatin treatment in patients after percutaneous coro-nary intervention ( PCI) could decrease the effect of contrast medium on kidney function and the incidence of con-trast-induced acute kidney injury( CI-AKI) . Methods A total of 128 patients with PCI were randomly divided into two groups:the enhanced treatment group (n=64) and the control group(n=64). The enhanced treatment group received 80 mg atorvastatin at 12~24 h before PCI and 24,48 h after PCI. The control group was given 20 mg ator-vastatin respectively before and after PCI. The primary end point was the incidence of CI-AKI. Serum creatinine (Scr), cystatin C, glomerular filtration rate(eGFR), urinary albumin and urinary β-2 microglobulin levels were observed at 24 h before PCI and 24, 48, 72 h after PCI. Results In the enhanced treatment group 3. 1 % (n=2) of patients developed CI-AKI versus 4. 7 % (n=3) in the control group, without statistical difference (P=1.00). There was no significant difference between two groups in postoperative Scr, cystatin C, eGFR, urinary al-bumin, urinary β-2 microglobulin and creatine kinase(CK). Three days after the operation, alanine aminotrans-ferase ( ALT) elevated in two groups, and aspartate aminotransferase ( AST) increased in the enhanced treatment group (P<0. 05), but they were all in the normal range. Conclusion There has been no significant difference in decreasing the incidence of CI-AKI and the damage of contrast medium on renal function between the enhanced treatment group and the control group before PCI.

Neutrophil gelatinase- associated lipocalin for diagnosis of acute kidney injury after cardiopulmonary bypass / 中国医师杂志

Objective To evaluate the value of neutrophil gelatinase - associated lipocalin (NGAL) for diagnosis of acute kidney injury (AKI) after cardiopulmonary bypass established. Method 120 children undergoing cardiopulmonary bypass were enrolled in this prospectively study. Serial urine samples were analyzed by ELISA for NGAL expression. The primary outcome measure was AKI, which was defined as a 50% or greater increase in serum creatinine from baseline. Result 21 children ( 17.5% ) developed AKI. Urine concentrations of NGAL increased after cardiopulmonary bypass had been established for 2 hours. The concentration of NGAL in urine after cardiopulmonary bypass had been established for 2 hours was used to diagnose AKI. The area under the receiver-operating characteristic curve was 0. 96, the sensitivity was 92%, and the specificity was 91% for the cutoff value of 100ng/mg Cr. Conclusion Concentrations of NGAL in urine might be used as a sensitive and specific biomarker for early prediction of AKI after cardiopulmonary bypass had been established.

Prevention of extracorporeal shock wave lithotripsy-induced renal Injury by pre -treating kidneys with low-energy shock waves / 中国医师杂志

Objective To investigate the prevention and mechanism of Extracorporeal shock wave lithotripsy(ESW) induced renal Injury by pre-treating kidneys with low-energy shock waves(LESW).Methods Forty healthy female domestic rabbits were surgically managed to the mono-nephron models and random divided into 4 groups consisting of ten each: Control,LESW,ESW and ESWL plus LESW pretreated groups.LESW group received 100 LESW,ESW group received 1500 standard ESW,and same dose on ESW group except 100 LESW pretreatment in ESW plus LESW pretreated group.The rabbit kidney tissues were obtained 24 hours after ESW.Activity of superoxide dismutase(SOD) and malondialdehyde(MDA) levels in the renal tissue,and the level of N-acetyl-β-D-glucosaminidase(NAG) in urinary were measured.Renal cell apoptosis was detected by TdT-mediated dUTP Nick End Labelling(TUNEL).Results The MDA,the urinary level of NAG and rate of apoptosis in the LESW groups were reduced(P<0.01),and the activity of SOD increased significantly(P<0.05) as compared with ESW group,and these changes in LESW group had no statistics difference compared with the control group(P>0.05).Conclusions LESW pretreatment protocol substantially limits the renal injury that often caused by ESW.LESW may suppress oxidative stress and antagonize the process of renal cellular apoptosis.

The changes of serum and urine guanidinoacetic acid level after cadmium chloride-induced renal injury in rabbits / 第三军医大学学报

Subcutaneous injection of 1.0 mg/kg cadmium chloride in 0.8% solution was given to rabbits weighing 1.7~2.5kg 3 times a week for 10 weeks.An equal volume of normal saline was injected to the rabbits of the control group.Blood specimen from the auricle vein and 24-hour-urine of every rabbit were collected once a week.Ten weeks later the renal cortex of the rabbits WES resected,processed routinely and examined under optical microscopy,The level of guanidinoacetic acid (GAA) of the serum and urine was determined with HPLC.It was found that the serum level of GAA increased after 3 weeks of cadmium administration while urinary excretion of GAA increased slightly in the first week and decreased significantly in the second week of cadmium injection and thereafter.

Study on the significance of prostacyclin and thromboxane in the pathogenesis of ischemic renal injury in rabbits / 第三军医大学学报

In order to investigate the significance of prostacyclin and throm-boxere A2 in the pathegertsis of ischemic renal injury,the level of 6-keto-PGF1? and TXB2 in the plasma and the dissected slices of the kidneys of the rabbits with iscbemic renal injury was determined with RIA,It was found that 6-keto-PGF1? increased significantly in the outer and inner medullae,TXB2 increased significantly in all the renal slices,and the 6-keto-PGF1?/TXB2 ratio decreased significantly in the outer cortex 3 hours after reperfusion,The findings suggest that the imbalance between the synthesis of prostacyclin and thromboxane A2 might be resporsible for the decline and redistribution of renal blood flow in the early stage of acute ischemic renal failure.