ABSTRACT
Urinary excretion of lipocalin-type prostaglandin D synthase (L-PGDS) has been suggested to be a useful biomarker of early diabetic nephropathy. We studied whether L-PGDS is also a marker of gentamicin (GM)-induced renal damage in the "creatinine-blind" range. A prospective study was conducted in 6 patients who were given long-term intravenous administration of GM (18-42 days in combination with a beta-lactam/carbapenem antibiotic or vancomycin) for the treatment of infective endocarditis. Urinary excretions of L-PGDS, beta2-microglobulin, and N-acetyl-beta-D-glucosaminidase were measured in the early (within 10 days from commencement) and late (thereafter) phases of GM therapy. Systemic clearance of GM (CLGM) and creatinine clearance (CLcr) was also measured concomitantly. CLGM was reduced significantly (P < 0.05) by 10% from the early to late treatment phase, whereas urinary L-PGDS excretion showed a significant (P < 0.05) increase (from 7.3 +/- 4.6 to 8.7 +/- 5.0 mg/g creatinine, mean +/- SD) concomitantly. In contrast, no significant changes were observed for urinary beta2-microglobulin and N-acetyl-beta-D-glucosaminidase concentrations. In conclusion, urinary L-PGDS may be a promising biomarker for the early phase of GM-induced renal impairment.
Subject(s)
Anti-Bacterial Agents/adverse effects , Gentamicins/adverse effects , Intramolecular Oxidoreductases/urine , Kidney Diseases/chemically induced , Kidney Diseases/urine , Lipocalins/urine , Acetylglucosaminidase/urine , Algorithms , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/therapeutic use , Biomarkers , Creatinine/urine , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/urine , Female , Gentamicins/pharmacokinetics , Gentamicins/therapeutic use , Half-Life , Humans , Infusions, Intravenous , Kidney Diseases/diagnosis , Kidney Function Tests , Male , Middle Aged , Pilot Projects , beta 2-Microglobulin/urineABSTRACT
A 5-month-old female Rottweiler was referred because of a 5-week diarrhea and a sudden onset of a cardiac murmur auscultated by its veterinarian. Definitive diagnosis of bacterial endocarditis was based on ultrasonographic visualization of vegetative cardiac lesions and positive cultures of Enterococcus faecalis in blood and urine. Complicating findings were suppurative nephritis and renal infarction. Despite intensive supportive care, the endocarditis and clinical condition deteriorated and the dog had to be euthanized.
Subject(s)
Dog Diseases/diagnostic imaging , Endocarditis, Bacterial/veterinary , Enterococcus faecalis , Gram-Negative Bacterial Infections/veterinary , Animals , Dog Diseases/blood , Dog Diseases/urine , Dogs , Endocarditis, Bacterial/blood , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/urine , Female , Gram-Negative Bacterial Infections/blood , Gram-Negative Bacterial Infections/diagnostic imaging , Gram-Negative Bacterial Infections/urine , UltrasonographyABSTRACT
Frequently, the presence of endocarditis is disguised. The emphasis of this description of the clinical manifestations of endocarditis is on the various modes of presentation, rather than on individual symptoms and signs. Endocarditis can manifest with cardiac, pulmonary, ophthalmic, central nervous system, renal, orthopedic, phthisic, and peripheral vascular disorders. The following clinical data are most useful in helping to establish a diagnosis of endocarditis: a history of fever, anorexia, weight loss, and back pain; a search for petechiae; splenomegaly; and daily examination, especially cardiac auscultation and funduscopic examination, of those patients in whom incomplete evidence exists at admission. The most helpful laboratory tests include those revealing anemia, increased erythrocyte sedimentation rate, abnormalities in the urine compatible with nephritis, or embolization. In patients who have not received antimicrobial therapy just before the diagnostic workup, one set of three blood cultures is sufficient to isolate the offending microorganism in about 95% of cases.
