Kidney international
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Kidney international · Apr 2014
Identification of IGFBP-7 by urinary proteomics as a novel prognostic marker in early acute kidney injury.
Early diagnosis of acute kidney injury (AKI) and accurate prognostic stratification is a prerequisite for optimal medical management. To identify novel prognostic markers of AKI, urine was collected on the first day of AKI in critically ill patients. Twelve patients with early recovery and 12 matching patients with late/non-recovery were selected and their proteome analyzed by gel electrophoresis and mass spectrometry. ⋯ Significant upregulation of the urinary markers predicted mortality (IGFBP-7: AUC 0.68; NGAL: AUC 0.81), recovery (IGFBP-7: AUC 0.74; NGAL: AUC 0.70), and severity of AKI (IGFBP-7: AUC 0.77; NGAL: AUC 0.69), and were associated with the duration of AKI. IGFBP-7 was a more accurate predictor of renal outcome than NGAL. Thus, IGFBP-7 is a novel prognostic urinary marker that warrants further investigation.
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Kidney international · Apr 2014
The cyclin-dependent kinase inhibitor p21 is essential for the beneficial effects of renal ischemic preconditioning on renal ischemia/reperfusion injury in mice.
The cyclin-dependent kinase inhibitor p21 plays important roles in chronic renal disorders; however, its roles in response to acute renal stress are unclear. Here we evaluated p21 in acute kidney injury and ischemic preconditioning using wild-type and p21 knockout mice that underwent renal ischemia followed by reperfusion. The decline in renal function and histological changes were worse in the knockout than in wild-type mice. ⋯ Ischemic preconditioning increased renal p21 expression and the number of cells in the G1 phase of the cell cycle before ischemia/reperfusion compared with sham surgery. Thus, renal p21 is essential for the beneficial effects of renal ischemic preconditioning. Transient cell cycle arrest induced by ischemic preconditioning by a p21-dependent pathway seems to be important for subsequent tubular cell proliferation after ischemia/reperfusion.
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Kidney international · Apr 2014
CommentUrine proteomics for acute kidney injury prognosis: another player and the long road ahead.
Urine represents a mine for proteomic markers of renal diseases, but its analysis is hindered by unresolved technical issues. Aregger et al. used an unbiased proteomics approach to analyze urine of critically ill patients. They discovered insulin-like growth factor-binding protein 7 (IGFBP-7) and linked it to acute kidney injury (AKI) outcome. Future efforts should address the biology of IGFBP-7 and related proteins to determine their role in AKI.
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Kidney international · Mar 2014
Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children.
Reliable prediction of severe acute kidney injury (AKI) has the potential to optimize treatment. Here we operationalized the empiric concept of renal angina with a renal angina index (RAI) and determined the predictive performance of RAI. This was assessed on admission to the pediatric intensive care unit, for subsequent severe AKI (over 200% rise in serum creatinine) 72 h later (Day-3 AKI). ⋯ Thus, we operationalized the renal angina concept by deriving and validating the RAI for prediction of subsequent severe AKI. The RAI provides a clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. The RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.
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Hospitalized children are experiencing acute kidney injury (AKI) with increasing frequency and are especially vulnerable to its long-term complications. Attempts to leverage novel biomarkers to improve phenotyping of this disease are limited by untargeted testing within broadly selected populations. Here, we review efforts by Basu et al. to use readily available clinical information to identify critically ill children at higher risk for developing severe AKI, who may benefit from novel diagnostic and prognostic information.