Kidney international
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Recent studies indicate that serum cystatin C is a better marker of glomerular filtration rate (GFR) and is a stronger predictor of cardiovascular disease and mortality than serum creatinine. Before cystatin C can gain wide acceptance, information about factors that affect generation, elimination, and analysis is needed. Stevens et al. analyze non-GFR-related factors associated with cystatin C and creatinine levels. The results will be useful in interpreting cystatin C levels in research and clinical practice.
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Kidney international · Feb 2009
Urinary neutrophil gelatinase-associated lipocalin levels reflect damage to glomeruli, proximal tubules, and distal nephrons.
Urinary neutrophil gelatinase-associated lipocalin (Ngal or lipocalin 2) is a very early and sensitive biomarker of kidney injury. Here we determined the origin and time course of Ngal appearance in several experimental and clinically relevant renal diseases. Urinary Ngal levels were found to be markedly increased in lipoatrophic- and streptozotocin-induced mouse models of diabetic nephropathy. ⋯ In the mouse model of unilateral ureteral obstruction, Ngal protein synthesis was dramatically increased in the dilated thick ascending limb of Henle and N was found in the urine present in the swollen pelvis of the ligated kidney. Five patients with nephrotic syndrome or interstitial nephritis had markedly elevated urinary Ngal levels at presentation, but these decreased in response to treatment. Our study shows that the urinary Ngal level may be useful for monitoring the status and treatment of diverse renal diseases reflecting defects in glomerular filtration barrier, proximal tubule reabsorption, and distal nephrons.
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Kidney international · Feb 2009
CommentPredicting progression in nondiabetic kidney disease: the importance of cardiorenal interactions.
The interplay between the heart and the kidneys has received widespread attention in recent years. A novel five-class definition of cardiorenal syndromes has been proposed. The ability of two markers of cardiac dysfunction to predict progression of primary kidney disease, described by Dieplinger and his co-workers, highlights the prognostic importance of the chronic cardiorenal (types 2 and 4) syndromes.