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Clin Exp Nephrol. 2011 Apr;15(2):220-5. doi: 10.1007/s10157-010-0384-y. Epub 2010 Dec 14.

Clinical significance of tubular and podocyte biomarkers in acute kidney injury.

Author information

1
Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan.

Abstract

BACKGROUND:

Acute kidney injury (AKI) is a common complication in critically ill patients. Urinary excretion of liver-type fatty acid-binding protein (L-FABP), which is expressed in the proximal tubules, reflects the presence of tubular injury. Urinary excretion of podocalyxin (PCX), a glycoprotein prominently expressed on podocytes, is associated with podocyte injury. Our aims were to evaluate the utility of urinary L-FABP for the early detection of AKI and to examine whether podocyte injury is present in AKI patients using the biomarker of urinary PCX.

METHODS:

Patients admitted to the intensive care unit (ICU) were divided into the AKI group (n = 14) and non-AKI group (n = 11), according to the occurrence of AKI during hospitalization in the ICU. Changes in various biomarkers were evaluated.

RESULTS:

In the AKI group, elevation of urinary L-FABP level [maximum value of L-FABP, 199.0 (92.5-433.6) μg/g creatinine, median (25-75% interquartile range)], which reflects tubular injury (area under the curve 0.95, cut-off value 44.1 μg/g Cr), occurred between -30 and 0 h before the occurrence of AKI (i.e., the time at which serum creatinine peaked), and elevation of urinary PCX level [maximum value of PCX, 389.5 (267.0-501.0) μg/g creatinine; upper limit of reference value, 160 μg/g creatinine] occurred during the time of recovery from AKI when serum creatinine levels were decreasing between 34.0 and 72.0 h after the occurrence of AKI. Furthermore, a parameter with the primary large AUC for predicting the onset of AKI was urinary L-FABP.

CONCLUSIONS:

Our study suggests that L-FABP is a useful biomarker for early detection of AKI and that podocyte injury was induced during the recovery phase of AKI.

PMID:
21153750
DOI:
10.1007/s10157-010-0384-y
[Indexed for MEDLINE]

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