Urine klotho is a potential early biomarker for acute kidney injury and associated with poor renal outcome after cardiac surgery.
Acute kidney injury
Cardiac surgery
Early biomarker
Klotho
NGAL
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
17 07 2019
17 07 2019
Historique:
received:
29
11
2017
accepted:
09
07
2019
entrez:
19
7
2019
pubmed:
19
7
2019
medline:
18
11
2020
Statut:
epublish
Résumé
Current paradigms of detecting acute kidney injury (AKI) are insensitive and non-specific. Klotho is a pleiotropic protein that is predominantly expressed in renal tubules. In this study, we evaluated the diagnostic and prognostic roles of urine Klotho for AKI following cardiac surgery. We conducted a prospective study involving 91 patients undergoing cardiac surgery. AKI was defined according to the AKIN definition. The renal outcomes within 7 days after operation were evaluated. Perioperative levels of urine Klotho and urine neutrophil gelatinase-associated lipocalin (NGAL) were measured by using ELISA. Of 91 participants, 33 patients (36.26%) developed AKI. Of these AKI patients, 21 (63.64%), 8 (24.24%), and 4 (12.12%) were staged 1, 2, and 3, respectively. Serum creatinine in AKI patients began to slightly increase at first postoperative time and reached the AKI diagnostic value 1 day after operation. Postoperative urine Klotho peaked at the first postoperative time (0 h after admission to the intensive care unit (ICU)) in patients with AKI, and was higher than that in non-AKI patients up to day 3. The AUC of detecting AKI for urine Klotho was higher than urine NGAL at the first postoperative time and 4 h after admission to the ICU. In a multivariate model, increased first postoperative urine Klotho may be an independent predictor for AKI occurrence following cardiac surgery. The concentrations of first postoperative urine Klotho were higher in AKI stage 2 and 3 than those in stage 1 (p < 0.05), and were higher in patients with incomplete recovery of renal function than those with complete recovery (p < 0.05). Urine Klotho may serve as an early biomarker for AKI and subsequent poor short-term renal outcome in patients undergoing cardiac surgery.
Sections du résumé
BACKGROUND
Current paradigms of detecting acute kidney injury (AKI) are insensitive and non-specific. Klotho is a pleiotropic protein that is predominantly expressed in renal tubules. In this study, we evaluated the diagnostic and prognostic roles of urine Klotho for AKI following cardiac surgery.
METHODS
We conducted a prospective study involving 91 patients undergoing cardiac surgery. AKI was defined according to the AKIN definition. The renal outcomes within 7 days after operation were evaluated. Perioperative levels of urine Klotho and urine neutrophil gelatinase-associated lipocalin (NGAL) were measured by using ELISA.
RESULTS
Of 91 participants, 33 patients (36.26%) developed AKI. Of these AKI patients, 21 (63.64%), 8 (24.24%), and 4 (12.12%) were staged 1, 2, and 3, respectively. Serum creatinine in AKI patients began to slightly increase at first postoperative time and reached the AKI diagnostic value 1 day after operation. Postoperative urine Klotho peaked at the first postoperative time (0 h after admission to the intensive care unit (ICU)) in patients with AKI, and was higher than that in non-AKI patients up to day 3. The AUC of detecting AKI for urine Klotho was higher than urine NGAL at the first postoperative time and 4 h after admission to the ICU. In a multivariate model, increased first postoperative urine Klotho may be an independent predictor for AKI occurrence following cardiac surgery. The concentrations of first postoperative urine Klotho were higher in AKI stage 2 and 3 than those in stage 1 (p < 0.05), and were higher in patients with incomplete recovery of renal function than those with complete recovery (p < 0.05).
CONCLUSIONS
Urine Klotho may serve as an early biomarker for AKI and subsequent poor short-term renal outcome in patients undergoing cardiac surgery.
Identifiants
pubmed: 31315593
doi: 10.1186/s12882-019-1460-5
pii: 10.1186/s12882-019-1460-5
pmc: PMC6637468
doi:
Substances chimiques
Biomarkers
0
Lipocalin-2
0
Glucuronidase
EC 3.2.1.31
Klotho Proteins
EC 3.2.1.31
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
268Références
Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
pubmed: 11904577
Am J Kidney Dis. 2003 Jan;41(1):76-83
pubmed: 12500223
FEBS Lett. 2004 May 7;565(1-3):143-7
pubmed: 15135068
J Am Soc Nephrol. 2005 Jan;16(1):162-8
pubmed: 15563569
Crit Care. 2007;11(2):R31
pubmed: 17331245
Clin J Am Soc Nephrol. 2006 Jan;1(1):19-32
pubmed: 17699187
Circulation. 2009 May 12;119(18):2444-53
pubmed: 19398670
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Nephron Clin Pract. 2010;115(1):c66-72
pubmed: 20173352
FASEB J. 2010 Sep;24(9):3438-50
pubmed: 20466874
Nephron Clin Pract. 2011;117(4):c305-11
pubmed: 20861652
Kidney Int. 2010 Dec;78(12):1240-51
pubmed: 20861825
J Am Soc Nephrol. 2011 May;22(5):810-20
pubmed: 21493774
J Am Soc Nephrol. 2011 Sep;22(9):1748-57
pubmed: 21836143
Aging Cell. 2012 Jun;11(3):410-7
pubmed: 22260450
Clin Exp Nephrol. 2012 Oct;16(5):722-9
pubmed: 22457086
Adv Clin Chem. 2012;58:141-91
pubmed: 22950345
Clin J Am Soc Nephrol. 2013 Jul;8(7):1079-88
pubmed: 23599408
J Am Soc Nephrol. 2014 Oct;25(10):2169-75
pubmed: 24854271
Nephrol Dial Transplant. 2015 Feb;30(2):223-33
pubmed: 25324355
Endocr Rev. 2015 Apr;36(2):174-93
pubmed: 25695404
J Am Soc Nephrol. 2016 Jan;27(1):79-90
pubmed: 25977312
Int J Clin Exp Med. 2015 May 15;8(5):7351-8
pubmed: 26221275
Kidney Int. 2015 Dec;88(6):1442-1444
pubmed: 26244922
Nefrologia. 2015;35(2):172-8
pubmed: 26300511
Diabetes. 2015 Dec;64(12):4298-311
pubmed: 26340932
Crit Care. 2016 Sep 10;20:286
pubmed: 27613644
Kidney Int. 2017 May;91(5):1104-1114
pubmed: 28131398
JCI Insight. 2017 Oct 19;2(20):
pubmed: 29046474
Cell Physiol Biochem. 2018;45(6):2268-2282
pubmed: 29550818