| BackgroundAcute kidney injury is a common medical emergency, which is complicated with about 50% of patients in the Intensive Care Unit. With the population aging and the Large-scale useage of antibiotics and immunosuppressive agent in the clinical practices, as well as the increasing popularity of angiography and chemotherapy, the morbidity and mortality of acute kidney injury ascend significantly. Acute renal injury is not irreversible in most cases, detection and treatment in the early stage can prevent its progression into renal failure. The key to reduce mortality of acute renal injury is to diagnose earlier, prevent and treat earlier. Traditional serum creatinine and blood urea nitrogen are either not applicable for the early identification nor earlier diagnosis of kidney injury. In recent years, researchers have found a series of acute renal injury markers applied in genomics and proteomics, such as kidney injury molecule-1 , Neutrophil gelatinase-associated lipocalin , interleukin-18, cystatinC and et al. Kidney injury molecule-1 is a new type I transmembrane glycoprotein, which is not detectable in normal kidney tissue, but expressed at a very high level on dedifferentiated renal proximal tubule epithelial cells undergoing regeneration after toxic or ischemic injury. Related research has shown that , in both ischemia-reperfusion and cisplatin-induced nephrotoxicity models in the rat, urinary Kim-1 is a sensitive and specific indicator of proximal tubular kidney injury and is increased earlier than any of the conventional biomarkers, e.g. serum creatinine, blood urea nitrogen, glycosuria, proteinuria, and urinary NAG. Kim-1 protein is shed from cells into the urine in rodents and in humans. The research of Kim-1 is limited to in vitro experiments and animal models, and clinical applications have rarely been reported. It is worth further research how the Kim-1 changes in the patients with acute kidney injury, and its role in the earlier diagnosis of Acute renal injury.ObjectivesTo investigate the change of Kim-1 in urine of the patients with acute kidney injury, and study the contribution and significance of it.MethodsTo collect cases in Xiangya hospital during January to October in 2008 according to the RIFLE criterion, including 10 cases of slight acute kidney injury, 15 cases of medium-severe acute kidney injury, 15 cases of the wounded in the 5.12 Wenchuan earthquake, 10 cases of end-stage renal disease and 20 healthy. ELISA method to detect urine Kim-1, colorimetric method to detect urine N-acetyl-beta-D-glucosaminidase, xanthine Oxidase method to detect serum superoxide dismutase, thibabituric acid method to detect serum malonaldehyde. To analyze the correlation between urine Kim-1 and urine NAG, and evaluate the sensitivity and specificity of urine Kim-1 using the receiver operator characteristic curve. To observe the variation of urine Kim-1 and evaluate the sensitivity and specificity of urine Kim-1 in early diagnosis of AKI.Results1. Compared with the healthy control group and ESRD group, the urine Kim-1 increases obviously in the slight acute kidney injury group and medium- Severe acute kidney injury group (P<0.05) ; In addition, the urine Kim-1 in the medium-severe acute kidney injury group increase more significantly. Urine Kim-1 is positively correlated with urine NAG, and the Kim-1 had an AUC-ROC of 0.914 (P<0.01) .2. There is no statistical significance of urinary Kim-1 between ESRD group and the healthy control group (P>0.05) .3. The urinary Kim-1 in the wounded in the 5.12 Wenchuan earthquake is also higher than the healthy control group (P<0.05) .Conclusion1. Urinary Kim-1 emerges earlier than any of the conventional biomarkers when AKI occurs; The serum SOD and MDA raise up accompanied by the urinary Kim-1, prompting that the increasing urinary Kim-1 may relate to the oxidative stress.2. Urinary Kim-1 had no significant increase in ESRD group, it attribute to the totally atrophic tubular which may loss the expression of Kim-1. |
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