The Value Of Sema 3A In Early Diagnosis Of Contrast-induced Acute Kidney Injury

Objectives: With the continuous development of modern imaging technology and interventional therapy technology,the incidence of Contrast-induced Acute Kidney Injury has also increased year by year.It has become the third cause of hospital acquired Acute Kidney Injury.The incidence of death rate,poor prognosis and end-stage renal disease will be significantly increased in patients with CIAKI,and the time of hospitalization is also prolonged.Therefore,the early diagnosis of CIAKI is very important to improve the prognosis of the patients.In recent years,a variety of potential clinical applications of AKI biomarker has been gradually recognized,such as Neutrophil Gelatinase Associated Lipocalin,?2-Mocroglobulin,Cystatin C,Kidney Injury Molecule 1 and Interleukin-18.But these biomarkers for the clinical diagnosis and treatment of disease has not yet been guidance.Meanwhile,Serum Creatinine which is the most common clinical diagnosis biomarker of AKI is not sensitive to early stage of AKI,and not an accurate evaluation of the severity of renal lesions.Therefore,in order to achieve early detection,diagnosis and treatment of CIAKI,it is urgent to find early biomarkers with high sensitivity and specificity.Semaphorin 3A(Sema 3A)is a secretory protein in the Semaphorin family,which is expressed in the distal tubular epithelial cells of the adult kidney.Research Updates that adult Sema 3A is usually not detected in urine,but can be quickly detected after the occurrence of AKI.The purpose of this study was to explore the early diagnostic value of Sema 3A in CIAKI.Methods: 350 patients which have undergone coronary angiography and stent implantation from June 2015 to June 2016 in Department of Cardiology of the Second Hospital of Tianjin Medical University were chosen and divided into 2 groups: 46 cases of CIAKI patients and 304 cases of non CIAKI patients.The serum and urine levels of Sema 3A,?2-MG,Cys C,and s Cr were determined at a total of 6 time periods of before surgery,6 h,12 h,24 h,48 h and 72 h.The data were comparative analyzed.Meanwhile,a rat model of contrast induced nephropathy was established,and the relationship between Sema 3A and CIAKI was analyzed at the histological level.Results: Urine Sema 3A was significantly increased 6 h after coronary angiography in patients with CIAKI,but only a short,small level increased in non CIAKI patients.Sema 3A was increased in urine of patients 6 h and 12 h after surgery,which was earlier than that of ?2-MG,Cys C and s Cr.ROC curve analysis showed that 6 h urine Sema 3A was the best diagnostic value at 6 h after surgery.The cutoff value was 245 pg/?mol u Cr.Animal experiments showed that Sema 3A can promote inflammatory reaction and aggravate renal injury through promoting the expression of IL-6 and MCP-1.Conclusions: Sema 3A was closely associated with the occurrence of early renal injury,and its change is earlier than traditional biomarkers such as s Cr,?2-MG and Cys C.It was supposed to be an early biomarker of CIAKI.