The online version of this article (doi:10.1186/s12882-017-0532-7) contains supplementary material, which is available to authorized users.
Paraquat ingestion is frequently fatal. While biomarkers of kidney damage increase during paraquat-induced acute kidney injury (AKI), significant concurrent proteinuria may alter diagnostic thresholds for diagnosis and prognosis to an unknown extent. This study evaluated the effect of albuminuria on biomarker cutoffs for diagnosis and outcome prediction.
This was a multi-centre prospective clinical study of patients following acute paraquat self-poisoning in 5 Sri Lankan hospitals. Biomarker concentrations were quantified using ELISA and microbead assays and correlated with urinary albumin. Functional-AKI was defined by the Acute Kidney Injury Network serum creatinine definition and alternatively by a ≥50% increase in serum cystatin C. Albuminuria was defined as albumin-creatinine ratio >30 mg/g. The study outcomes were compared with a retrospective analysis of a pre-clinical study of paraquat-induced nephrotoxicity with appropriate controls.
Albuminuria was detected in 34 of 50 patients, and increased with functional-AKI severity. The concentrations of uNGAL, uCysC, uClusterin, uβ2M, and uKIM-1 were higher in albuminuric compared to non-albuminuric patients (p < 0.001). Albuminuria correlated with biomarker concentration (r > 0.6, p < 0.01) and was associated with death (p = 0.006). Optimal biomarker cutoffs for prediction of death were higher in the albuminuric group. Similar outcomes with more detailed analysis were obtained in experimental paraquat nephrotoxicity.
Albuminuria was associated with paraquat-induced nephrotoxicity and increased excretion of low-molecular weight protein biomarkers. AKI biomarker cutoffs for diagnosis, outcome prediction and AKI stratification increased in the presence of albuminuria. This may lead to over-diagnosis of AKI in conditions independently associated with proteinuria.
Gil HW, Yang JO, Lee EY, Hong SY. Clinical implication of urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 in patients with acute paraquat intoxication. Clin Toxicol (Phila). 2009;47(9):870–5. CrossRef
Roberts DM, Buckley NA, Mohamed F, et al. A prospective observational study of the clinical toxicology of glyphosate-containing herbicides in adults with acute self-poisoning. Clin Toxicol (Phila). 2010;48(2):129–36. CrossRef
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12. CrossRefPubMedPubMedCentral
Zhang X, Gibson Jr B, Mori R, et al. Analytical and biological validation of a multiplex immunoassay for acute kidney injury biomarkers. Clin Chim Acta. 2012;415C:88–93.
Nejat M, Hill JV, Pickering JW, Edelstein CL, Devarajan P, Endre ZH. Albuminuria increases cystatin C excretion: implications for urinary biomarkers. Nephrol Dial Transplant. 2011;27 Suppl 3:iii96–iii103. PubMed
Sacks DB, Arnold M, Bakris GL, et al. Albuminuria (formerly microalbuminuria). Guidel Recomm Lab Anal Diagn Manag Diab Mellitus. 2011;12:39–42.
Johnson DW, Jones GR, Mathew TH, et al. Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement. Med J Aust. 2012;197(4):224–5.
Ben Rejeb A, Maillet M, Bescol-Liversaac J, Guillam-Megnin C. Ultrastructure of the kidney in paraquat-poisoned rats. Comparative study with literature data on man and animal. Arch Anat Cytol Pathol. 1997;45(4):199–207. PubMed
- Nephrotoxicity-induced proteinuria increases biomarker diagnostic thresholds in acute kidney injury
Nicholas A. Buckley
John W. Pickering
Zoltan H. Endre
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II