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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Nephrology 1/2017

Nephrotoxicity-induced proteinuria increases biomarker diagnostic thresholds in acute kidney injury

Zeitschrift:
BMC Nephrology > Ausgabe 1/2017
Autoren:
Fahim Mohamed, Nicholas A. Buckley, John W. Pickering, Klintean Wunnapuk, Sandamali Dissanayake, Umesh Chathuranga, Indika Gawarammana, Shaluka Jayamanne, Zoltan H. Endre
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12882-017-0532-7) contains supplementary material, which is available to authorized users.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
Zusatzmaterial
Additional file 1: Table S1. Urinary functional and injury biomarkers in healthy subjects. (DOCX 12 kb)
12882_2017_532_MOESM1_ESM.docx
Additional file 2: Figure S1. Biomarker profiles stratified by ACR. (DOCX 647 kb)
12882_2017_532_MOESM2_ESM.docx
Literatur
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