Русский
Prognostic and diagnostic value of NGAL and KIM-1 in patients with acute kidney injury treated with antibiotics
DOI: https://dx.doi.org/10.18565/therapy.2022.4.49-55
Nikitin E.Yu., Drozdov V.N., Vorobyeva O.A., Astapovsky A.A., Khalaidzheva K.N., Shikh E.V.
I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University)
The aim of the study is examination and estimation the prognostic and diagnostic significance of NGAL and KIM-1 markers in the blood in patients with AKI receiving antibacterial therapy.
Material and methods. The incidence of AKI was estimated in 276 postoperative patients of the Department of urology and coloproctology using a prospective analysis method in accordance with the KDIGO clinical practice guidelines criteria after antibiotics were prescribed. The criterion for selecting patients in the study was antibiotic therapy initiation. Estimation of the level of serum concentrations of new markers, creatinine and proteinuria was carried out before the prescription of an antibiotic, 24–48 hours after the prescription of an antibacterial drug, and in patients with AKI – after 72–96 hours, and then once a day until the restoration of kidney function.
Results. The critical KIM-1 level for the development of AKI 24–48 hours after antibiotic administration was ≥117 pg/mL (OR 24,2; 95% CI: 7,2–75,8). The critical level of NGAL as determined by the ROC analysis was ≤103 ng/mL before antibiotics prescription (OR 15,1; 95% CI: 5,8–39,3), p <0,0001.
Conclusion. Fixing the levels of NGAL and KIM-1 in patients at risk of AKI developing can improve the prognosis of the development and diagnosis of this disease, which in turn creates background for improving the effectiveness of therapy and reducing the risk of serious nephrotoxic reactions during antibacterial drugs treatment. The level of NGAL less than 103 ng/ml can serve as a prognostic factor for the development of AKI in the appointment of antibacterial agents. An increase in serum KIM-1 of more than 117 pg/ml during the first 24–48 hours after antibiotics prescription can be considered as an early diagnostic criterion for the development of AKI.
Literature
1. Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012; 2(1): 1–138. https://dx.doi.org/10.1038/kisup.2012.1. 2. Susantitaphong P., Cruz D.N., Cerda J. et al. Acute Kidney Injury Advisory Group of the American Society of Nephrology. World incidence of AKI: A meta-analysis. Clin J Am Soc Nephrol. 2013 ;8(9): 1482–93. https://dx.doi.org/10.2215/CJN.00710113. Erratum in: Clin J Am Soc Nephrol. 2014; 9(6): 1148. 3. Silver S.A., Long J., Zheng Y., Chertow G.M. Cost of acute kidney injury in hospitalized patients. J Hosp Med. 2017; 12(2): 70–76. https://dx.doi.org/10.12788/jhm.2683. 4. Zeng X., McMahon G.M., Brunelli S.M. et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol. 2014; 9(1): 12–20. https://dx.doi.org/10.2215/CJN.02730313. 5. Kerr M., Bedford M., Matthews B., O’Donoghue D. The economic impact of acute kidney injury in England. Nephrol Dial Transplant. 2014; 29(7): 1362–68. https://dx.doi.org/10.1093/ndt/gfu016. 6. Vaidya V.S., Ferguson M.A., Bonventre J.V. Biomarkers of acute kidney injury. Annu Rev Pharmacol Toxicol. 2008; 48: 463–93. https://dx.doi.org/10.1146/annurev.pharmtox.48.113006.094615. 7. Bao G., Clifton M., Hoette T.M. et al. Iron traffics in circulation bound to a siderocalin (Ngal)-catechol complex. Nat Chem Biol. 2010; 6(8): 602–9. https://dx.doi.org/10.1038/nchembio.402. 8. Schroll A., Eller K., Feistritzer C. et al. Lipocalin-2 ameliorates granulocyte functionality: innate immunity. Eur J Immunol. 2012; 42(12): 3346–57. https://dx.doi.org/10.1002/eji.201142351. 9. Goetz D.H. The neutrophil lipocalin NGAL is a bacteriostatic agent that interferes with siderophore-mediated iron acquisition. Mol Cell. 2002; 10(5): 1033–43. https://dx.doi.org/10.1016/s1097-2765(02)00708-6. 10. Schmidt-Ott K.M., Mori K., Li J.Y. et al. Dual action of neutrophil gelatinase-associated lipocalin. J Am Soc Nephrol. 2007; 18(2): 407–13. https://dx.doi.org/10.1681/ASN.2006080882. 11. Mori K., Lee H.T., Rapoport D. et al. Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest. 2005; 115(3): 610–21. https://dx.doi.org/10.1172/JCI23056. 12. Ichimura T., Bonventre J.V., Bailly V. et al. Kidney injury molecule-1 (KIM-1), a putative epithelial cell adhesion molecule containing a novel immunoglobulin domain, is up-regulated in renal cells after injury. J Biol Chem. 1998; 273(7): 4135–42. https://dx.doi.org/10.1074/jbc.273.7.4135. 13. Shao X., Tian L., Xu W. et al. Diagnostic value of urinary kidney injury molecule 1 for acute kidney injury: A meta-analysis. PLoS One. 2014; 9(1): e84131. https://dx.doi.org/10.1371/journal.pone.0084131. 14. Chen J.J., Lee T.H., Lee C.C., Chang C.H. Using lipocalin as a prognostic biomarker in acute kidney injury. Expert Rev Mol Diagn. 2021; 21(5): 455–64. https://dx.doi.org/10.1080/14737159.2021.1917384. 15. Jahaj E., Vassiliou A.G., Pratikaki M. et al. Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) could provide better accuracy than creatinine in predicting acute kidney injury development in critically ill patients. J Clin Med. 2021; 10(22): 5379. https://dx.doi.org/10.3390/jcm10225379. 16. Bonventre J.V., Yang L. Kidney injury molecule-1. Curr Opin Crit Care. 2010; 16(6): 556–61. https://dx.doi.org/10.1097/MCC.0b013e32834008d3. 17. Lee C.W., Kou H.W., Chou H.S. et al. A combination of SOFA score and biomarkers gives a better prediction of septic AKI and in-hospital mortality in critically ill surgical patients: A pilot study. World J Emerg Surg. 2018; 13: 41. https://dx.doi.org/10.1186/s13017-018-0202-5.
About the Autors
Evgeniy Yu. Nikitin, postgraduate student of Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. E-mail: E.U.Nikitin@ya.ru.
ORCID: https://orcid.org/0000-0001-5274-1570
Vladimir N. Drozdov, Dr. med. habil., professor, professor of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. E-mail: vndrozdov@yandex.ru.
ORCID: https://orcid.org/0000-0002-0535-2916
Olga A. Vorobieva, postgraduate student of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. E-mail: Asturia777@mail.ru.
ORCID: https://orcid.org/0000-0001-9292-4769
Alexander A. Astapovsky, postgraduate student of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. E-mail: al.astapovskii@gmail.com. ORCID: https://orcid.org/0000-0002-7430-3341
Ksenia N. Khalaidzheva, postgraduate student of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. E-mail: Kseniyakhalaidzheva@mail.ru.
ORCID: https://orcid.org/0000-0002-5484-0537
Evgenia V. Shikh, Dr. med. habil., professor, head of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. E-mail: chih@mail.ru.
ORCID: https://orcid.org/0000-0001-6589-7654
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