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ABSTRACT: BACKGROUND: Urinary interleukin-18 (uIL-18) and cystatin C (uCysC) are biomarkers of acute kidney injury (AKI). We hypothesized that in non-AKI neonates, the level of uIL-18 and uCysC would be higher in those with sepsis compared to those without sepsis. The aims of this study were to determine the association between urinary biomarkers and sepsis in non-AKI critically ill neonates, and to evaluate whether uIL-18 and uCysC could serve as predictors of sepsis in this population. METHODS: The study included 111 non-AKI critically ill neonates with acute clinical deterioration suggestive of sepsis: 26 with infection, 57 without infection, and 28 were assigned to the unclassified group. Urinary samples were collected and a full sepsis screen was performed at the time of enrollment. RESULTS: The level of uIL-18, but not uCysC, was significantly elevated in non-AKI septic neonates. Urinary IL-18 was an independent factor associated with sepsis assessed by multivariate analysis, had odds ratio of 1.73 (95 % CI 1.15 to 2.58, p = 0.008), and achieved the area under the receiver operating characteristic curve of 0.74 for predicting the presence of sepsis in non-AKI critically ill neonates. CONCLUSIONS: Sepsis has an impact on the level of uIL-18, but not on the uCysC in non-AKI neonates, suggesting systemic infection might influence the diagnostic value of uIL-18 to detect AKI in the general population.
Pediatric Nephrology 08/2012; · 2.52 Impact Factor
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ABSTRACT: Several renal histopathological features, including mesangial hypercellularity, glomerulosclerosis, tubular atrophy and interstitial fibrosis, are considered to be independent predictors of end-stage renal failure in patients with glomerular diseases. Mesangial proliferative glomerulonephritis (MesPGN) is characterized by proliferations of mesangial cells with increase in mesangial matrix and/or deposits in mesangial region. The purpose of this study is to determine the association between urinary protein markers measured at the same time as renal biopsy and the severity of renal histological lesions in children with MesPGN, and to evaluate whether these markers could serve as predictors of severe renal histological lesions in this population.
Ninety-eight children with MesPGN (40 with IgA nephropathy, 37 with IgM nephropathy, and 21 with MesPGN without IgA/IgM deposition) were enrolled. Urinary level of IgG, albumin, transferrin, α1-microglobulin, β2-microglobulin and N-acetyl-β-glucosaminidase from a morning sample before biopsy was measured.The scores of mesangial hypercellularity, glomerulosclerosis, and tubule-interstitial damage were used to semi-quantitatively evaluate renal histological lesions.
The urine proteins, as independent factors associated with severe mesangial cellularity (> 5 mesangial cells/ mesangial area) were transferrin, albumin, α1-microglobulin, IgG and 24-hour total protein, with severe glomerulosclerosis (≥ 10 % glomeruli showing segmental adhesions or sclerosis) were transferrin and 24-hour total protein, and with severe tubule-interstitial damage (focal or diffuse tubular and interstitial lesions) were transferrin and N-acetyl-β-glucosaminidase. Urinary transferrin achieved the area under-the-receiver-operating-characteristic curve (AUC) of 0.86 and 0.82, respectively, for predicting severe mesangial cellularity and glomerulosclerosis. Urinary N-acetyl-β-glucosaminidase achieved the highest AUC of 0.82 for predicting severe tubule-interstitial damage. The combination of urinary protein markers, however, did not improve the predictability for renal histological lesions.
Urinary protein markers are useful to predict the severity of renal histological lesions in children with MesPGN, which suggests that urinary proteins might be useful to predict the development and progression of renal histological lesions, and assist in evaluating the outcome and prognosis in children with MesPGN as non-invasive and easily repeatable indicators on the follow-up examination.
BMC Nephrology 05/2012; 13:29. · 2.18 Impact Factor
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ABSTRACT: Abnormalities of the complement system in Henoch-Schönlein purpura (HSP) have been reported, but how this abnormality in the complement system impacts on the prognosis of HSP remains unknown.
We retrospectively studied patients hospitalized for HSP in the Children's Hospital Affiliated to Soochow University between October 2010 and May 2011. Patients with HSP and hypocomplementemia were the cases, and those without hypocomplementemia were the HSP controls. Another group of children (n = 50) with upper respiratory tract infections, but without HSP acted as negative controls.
A total number of 338 HSP patients were included in this study (n = 53 cases, n = 285 controls). In the cases, C3 and C4 levels decreased in 29 patients, C3 was low in 6, and C4 in 18. Complement levels returned to normal within 3 months in all HSP patients except one. Case group patients had higher levels of serum IgG and arthralgia, as well as positive titers of antistreptolysin-O. Rates of abdominal pain, gastrointestinal bleeding, Henoch-Schönlein purpura nephritis (HSPN), and serum IgA and IgM levels were similar in the two HSP groups.
Hypocomplementemia associated with HSP is a transient phenomenon. The incidence of significant sequelae such as HSPN between patients with and without hypocomplementemia does not differ.
Pediatric Nephrology 01/2012; 27(5):801-6. · 2.52 Impact Factor
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ABSTRACT: Urinary interleukin-18 and cystatin-C are suggested to be biomarkers for predicting acute kidney injury (AKI). The aims of this study are to examine whether the urinary concentrations of interleukin-18 and cystatin-C vary with gestational age and other factors in non-AKI control neonates, and to determine whether urinary interleukin-18 and cystatin-C can predict AKI development in non-septic critically ill neonates, independently of potential confounders.
We enrolled 62 non-septic critically ill neonates. Urine was collected every 48-72 h during the first 10 days of life.
Urinary concentration of cystatin-C, but not interleukin-18, decreased with increasing gestational age and body weight, but not with increasing postnatal age in non-AKI control neonates. Both urinary interleukin-18 and cystatin-C were associated with AKI, even after controlling for gestational and postnatal age, birth weight, gender, Apgar score and the score for neonatal acute physiology in non-septic critically ill neonates. Urinary interleukin-18 and cystatin-C had odds ratios of 2.27 and 2.07, and achieved the area under-the-receiver-operating-characteristic curve of 0.72 and 0.92, respectively, for predicting AKI.
The urinary concentration of cystatin-C, but not interleukin-18, may decrease with increasing renal maturity. Both urinary interleukin-18 and cystatin-C are independently predictive of AKI in non-septic critically ill neonates.
Pediatric Nephrology 01/2012; 27(5):851-60. · 2.52 Impact Factor
