Affiliations: Department of Medicine and Therapeutics, Prince of
Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong,
China | Department of Chemical Pathology, Prince of Wales
Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China | Department of Anatomical and Cellular Pathology,
Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong
Kong, China
Note: [] Corresponding author: Cheuk-Chun Szeto, Department of Medicine
and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong
Kong, Shatin, NT, Hong Kong, China. Tel.: +852 2632 3878; Fax: +852 2637 3852;
E-mail: ccszeto@cuhk.edu.hk
Abstract: BACKGROUND: There is no reliable clinical test to predict the
reversibility of acute-on-chronic renal failure. We study whether urinary
biomarkers could be used as a noninvasive prognostic marker in patients with
acute-on-chronic renal failure. METHODS: We studied 39 adult patients with pre-existing chronic
renal impairment presenting to us with acute-on-chronic renal failure. Urinary
neutrophil gelatinase-associated lipocalin (NGAL) level was measured. The mRNA
of kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18),
alpha-1-microglobulin (α1M), sodium/hydrogen exchanger-3 (NHE3), beta-2
microglobulin (β2M), and N-acetyl-β-D-glucosaminidase (NAG) in
urinary sediment were quantified. RESULTS: Urinary NGAL level significantly correlated with the serum
creatinine at presentation (r=0.762, p< 0.0001) but not baseline serum
creatinine. Urinary sediment β2M expression significantly correlated with
baseline glomerular filtration rate (GFR) (r= −0.400, p=0.012). Urinary
α1M and NHE3 expressions were significantly higher in ischemic acute
tubular necrosis than other causes of acute kidney injury (p< 0.0001 and
p=0.006, respectively). Urinary α1M expression significantly correlated
with the degree of improvement in renal function (r=0.387, p=0.026), as well as
the estimated GFR 6 months later (r=0.386, p=0.027). CONCLUSION: In patients with acute-on-chronic renal failure, urinary
NGAL level correlates with the severity of renal failure, while urinary
α1M expression correlates with the degree of renal function recovery.
Quantification of urinary α1M mRNA may be developed as an non-invasive
tool for risk stratification of this group of patients.
