Schanz Moritz, Hoferer Anette, Shi Jing, Alscher Mark Dominik, Kimmel Martin
Division of General Internal Medicine and Nephrology, Department of Internal Medicine.
Division of Oncology, Department of Internal Medicine, Robert-Bosch Hospital, Stuttgart, Germany.
Int J Nephrol Renovasc Dis. 2017 Jun 28;10:175-181. doi: 10.2147/IJNRD.S135271. eCollection 2017.
Platinum-based chemotherapy (PBC) is a potent antineoplastic treatment, but cisplatin nephrotoxicity is often the limiting factor. Identifying the patients who are at risk for developing platinum-induced renal injury is an important issue. We tested urinary TIMP2·IGFBP7, a new US Food and Drug Administration (FDA)-cleared test to assess the risk of acute kidney injury (AKI), in a cohort of patients with malignant neoplastic disease receiving PBC.
A total of 58 patients with malignant neoplastic disease were enrolled in this study, of whom 32 patients had both urine samples and subsequent serum creatinine values available for detecting AKI within 72 hours. Urine samples were collected within 6 hours prior to PBC application and within 12 hours after the end of chemotherapy administration. We examined the predictive ability of TIMP2·IGFBP7 for the development of AKI as defined by KDIGO (Kidney Disease: Improving Global Outcomes) criteria within 72 hours after the administration of chemotherapy. Operating characteristics were determined for the previously validated TIMP2·IGFBP7 cutoff of 0.3 (ng/mL)/1000.
Four (12.5%) patients developed AKI within 72 hours. Primary disease was lymphoma in 13 patients (40.6%) and solid tumors in 19 patients (59.4%). Eight patients (25.0%) received carboplatin and 24 (75.0%) cisplatin. TIMP2·IGFBP7 after PBC administration discriminated for the risk of AKI with an area under the receiver operating characteristic curve (AUC; 95% confidence interval) of 0.92 (0.80-1.00). At the cutoff of 0.3 for TIMP2·IGFBP7, sensitivity was 50%, specificity was 87%, negative predictive value was 95% and positive predictive value was 25% for the prediction of AKI within 72 hours.
Urinary TIMP2·IGFBP7 measured in specimens gathered after PBC may be a useful tool to early identify patients who are at risk for developing platinum-induced AKI.
铂类化疗（PBC）是一种有效的抗肿瘤治疗方法，但顺铂肾毒性常常是限制因素。识别有发生铂诱导肾损伤风险的患者是一个重要问题。我们在一组接受PBC的恶性肿瘤疾病患者中检测了尿TIMP2·IGFBP7，这是一种新的经美国食品药品监督管理局（FDA）批准用于评估急性肾损伤（AKI）风险的检测方法。
本研究共纳入58例恶性肿瘤疾病患者，其中32例患者同时有尿液样本及随后72小时内用于检测AKI的血清肌酐值。在PBC应用前6小时内及化疗结束后12小时内收集尿液样本。我们根据KDIGO（改善全球肾脏病预后组织）标准，检验了TIMP2·IGFBP7对化疗给药后72小时内AKI发生的预测能力。针对先前验证的TIMP2·IGFBP7临界值0.3（ng/mL）/1000确定了操作特征。
4例（12.5%）患者在72小时内发生AKI。原发疾病为淋巴瘤的有13例（40.6%），实体瘤的有19例（59.4%）。8例（25.0%）患者接受卡铂治疗，24例（75.0%）接受顺铂治疗。PBC给药后TIMP2·IGFBP7对AKI风险的区分能力，其受试者操作特征曲线下面积（AUC；95%置信区间）为0.92（0.80 - 1.00）。对于TIMP2·IGFBP7临界值0.3，预测72小时内AKI的敏感性为50%，特异性为87%，阴性预测值为95%，阳性预测值为25%。
在PBC后收集的标本中检测尿TIMP2·IGFBP7可能是早期识别有发生铂诱导AKI风险患者的有用工具。
