a Department of Cardiovascular Medicine, Graduate School of Medicine , Akita University , Akita , Japan.
b Department of Applied Molecular Biosciences, Graduate School of Bioagricultural Sciences , Nagoya University , Nagoya , Japan.
Biomarkers. 2019 Mar;24(2):159-165. doi: 10.1080/1354750X.2018.1528632. Epub 2018 Oct 23.
D-serine, the enantiomer of L-serine, was identified in mammals 20 years ago. Although a close relationship between D-serine and renal dysfunction has been shown, the clinical implications of urinary D- and L-serine in humans are poorly understood. The aim of this study was to evaluate the relationship between urinary D- and L-serine with well-known renal biomarkers, and clarify the prognostic value of D- and L-serine for renal events.
This cross-sectional, prospective study included 65 patients with atherosclerotic risk factors, who were followed up for a median of 16 months. The primary endpoint was a composite of end-stage renal disease and a decline in estimated glomerular filtration rate (eGFR) ≥ 25% from baseline.
Urinary D-serine concentrations showed a better correlation with eGFR than did urinary L-serine, whereas neither urinary D- nor L-serine correlated with tubular markers such as urinary liver-type fatty acid-binding protein and N-acetyl-beta-D-glucosaminidase. A Cox regression analysis revealed that low urinary D-serine levels were significantly associated with the primary endpoint after adjusting for confounding factors (hazard ratio 12.60; 95% confidence interval, 3.49-45.51).
Urinary D-serine is associated with glomerular filtration and can be a prognostic biomarker of renal dysfunction in patients with atherosclerotic risk factors.
D-丝氨酸是 L-丝氨酸的对映异构体，20 年前在哺乳动物中被发现。尽管 D-丝氨酸与肾功能障碍之间存在密切关系，但人类尿液中 D-和 L-丝氨酸的临床意义仍不清楚。本研究旨在评估尿 D-和 L-丝氨酸与已知肾生物标志物之间的关系，并阐明 D-和 L-丝氨酸对肾脏事件的预后价值。
这是一项横断面前瞻性研究，纳入了 65 名具有动脉粥样硬化危险因素的患者，中位随访时间为 16 个月。主要终点是终末期肾脏疾病和估算肾小球滤过率（eGFR）从基线下降≥25%的复合终点。
尿 D-丝氨酸浓度与 eGFR 的相关性优于尿 L-丝氨酸，而尿 D-丝氨酸和 L-丝氨酸均与肾小管标志物如尿肝型脂肪酸结合蛋白和 N-乙酰-β-D-氨基葡萄糖苷酶无相关性。Cox 回归分析显示，在校正混杂因素后，低尿 D-丝氨酸水平与主要终点显著相关（危险比 12.60；95%置信区间，3.49-45.51）。
尿 D-丝氨酸与肾小球滤过有关，可作为动脉粥样硬化危险因素患者肾功能障碍的预后生物标志物。
