Department of Internal, Autoimmune and Metabolic Diseases, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland.
Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland.
Ren Fail. 2020 Nov;42(1):853-859. doi: 10.1080/0886022X.2020.1801468.
Kidney dysfunction is a common complication in patients with severe liver cirrhosis. There is a need for discovery and validation of novel biomarkers for earlier AKI detection. The aim of this study was to determine if tubular injury markers: NGAL and KIM-1 could be helpful in the early diagnosis of AKI in patients undergoing therapeutic paracentesis.
This preliminary study included 24 adult patients diagnosed with liver cirrhosis who had been hospitalized due to massive ascites requiring paracentesis. Pre- and post-paracentesis plasma samples were taken from each patient and biomarkers were measured.
Before paracentesis, the levels of serum and urinary NGAL were similar between patients and controls; while urinary KIM-1 was markedly increased in liver cirrhotic patients (0.76 vs. 0.24 ng/ml; respectively). Although urinary NGAL levels in AKI patients were 5-time greater than in non-AKI subgroup, the difference did not reach statistical significance (13.2 vs 1.5 pg/mL, = 0.06). Serum NGAL level, post-procedure, was 3 times greater in AKI subgroup.
Kidney injury markers, especially serum NGAL, may be useful for the early detection of AKI. However, further research is required to determine if biomarkers of kidney injury may help identify patients with cirrhosis who would most likely benefit from early AKI prevention and treatment.
肾功能障碍是严重肝硬化患者的常见并发症。需要发现和验证新的生物标志物，以更早地检测到急性肾损伤。本研究旨在确定肾小管损伤标志物：中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤分子-1（KIM-1）是否有助于在接受治疗性腹穿的患者中早期诊断急性肾损伤。
这项初步研究纳入了 24 名成年肝硬化患者，因大量腹水需要腹穿而住院。每位患者均采集腹穿前和腹穿后血浆样本，并测量生物标志物。
在腹穿前，血清和尿 NGAL 水平在患者和对照组之间相似；而尿 KIM-1 在肝硬化患者中明显升高（分别为 0.76 和 0.24ng/ml）。虽然 AKI 患者的尿 NGAL 水平是无 AKI 亚组的 5 倍，但差异无统计学意义（13.2 与 1.5pg/ml，=0.06）。AKI 亚组的血清 NGAL 水平术后增加了 3 倍。
肾脏损伤标志物，尤其是血清 NGAL，可能有助于早期检测急性肾损伤。然而，需要进一步研究以确定肾脏损伤的生物标志物是否有助于识别最有可能受益于早期急性肾损伤预防和治疗的肝硬化患者。
