The present study investigated the clinical significance of the novel biomarker neutrophil gelatinase-associated lipocalin (NGAL) for the early diagnosis of acute renal injury (AKI). Thirty-eight critically ill patients with acute renal injury treated at Zhengzhou No. 7 People's Hospital between December 2015 and November 2016 served as the AKI group (observation group). At the same time, 38 critically ill patients without acute renal injury were also selected as the non-AKI group (control group). Serum NGAL and creatinine (SCr) levels were measured by enzyme-linked immunosorbent assay (ELISA) at 2, 8, 12 and 24 h post-operation, whereas particle-enhanced turbidimetric immunoassay (PETIA) was used to quantify the levels of cysteine protease inhibitor cystatin C (CysC) in serum at 2, 8, 12 and 24 h post-operation. The correlations between indicators were also analyzed, with ROC curves used to evaluate the diagnostic values of NGAL, SCr and CysC in AKI. No significant differences in SCr levels were found between the two groups at different time-points after operation (P>0.05), but NGAL and CysC levels in the observation group were significantly higher than in the control group (P<0.05). Pearson correlation coefficient analysis showed NGAL and CysC were positively correlated with Scr levels. For NGAL in early diagnosis, the area under the AKI curve was 0.904, the sensitivity was 90.2% and the specificity was 89.5%; for CysC in early diagnosis, the area under the AKI curve was 0.806, the sensitivity was 79.2% and the specificity was 78.5%; for SCr in early diagnosis, the area under the AKI curve was 0.634, the sensitivity was 64.2% and the specificity was 62.5%. Therefore, NGAL demonstrated a satisfactory early predictive value for AKI and can be used as a biomarker for early AKI diagnosis.
Aim: To evaluate retrospectively the association of cytochrome P450 3A (CYP3A) and ATP-binding cassette sub-family B member 1 (ABCB1) gene polymorphisms with the pharmacokinetics of cyclosporine A (CsA) in Chinese renal transplant patients. Methods: One hundred and twenty-six renal transplant patients were recruited. Blood samples were collected, and corresponding clinical indices were recorded on the seventh day after the procedure. The patients were genotyped for CYP3A4*1G, CYP3A5*3C, ABCB1 1236 C>T, ABCB1 2677 G>T/A, and ABCB1 3435 C>T polymorphisms. Whole blood trough concentrations of CsA at time zero (C 0 ) were measured before the drug administration. A multiple regression model was developed to analyze the effects of genetic factors on the CsA dose-adjusted C 0 (C 0 /dose) based on several clinical indices. Results: The CYP3A5*3C polymorphism influenced the C 0 and C 0 /dose of CsA, which were significantly higher in patients with the GG genotype than in patients with the AA or GA genotypes. No significant differences were detected for other SNPs (CYP3A4*1G, ABCB1 1236 C>T, ABCB1 2677 G>T/A, and ABCB1 3435 C>T). In a univariate analysis using Pearson's correlation test, age, hemoglobin, blood urea nitrogen and blood creatinine levels were significantly correlated with the log-transformed CsA C 0 /dose. In the multiple regression model, CYP3A5*3C, age, hemoglobin and blood creatinine level were associated with the log-transformed CsA C 0 /dose. Conclusion: CYP3A5*3C correlates with the C 0 /dose of CsA on the seventh day after renal transplantation. The allele is a putative indicator for the optimal CsA dosage in the early phase of renal transplantation in the Chinese population.
This study investigated the diagnostic value of urinary interleukin-18 (uIL-18) in acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in clinical practice. A total of 103 patients who underwent CPB were divided into the AKI group and non-AKI group according to the diagnostic criteria of AKI, and we collected the urine samples before and at 2, 4, 6, 8 and 12 h after CPB and the blood samples before and at 12, 24, 48 and 72 h after CPB for detection of the levels of uIL-18 and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in urine samples and the levels of serum creatinine (Scr) in blood samples, respectively. With the results of detection, we measured the sensitivity and specificity of uIL-18 and uNGAL levels at 2 h after CPB in early diagnosis of AKI using the receiver operating characteristic (ROC) curve and area under curve (AUC). There were a total of 22 patients (21.4%) with AKI. From 12 h after CPB, the level of Scr in the AKI group was significantly elevated, and this increasing trend lasted for 60 h; comparisons with the levels before CPB and in non-AKI group showed that the differences had statistical significance (P<0.05). In AKI group, uIL-18 attained the peak level at 2 h after CPB, and the high level lasted for 10 h; comparisons with the levels before CPB and in non-AKI group showed that the differences had statistical significance (P<0.05); 2 h after CPB, the AUC was 90.48, and when the critical value was set as 1.6 µg/l, the sensitivity and specificity was 90.91 and 91.36%, respectively. Although there was a significant elevation in uNGAL level at 2 h after CPB in the AKI group, the level was dramatically decreased as soon as the peak level was attained at 4 h, and the high level only lasted for 8 h; difference between the level at 2 h after CPB and the level before CPB as well as that in the non-AKI group had statistical significance (P<0.05); at 2 h after CPB, the AUC was 83.25, and when the critical value was set as 100 µg/l, the sensitivity and specificity was, respectively 90.91 and 93.83%. The results indicated that after CPB, the level of uIL-18 shows a more promising diagnostic value in clinical practice than Scr and uNGAL in early diagnosis of AKI.
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