New Biomarkers in Acute Tubulointerstitial Nephritis: A Novel Approach to a Classic Condition

Valenzuela, Laura Martínez; Draibe, Juliana; Fulladosa, Xavier; Torras, Juan

doi:10.3390/ijms21134690

Cited by 14 publications

(10 citation statements)

References 44 publications

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“…In these patients, the most likely source of ecDNA are injured tubular cells releasing their content caused by inflammatory infiltrates. Moreover, resulting inflammation itself further promotes a rise in ecDNA 45 . On the other hand, necroptosis might be involved in direct drug toxicity to tubular cells during TIN.…”

Section: Discussionmentioning

confidence: 99%

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Extracellular DNA concentrations in various aetiologies of acute kidney injury

Kovalčíková

Janovičová

Hodosy

et al. 2022

Sci Rep

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Extracellular DNA (ecDNA) in plasma is a non-specific biomarker of tissue damage. Urinary ecDNA, especially of mitochondrial origin, is a potential non-invasive biomarker of kidney damage. Despite prominent tissue damage, ecDNA has not yet been comprehensively analysed in acute kidney injury (AKI). We analysed different fractions of ecDNA, i.e. total, nuclear and mitochondrial, in plasma and urine of children, and different animal models of AKI. We also analysed the activity of the deoxyribonuclease (DNase), which is contributes to the degradation of ecDNA. Patients with AKI had higher total and nuclear ecDNA in both, plasma and urine (sixfold and 12-fold in plasma, and 800-fold in urine, respectively), with no difference in mitochondrial ecDNA. This was mainly found for patients with AKI due to tubulointerstitial nephritis and atypical haemolytic uremic syndrome. Increased plasma ecDNA was also found in animal models of AKI, including adenine nephropathy (fivefold), haemolytic uremic syndrome (fourfold), and ischemia–reperfusion injury (1.5-fold). Total urinary ecDNA was higher in adenine nephropathy and ischemia–reperfusion injury (1300-fold and twofold, respectively). DNase activity in urine was significantly lower in all animal models of AKI in comparison to controls. In conclusion, plasma total and nuclear ecDNA and urinary total ecDNA is increased in patients and animals with particular entities of AKI, suggesting a mechanism-dependent release of ecDNA during AKI. Further studies should focus on the dynamics of ecDNA and its potential role in the pathogenesis of AKI.

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Section: Discussionmentioning

confidence: 99%

“…The released ecDNA activates immune system extending inflammation and release of additional ecDNA in turn. This might be an alternative and/or supplemental source of ecDNA, particularly in the urine 45 .…”

Section: Discussionmentioning

confidence: 99%

Extracellular DNA concentrations in various aetiologies of acute kidney injury

Kovalčíková

Janovičová

Hodosy

et al. 2022

Sci Rep

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“…Main clinical and laboratory features of TINU include sudden onset of bilateral non-granulomatous anterior uveitis (rare posterior uveitis or panuveitis) associated with typical anterior uveitis symptoms (eye pain, redness, decreased vision, and photophobia) and mildly to moderately abnormal renal function, in particular elevated Creatinine with or without raised urea, high inflammatory markers (ESR, CRP), abnormal urinalysis (low-grade proteinuria, normoglycemic glucosuria, microscopic haematuria and elevated β2-microglobulin). To confirm the renal involvement, kidney biopsy can be considered demonstrating tubulointerstitial inflammatory infiltrations containing lymphocytes and non-specific histiocytes with vessels and glomeruli being typically spared ( 87 , 90 , 92 ). Apart from the mentioned above clinical and laboratory changes, most of the patients with TINU have systemic features, including fever, weight loss, fatigue, and abdominal/flank pain.…”

Section: Non-infectious Uveitismentioning

confidence: 99%

Pediatric uveitis: Role of the pediatrician

et al. 2022

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The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.

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“…Eosinophilia is only present in 10% of patients [ 5 ], thus resulting in poor diagnostic performance [ 6 , 7 ]. Previous studies have evaluated novel biomarkers of AIN by analyzing markers of inflammation, interstitial edema, cellular damage, and tubular lesions; however, their clinical utility remains unknown [ 8 ]. Despite the many examined biomarkers, the gold standard continues to be percutaneous renal biopsy [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A low BUN/creatinine ratio predicts histologically confirmed acute interstitial nephritis

et al. 2023

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Introduction In hospitalized patients with acute renal injury (AKI), acute tubulointerstitial nephritis (AIN) constitutes one of the leading etiologies. The objective of this study was to identify clinical and biochemical variables in patients with AKI associated with kidney biopsy-confirmed AIN. Methods For our prospective study, we recruited hospitalized patients aged 18 years and older who were diagnosed with AKI based on biochemical criteria. Prior to enrollment, each patient was assessed with a complete metabolic panel and a kidney biopsy. Results The study consisted of 42 patients (with a mean age of 45 years) and equal numbers of male and female patients. Diabetes and hypertension were the main comorbidities. Nineteen patients had histological findings consistent with AIN. There was a correlation between histology and the BUN/creatinine ratio (BCR) (r = -0.57, p = 0.001). The optimal Youden point for classifying AIN via a receiver operating characteristic (ROC) curve analysis was a BCR ≤ 12 (AUC = 0.73, p = 0.024). Additionally, in diagnosing AIN, BCR had a sensitivity of 76%, a specificity of 81%, a positive predictive value of 81%, a negative predictive value of 76%, and OR of 14 (95% CI = 2.6 to 75.7, p = 0.021). In the multivariable analysis, BCR was the sole variable associated with AIN. Conclusion A BCR ≤ 12 identifies AIN in patients with AKI. This study is the first to prospectively assess the relationship between renal biopsy results and BCR.

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New Biomarkers in Acute Tubulointerstitial Nephritis: A Novel Approach to a Classic Condition

Cited by 14 publications

References 44 publications

Extracellular DNA concentrations in various aetiologies of acute kidney injury

Extracellular DNA concentrations in various aetiologies of acute kidney injury

Pediatric uveitis: Role of the pediatrician

A low BUN/creatinine ratio predicts histologically confirmed acute interstitial nephritis

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