Urinary Angiotensinogen: A Promising Biomarker of AKI Progression in Acute Decompensated Heart Failure: What Does It Mean?

Wysocki, Jan; Batlle, Daniel

doi:10.2215/cjn.07780716

Cited by 13 publications

(22 citation statements)

References 29 publications

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“…AGT is a 453-amino-acid-long protein with 10 N-terminal amino acids that are cleavable by renin, leading to the formation of angiotensin I [55,149]. Angiotensin I is further converted to angiotensin II by angiotensin-converting enzyme and exerts its robust biologic effects [55,149].…”

Section: Urine Angiotensinogenmentioning

confidence: 99%

“…Angiotensin I is further converted to angiotensin II by angiotensin-converting enzyme and exerts its robust biologic effects [55,149].…”

Section: Urine Angiotensinogenmentioning

confidence: 99%

“…Although early recognition of the declining GFR is critical, some biomarkers may independently provide insights into AKI progression regardless of GFR changes [149]. Biomarkers have been used to risk stratify for severe AKI, the need for RRT, or death.…”

Section: Biomarkers Of Aki Outcome Prognosticationmentioning

confidence: 99%

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Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Kashani

Cheungpasitporn

Ronco

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

228

197

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Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.

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Section: Urine Angiotensinogenmentioning

confidence: 99%

“…Angiotensin I is further converted to angiotensin II by angiotensin-converting enzyme and exerts its robust biologic effects [55,149].…”

Section: Urine Angiotensinogenmentioning

confidence: 99%

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Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Kashani

Cheungpasitporn

Ronco

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

228

197

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“…AGT, a principal substrate of the local intrarenal renin-angiotensin system (RAS), is mainly formed in the proximal tubule cells and secreted into the tubule lumen [32,33]. Increasing evidence has suggested the strong predictive role of uAGT in the initiation and progression of AKI, particularly in the setting of heart failure.…”

Section: Clinical Application Of the Nomogrammentioning

confidence: 99%

Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure

Fan

Yang

et al. 2018

Kidney Blood Press Res

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Background/Aims: Cardiorenal syndrome type 1(CRS1) is a serious clinical condition in patients with acute heart failure (AHF) associated with adverse clinical outcomes. Although several biomarkers for identifying CRS1 have been reported, early and accurate predicting CRS1 still remains a challenge. This study was aimed to develop and validate an individualized predictive nomogram for the risk of CRS1 in patients with AHF. Methods: A total of 1235 AHF patients between 2013 and 2018 were included in this study. The patients were randomly classified into training set (n=823) and validation set (n=412). All data of the training set were used to screen the predictors of CRS1 via univariate and multivariate analyses. A nomogram was developed based on these predictors and validated by internal and external validation. The nomogram validation comprised discriminative ability determined by the area under the curve (AUC) of receiver-operating characteristic (ROC) curve and the predictive accuracy by calibration plots. Results: The overall incidence of CRS1 was 31.7%. Multivariate logistic regression revealed that age, diabetes, NYHA class, eGFR, hs-CRP and uAGT were independently associated with CRS1. A nomogram developed based on the six variables was with the AUC 0.885 and 0.823 on internal and external validation, respectively. Calibration plots showed that the predicted and actual CRS1 probabilities were fitted well on both internal and external validation. Conclusion: The proposed nomogram could predict the individualized risk of CRS1 with good accuracy, high discrimination, and potential clinical applicability in patients with AHF.

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“…The kinetic glomerular filtration rate (GFR) formula developed by Chen [ 14 ] is, in our opinion, a sensitive tool to recognize AKI early and more precisely estimate the decline and recovery of kidney function. Although early recognition of the fall in GFR is critical, some biomarkers may provide insights on AKI progression that the GFR itself cannot provide [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Angiotensinogen as a biomarker of acute kidney injury

Aqeel

Sánchez-Nadales

Batlle

2017

Clinical Kidney Journal

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Early recognition of acute kidney injury (AKI) is critical to prevent its associated complications as well as its progression to long term adverse outcomes like chronic kidney disease. A growing body of evidence from both laboratory and clinical studies suggests that inflammation is a key factor contributing to the progression of AKI regardless of the initiating event. Biomarkers of inflammation are therefore of interest in the evaluation of AKI pathogenesis and prognosis. There is evidence that the renin angiotensin aldosterone system is activated in AKI, which leads to an increase in angiotensin II (Ang II) formation within the kidney. Ang II activates pro-inflammatory and pro-fibrotic pathways that likely contribute to the progression of AKI. Angiotensinogen is the parent polypeptide from which angiotensin peptides are formed and its stability in urine makes it a more convenient marker of renin angiotensin system activity than direct measurement of Ang II in urine specimens, which would provide more direct information. The potential utility of urinary angiotensinogen as a biomarker of AKI is discussed in light of emerging data showing a strong predictive value of AKI progression, particularly in the setting of decompensated heart failure. The prognostic significance of urinary angiotensinogen as an AKI biomarker strongly suggests a role for renin–angiotensin system activation in modulating the severity of AKI and its outcomes.

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Urinary Angiotensinogen: A Promising Biomarker of AKI Progression in Acute Decompensated Heart Failure: What Does It Mean?

Cited by 13 publications

References 29 publications

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure

Angiotensinogen as a biomarker of acute kidney injury

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