Urinary Calprotectin and Posttransplant Renal Allograft Injury

Objective

Current methods do not predict the acute renal allograft injury immediately after kidney transplantation. We evaluated the diagnostic performance of urinary calprotectin for predicting immediate posttransplant allograft injury.

Methods

In a multicenter, prospective-cohort study of 144 incipient renal transplant recipients, we postoperatively measured urinary calprotectin using an enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) after 4 weeks, 6 months, and 12 months.

Results

We observed a significant inverse association of urinary calprotectin concentrations and eGFR 4 weeks after transplantation (Spearman r = −0.33; P<0.001). Compared to the lowest quartile, patients in the highest quartile of urinary calprotectin had an increased risk for an eGFR less than 30 mL/min/1.73 m² four weeks after transplantation (relative risk, 4.3; P<0.001; sensitivity, 0.92; 95% CI, 0.77 to 0.98; specificity, 0.48; 95% CI, 0.31 to 0.66). Higher urinary calprotectin concentrations predicted impaired kidney function 4 weeks after transplantation, as well as 6 months and 12 months after transplantation. When data were analyzed using the urinary calprotectin/creatinine-ratio similar results were obtained. Urinary calprotectin was superior to current use of absolute change of plasma creatinine to predict allograft function 12 months after transplantation. Urinary calprotectin predicted an increased risk both in transplants from living and deceased donors. Multivariate linear regression showed that higher urinary calprotectin concentrations and older donor age predicted lower eGFR four weeks, 6 months, and 12 months after transplantation.

Conclusions

Urinary calprotectin is an early, noninvasive predictor of immediate renal allograft injury after kidney transplantation.     

Renal Ischaemia Reperfusion Injury: A Mouse Model of Injury and Regeneration

Renal ischaemia reperfusion injury (IRI) is a common cause of acute kidney injury (AKI) in patients and occlusion of renal blood flow is unavoidable during renal transplantation. Experimental models that accurately and reproducibly recapitulate renal IRI are crucial in dissecting the pathophysiology of AKI and the development of novel therapeutic agents. Presented here is a mouse model of renal IRI that results in reproducible AKI. This is achieved by a midline laparotomy approach for the surgery with one incision allowing both a right nephrectomy that provides control tissue and clamping of the left renal pedicle to induce ischaemia of the left kidney. By careful monitoring of the clamp position and body temperature during the period of ischaemia this model achieves reproducible functional and structural injury. Mice sacrificed 24 hr following surgery demonstrate loss of renal function with elevation of the serum or plasma creatinine level as well as structural kidney damage with acute tubular necrosis evident. Renal function improves and the acute tissue injury resolves during the course of 7 days following renal IRI such that this model may be used to study renal regeneration. This model of renal IRI has been utilized to study the molecular and cellular pathophysiology of AKI as well as analysis of the subsequent renal regeneration.     

Detection of Renal Tissue and Urinary Tract Proteins in the Human Urine after Space Flight

The urine protein composition samples of ten Russian cosmonauts (male, aged of 35 up to 51) performed long flight missions and varied from 169 up to 199 days on the International Space Station (ISS) were analyzed. As a control group, urine samples of six back-up cosmonauts were analyzed. We used proteomic techniques to obtain data and contemporary bioinformatics approaches to perform the analysis. From the total number of identified proteins (238) in our data set, 129 were associated with a known tissue origin. Preflight samples contained 92 tissue-specific proteins, samples obtained on Day 1 after landing had 90 such proteins, while Day 7 samples offered 95 tissue-specific proteins. Analysis showed that consistently present proteins in urine (under physiological conditions and after space flight) are cubilin, epidermal growth factor, kallikrein-1, kininogen-1, megalin, osteopontin, vitamin K-dependent protein Z, uromodulin. Variably present proteins consists of: Na(+)/K(+) ATPase subunit gamma, β-defensin-1, dipeptidyl peptidase 4, maltasa-glucoamilasa, cadherin-like protein, neutral endopeptidase and vascular cell adhesion protein 1. And only three renal proteins were related to the space flight factors. They were not found in the pre-flight samples and in the back-up cosmonaut urine, but were found in the urine samples after space flight: AFAM (afamin), AMPE (aminopeptidase A) and AQP2 (aquaporin-2). This data related with physiological readaptation of water-salt balance. The proteomic analysis of urine samples in different phases of space missions with bioinformation approach to protein identification provides new data relative to biomechemical mechanism of kidney functioning after space flight.     

Serum and Urinary Enzyme Activity After Renal Infarction

Recently it has been observed that the activity of certain enzymes in serum and urine may be increased after renal infarction. Although aortography or selective renal angiography should be the diagnostic corner-stone on which one would proceed to embolectomy, it is possible that enzyme assays may serve as laboratory aids to suggest or confirm the diagnosis. This paper reviews the few existing clinical and experimental studies and reports on two patients who had a total of three episodes of renal infarction. Serial determinations after one episode showed increased activity of serum oxaloacetic glutamic transaminase (SGOT) and of lactic acid dehydrogenase (LDH) and alkaline phosphatase in the serum and urine; some elevated serum LDH and SGOT values were recorded after the other two infarctions. The time of onset and duration of these increases are discussed, and the possible difficulty in differentiating renal from myocardial infarction is illustrated.     

尿微量蛋白与尿酶联合检测在早期肾脏损害诊断中的临床应用价值

目的:探讨尿微量蛋白与尿酶联合检测在早期肾脏损害诊断中的临床应用价值.方法:尿微量白蛋白( mALB)、视黄醇结合蛋白(RBP)采用免疫透射比浊法测定;尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)采用终点法测定,尿肌酐(Cr)采用肌氨酸氧化酶法测定.结果:①尿蛋白定性为阴性的高血压、糖尿病、系统性红斑狼疮患者(尿蛋白阴性组)尿mALB/Cr、RBP/Cr、NAG/Cr显著高于正常对照组,两组比较差异具有统计学意义(P均＜0.05).尿蛋白定性为阳性的高血压、糖尿病、系统性红斑狼疮患者(尿蛋白阳性组)尿mALB/Cr、RBP/Cr、NAG/Cr显著高于阴性组,两组比较差异具有统计学意义(P均＜0.05).②应用单个指标或任意两个指标联合诊断早期肾损害的灵敏度较低,应用3个指标联合诊断早期肾损害的灵敏度达到86.30％.结论:尿mALB、RBP、NAG联合检测可以早期、可靠地诊断肾脏损害.     

尿微量蛋白与尿酶联合检测在早期肾脏损害诊断中的临床应用价值

目的:探讨尿微量蛋白与尿酶联合检测在早期肾脏损害诊断中的临床应用价值。方法:尿微量白蛋白(mALB)、视黄醇结合蛋白(RBP)采用免疫透射比浊法测定;尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)采用终点法测定,尿肌酐(Cr)采用肌氨酸氧化酶法测定。结果:①尿蛋白定性为阴性的高血压、糖尿病、系统性红斑狼疮患者(尿蛋白阴性组)尿mALB/Cr、RBP/Cr、NAG/Cr显著高于正常对照组,两组比较差异具有统计学意义(P均<0.05)。尿蛋白定性为阳性的高血压、糖尿病、系统性红斑狼疮患者(尿蛋白阳性组)尿mALB/Cr、RBP/Cr、NAG/Cr显著高于阴性组,两组比较差异具有统计学意义(P均<0.05)。②应用单个指标或任意两个指标联合诊断早期肾损害的灵敏度较低,应用3个指标联合诊断早期肾损害的灵敏度达到86.30%。结论:尿mALB、RBP、NAG联合检测可以早期、可靠地诊断肾脏损害。     

Urinary Excretion of Fibrinogen-related Materials,Complement, and Immunoglobulins in Proliferative Glomerulonephritis and after Renal Transplantation

Using a radial immunodiffusion technique we measured the urinary concentration of material related to complement (C3), IgM, and IgG along with fibrin-fibrinogen degradation products and heterophile (sheep) haemagglutinins in 15 patients with proliferative glomerulonephritis and in 10 patients after renal transplantation. There was a significant correlation between all variables measured, and serial studies showed that with the exception of IgG-related materials potentially useful information could be obtained on the detection of rejection and the response to treatment in both conditions. The significance of these observations is discussed.     

Tight Junction Dynamics in the Frog Urinary Bladder

In a previous study in frog skin (Castro et al., J. Memb. Biol. 134:15–29, 1993), it was shown that TJs experimentally disrupted by a selective deposition of BaSO₄ could be re-sealed upon addition of Ca²⁺to the apical solution; in the absence of apical Ca²⁺, the normal Ca²⁺ activity of the Na₂SO₄-Ringer's bathing the basolateral side was not able to induce TJ resealing. We now show that apical Ca²⁺also activates the TJ sealing mechanism in frog urinary bladders. Three known procedures were utilized to increase TJ permeability, all in the absence of apical Ca²⁺: (i) exposure to high positive transepithelial clamping potentials; (ii) exposure of the apical surface to hypertonic solutions; and (iii) selective deposition of BaSO₄ in the TJs. The resealing of the TJs was promoted by raising the concentration of Ca²⁺ in the apical solution. This effect of Ca²⁺ is not impaired by the presence of Ca²⁺ channel blockers (nifedipine, verapamil, Mn²⁺ or Cd²⁺) in the apical solution, indicating that junction resealing does not depend on Ca²⁺ entering the cells through the apical membrane. TJ resealing that occurs in response to raised apical Ca²⁺ most likely results from a direct effect of Ca²⁺, entering the disrupted TJs from the apical solution and reaching the zonula adhaerens Ca²⁺ receptors (E-cadherins). Protein kinase C (PKC) must play a significant role in the control of TJ assembly in this tight epithelia since the PKC inhibitor (H7) and the activator (diC8) markedly affect TJ recovery after disruption by apical hypertonicity. H7 treated tissues show marked recuperation of conductance even in the absence of apical Ca²⁺. In contrast, diC8 prevents tissue recuperation which normally occurs after addition of Ca²⁺ to the apical solution.     

Tight Junction Dynamics in the Frog Urinary Bladder

In a previous study in frog skin (Castro et al., J. Memb. Biol. 134:15-29, 1993), it was shown that TJs experimentally disrupted by a selective deposition of BaSO₄ could be re-sealed upon addition of Ca²⁺to the apical solution; in the absence of apical Ca²⁺, the normal Ca²⁺ activity of the Na₂SO₄-Ringer's bathing the basolateral side was not able to induce TJ resealing. We now show that apical Ca²⁺also activates the TJ sealing mechanism in frog urinary bladders. Three known procedures were utilized to increase TJ permeability, all in the absence of apical Ca²⁺: (i) exposure to high positive transepithelial clamping potentials; (ii) exposure of the apical surface to hypertonic solutions; and (iii) selective deposition of BaSO₄ in the TJs. The resealing of the TJs was promoted by raising the concentration of Ca²⁺ in the apical solution. This effect of Ca²⁺ is not impaired by the presence of Ca²⁺ channel blockers (nifedipine, verapamil, Mn²⁺ or Cd²⁺) in the apical solution, indicating that junction resealing does not depend on Ca²⁺ entering the cells through the apical membrane. TJ resealing that occurs in response to raised apical Ca²⁺ most likely results from a direct effect of Ca²⁺, entering the disrupted TJs from the apical solution and reaching the zonula adhaerens Ca²⁺ receptors (E-cadherins). Protein kinase C (PKC) must play a significant role in the control of TJ assembly in this tight epithelia since the PKC inhibitor (H7) and the activator (diC8) markedly affect TJ recovery after disruption by apical hypertonicity. H7 treated tissues show marked recuperation of conductance even in the absence of apical Ca²⁺. In contrast, diC8 prevents tissue recuperation which normally occurs after addition of Ca²⁺ to the apical solution.     

Urinary Signatures of Renal Cell Carcinoma Investigated by Peptidomic Approaches

Renal Cell Carcinoma (RCC) is typically asymptomatic and surgery usually increases patient''s lifespan only for early stage tumours. Moreover, solid renal masses cannot be confidently differentiated from RCC. Therefore, markers to distinguish malignant kidney tumours and for their detection are needed. Two different peptide signatures were obtained by a MALDI-TOF profiling approach based on urine pre-purification by C8 magnetic beads. One cluster of 12 signals could differentiate malignant tumours (n = 137) from benign renal masses and controls (n = 153) with sensitivity of 76% and specificity of 87% in the validation set. A second cluster of 12 signals distinguished clear cell RCC (n = 118) from controls (n = 137) with sensitivity and specificity values of 84% and 91%, respectively. Most of the peptide signals used in the two models were observed at higher abundance in patient urines and could be identified as fragments of proteins involved in tumour pathogenesis and progression. Among them: the Meprin 1α with a pro-angiogenic activity, the Probable G-protein coupled receptor 162, belonging to the GPCRs family and known to be associated with several key functions in cancer, the Osteopontin that strongly correlates to tumour stages and invasiveness, the Phosphorylase b kinase regulatory subunit alpha and the SeCreted and TransMembrane protein 1.     

Increased Resistance Against Oxidative Stress Is Observed During A Short Period of Renal Reperfusion After A Temporal Ischaemia

Reperfusion of rat kidney submitted to temporal ischaemia induces a decrease in glutathione content. Lipid peroxidation is not detected in kidney homogenates but microsomes obtained after periods of reperfusion longer than 60 minutes show increased malondialdehyde values correlated with high oxygen consumption and superoxide free radical generation. Microsomes obtained from kidneys submitted to 15 or 60 minutes of reperfusion are resistant to NADPH-induced lipid peroxidation but after 120 minutes of reperfusion an increased lipid peroxidative response is observed. Although the mechanism of the protection found in microsomes against the induction of oxidative stress in the first 60 minutes of reperfusion is unknown, it is postulated that this subcellular fraction plays an important role in the oxidative stress observed after longer periods of reperfusion.