Reply to the Letter to the Editor: "GDF-15 - A matter of the heart or the kidney?".
Reply to the Letter to the Editor: "GDF-15 - A matter of the heart or the kidney?".
复制标题
回复给编辑的信：“GDF-15 - 心脏还是肾脏的问题？”。
DOI：
10.1016/j.ijcard.2020.04.008
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发表时间：
2020
影响因子：
3.5
通讯作者：
Book,Wendy
中科院分区：
文献类型：
--
作者：
Saraf,Anita;Book,Wendy
我们感谢Thorsteindottir等人。[2]他们对肾功能对GDF-15水平的影响的见解，因为它与理解我们的Fontan患者中全身失调的生物标志物的病理生理学有关。事实上，我们认识到，我们研究的一些生物标志物可能起源于多个器官，或者可能由于亚临床多器官失调而异常，这是临床实践中使用的标准实验室测试所不认识的。因为它在调节各种器官损伤情况下的趋化因子表达中起重要作用。然而，在我们的Fontan队列中，使用Thorsteindottir等人使用的参数，没有慢性肾损伤的证据。正如所指出的，（表2b）基线和随访时肌酐水平均正常。通过标准实验室检查测量，队列中的GFR水平（未报告）> 70 mL/min/1.73 m2。然而，这些患者的其他肾脏失调标志物（例如半胱氨酸蛋白酶抑制剂C和uPAR）异常，这进一步强调了对我们的复杂患者进行先进生物标志物检测的必要性。我们预期一些生物标志物将彼此相关（补充图1），因为在GDF-15与肾标志物uPAR和胱抑素C之间存在正相关性，进一步证实Fontan生理学在临床恶化之前对各种器官系统（包括肾）具有长期后果。
We thank Thorsteindottir et al.[2] for their insight into the influence of renal function on GDF-15 levels, as it is relevant to understanding the pathophysiology of systemically dysregulated biomarkers in our Fontan patients. In fact, we appreciate that some of the biomarkers that we investigated may originate in multiple organs or may be abnormal as a consequence of subclinical multiorgan dysregulation that is not appreciated by standard laboratory tests used in clinical practice.In our study [1], we considered GDF-15 to be an inflammatory marker (Table 3), as it plays a significant role in modulating chemokine expression in various instances of organ injury. In our Fontan cohort, however, there was no evidence of chronic kidney injury using parameters used by Thorsteindottir et al. As noted,(Table 2b) creatinine levels were normal both at baseline and follow up. GFR levels (not reported) were> 70 mL/min/1.73 m2 in the cohort as measured by standard laboratory tests. However, other markers of renal dysregulation such as Cystatin C and uPAR were abnormal in these patients, which further emphasizes the need to employ advanced biomarker testing in our complex patients. We expect that some biomarkers will correlate with each other,(Supplemental Fig. 1) as there is a positive correlation between GDF-15 and renal makers uPAR and Cystatin C, further validating that Fontan physiology has long term consequences on various organ systems, including the kidney, that precedes clinical deterioration.