Clinical Risk Factors For Kidney Tubule Biomarker Abnormalities Among Hypertensive Adults With Reduced eGFR in the SPRINT Trial.
Clinical Risk Factors For Kidney Tubule Biomarker Abnormalities Among Hypertensive Adults With Reduced eGFR in the SPRINT Trial.
复制标题
SPRINT 试验中 eGFR 降低的高血压成人肾小管生物标志物异常的临床危险因素。
DOI：
10.1093/ajh/hpac102
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发表时间：
2022
影响因子：
3.2
通讯作者：
Shlipak,MichaelG
中科院分区：
文献类型：
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作者：
Ikeme,JesseC;Katz,Ronit;Muiru,AnthonyN;Estrella,MichelleM;Scherzer,Rebecca;Garimella,PranavS;Hallan,SteinI;Peralta,CarmenA;Ix,JoachimH;Shlipak,MichaelG
背景肾小管健康的尿液生物标志物可以区分当前肾小球测量无法捕获的肾脏损伤的各个方面。临床危险因素与特定肾小管生物标志物的关联尚未得到详细评估。方法我们在收缩压干预试验中对 2,436 名基线估计肾小球滤过率 (eGFR) <60 ml/min/1.73 m2 的参与者进行了横断面研究。使用所选变量的同时多变量线性回归来评估人口统计学和临床特征与肾小管健康尿液生物标志物之间的关联。结果每个标准差较高的年龄（9岁）与几丁质酶3样蛋白1（YKL-40）水平升高13％相关，表明肾小管间质炎症和修复水平较高。男性的 α-1 微球蛋白水平高出 31%，β-2 微球蛋白水平高出 16%，反映出肾小管重吸收功能较差。黑人种族与中性粒细胞明胶酶相关脂质运载蛋白 (12%) 水平显着升高以及肾损伤分子 1 (26%) 和尿调节蛋白 (22%) 水平显着降低相关。每个标准差 (SD) 较高的收缩压 (SBP) (16 mmHg) 都与 10% 较高的 β-2 微球蛋白和 10% 较高的 α-1 微球蛋白相关，这反映了肾小管重吸收功能较低。 结论 临床和人口特征，如种族、性别和升高的 SBP，与肾小管损伤的独特特征相关，这可能反映了肾小管损伤患者中未被充分认识的肾小管疾病模式。肾小球滤过率。
BACKGROUNDUrine biomarkers of kidney tubule health may distinguish aspects of kidney damage that cannot be captured by current glomerular measures. Associations of clinical risk factors with specific kidney tubule biomarkers have not been evaluated in detail.METHODSWe performed a cross-sectional study in the Systolic Blood Pressure Intervention Trial among 2,436 participants with a baseline estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Associations between demographic and clinical characteristics with urine biomarkers of kidney tubule health were evaluated using simultaneous multivariable linear regression of selected variables.RESULTSEach standard deviation higher age (9 years) was associated with 13% higher levels of chitinase-3-like protein-1 (YKL-40), indicating higher levels of tubulointerstitial inflammation and repair. Men had 31% higher levels of alpha-1 microglobulin and 16% higher levels of beta-2 microglobulin, reflecting worse tubule resorptive function. Black race was associated with significantly higher levels of neutrophil gelatinase-associated lipocalin (12%) and lower kidney injury molecule-1 (26%) and uromodulin (22%). Each standard deviation (SD) higher systolic blood pressure (SBP) (16 mmHg) was associated with 10% higher beta-2 microglobulin and 10% higher alpha-1 microglobulin, reflecting lower tubule resorptive function.CONCLUSIONSClinical and demographic characteristics, such as race, sex, and elevated SBP, are associated with unique profiles of tubular damage, which could reflect under-recognized patterns of kidney tubule disease among persons with decreased eGFR.