Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease.
Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease.
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DOI：
10.4103/2229-516x.205811
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发表时间：
2017-04-01
影响因子：
1.1
通讯作者：
Nkhoma, Panji
中科院分区：
文献类型：
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作者：
Sinkala, Musalula;Zulu, Mildred;Nkhoma, Panji
背景：由于缺乏可靠的生物标志物来评估肾功能，肾功能损害的诊断和评估仍然是一个挑战。现有的生物标志物组目前显示出一些局限性，最近肾损伤分子-1（KIM-1）已被建议作为肾功能的敏感生物标志物并被提议进入临床实践。目的：进行本研究以确定血清肌酐、尿素和微量白蛋白尿（MAU）与新型生物标志物KIM-1相关的诊断价值。材料和方法：血清肌酐，尿素，MAU和KIM-1测定40人与40个没有肾脏疾病。结果：肌酐（0.924 ± 0.0066）和尿素（0.925 ± 0.0068）的受试者-操作者特征曲线下面积（AUC）较MAU（0.880 ± 0.078）和KIM-1（0.35 ± 0.124）的诊断优势明显。肌酐和尿素的总体诊断效率较高（分别为89.5%和90.9%），其次是MAU（85.7%），然后是KIM-1（56.3%）。Logistic回归分析显示，肌酐和尿素（R2分别为0.75和0.72，P均< 0.001）较MAU（R2 = 0.64，P < 0.001）和KIM-1（R2 = 0.046，P = 0.116）更能预测肾脏疾病。进一步的一致性分析显示尿素与肌酐具有极好的一致性（kappa r = 0.835，P < 0.001），与KIM-1（kappa r =-0.198，P = 0.087）与肌酐的一致性较差。我们的研究结果表明，血清肌酐和尿素升高高于特定的临界点，可靠地确定患者患有急性肾损伤或慢性肾损伤疾病然而，在其应用于临床实践之前，还需要更多的研究来进一步验证MAU和KIM-1的诊断效率和应用。
CONTEXT: The diagnosis and evaluation of impaired renal function remains a challenge owing to lack of reliable biomarker for assessment of kidney function. The existing panel of biomarkers currently displays several limitations, and recently kidney injury molecule-1 (KIM-1) has been suggested as a sensitive biomarker of renal function and proposed to enter clinical practice.AIMS: This study was conducted to determine the diagnostic value of serum creatinine, urea, and microalbuminuria (MAU) in relation to the novel biomarker, KIM-1.MATERIALS AND METHODS: Serum creatinine, urea, MAU, and KIM-1 were measured in forty individuals with and forty without kidney disease. Data were analyzed using multivariate methods of assessing diagnostic efficiency, test agreement, condition effects, and variability.RESULTS: The area under the receiver-operator characteristic curve revealed a diagnostic advantage of creatinine (0.924 ± 0.0066) and urea (0.925 ± 0.0068) over MAU (0.880 ± 0.078) and KIM-1 (0.35 ± 0.124). Overall diagnostic efficiency was higher for creatinine and urea (89.5% and 90.9%, respectively), followed by MAU (85.7%) and then KIM-1 (56.3%). Logistic regression analysis showed that creatinine and urea (R2 = 0.75 and R2 = 0.72, respectively, P < 0.001 for both) were better predictors of kidney disease than MAU (R2 = 0.64, P < 0.001) and KIM-1 (R2 = 0.046, P = 0.116). Further analysis of agreement showed that urea had an excellent agreement with creatinine (kappa r = 0.835, P < 0.001), with KIM-1 (kappa r = -0.198, P = 0.087) showing a poor agreement with creatinine.CONCLUSION: Our results indicate that elevated serum creatinine and urea above specific cutoff points reliably identifies patients with acute kidney injury or chronic kidney disease. However, more researches are warranted to further validate the diagnostic efficiency and application of MAU and for KIM-1 before its implementation in clinical practice.