Predicting Cisplatin-Induced Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin Excretion: A Pilot Prospective Case-Control Study
Predicting Cisplatin-Induced Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin Excretion: A Pilot Prospective Case-Control Study
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DOI：
10.1159/000312879
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发表时间：
2010-01-01
影响因子：
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通讯作者：
Ruggenenti, Piero
中科院分区：
文献类型：
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作者：
Gaspari, Flavio;Cravedi, Paolo;Ruggenenti, Piero
背景/目的：肾毒性是顺铂治疗实体瘤的主要限制。我们的目的是评估血清/尿液中性粒细胞明胶酶相关脂钙蛋白（NGAL）（小管损伤和再生的生物标志物）水平的早期升高是否可以预测顺铂诱导的急性肾损伤（AKI）。方法：我们比较了顺铂输注（70- 80mg /m(2)）后1和4小时以及1、2、3、7和15天的血清肌酐和血清/尿NGAL水平（ELISA测定）与基线相比的变化，12例连续的AKI癌症患者（病例）（与基线相比，血清肌酐升高25%）和12例连续的无AKI对照。结果：两组患者的基线特征和治疗后血清NGAL水平相似。在顺铂治疗后1、2、3和15天，尿NGAL水平明显高于对照组。NGAL升高在AKI发生前4.5天，顺铂治疗后第2天NGAL升高独立预测AKI （p < 0.05）。与肾功能恢复的患者相比，6例肾功能不全患者在术后15天尿NGAL水平有较早和较高的升高趋势。结论：尿NGAL排泄的早期增加可能有助于识别有顺铂诱导AKI风险的患者，这些患者可能受益于预防顺铂肾毒性的创新治疗。版权所有：S. Karger AG，巴塞尔
Background/Aims: Nephrotoxicity is the major limitation to cisplatin therapy for solid tumors. We aimed at evaluating whether early increases in serum/urine levels of neutrophil gelatinase-associated lipocalin (NGAL), a biomarker of tubular damage and regeneration, predict cisplatin-induced acute kidney injury (AKI). Methods: We compared changes in serum creatinine and serum/urine NGAL levels (ELISA assay) at 1 and 4 h and 1, 2, 3, 7 and 15 days after cisplatin infusion (70-80 mg/m(2)) versus baseline in 12 consecutive cancer patients (cases) with AKI (>25% serum creatinine increase vs. baseline) and 12 consecutive controls without AKI. Results: Baseline characteristics and posttreatment serum NGAL levels were similar in both groups. Urinary NGAL levels increased significantly more in cases than in controls at 1, 2, 3 and 15 days after cisplatin. The NGAL increase preceded AKI by 4.5 days and the NGAL increase at day 2 after cisplatin independently predicted AKI (p < 0.05). Six cases with residual kidney dysfunction at 15 days showed a trend to earlier and higher increase in urinary NGAL levels compared to cases with renal function recovery. Conclusion: An early increase in urinary NGAL excretion may help in identifying patients at risk of cisplatin-induced AKI who might benefit from innovative treatments to prevent cisplatin nephrotoxicity. Copyright (C) 2010 S. Karger AG, Basel