Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate.
Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate.
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DOI：
10.1136/hrt.2010.194878
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Hillege HL
中科院分区：
文献类型：
--
作者：
Damman K;Van Veldhuisen DJ;Navis G;Vaidya VS;Smilde TD;Westenbrink BD;Bonventre JV;Voors AA;Hillege HL
人们越来越认识到肾小球滤过率（GFR）降低对慢性心力衰竭（CHF）的预后影响，但对这些患者的肾小管损伤知之甚少。调查 CHF 患者肾小管损伤的患病率及其与 GFR 和预后的关系。在 90 名 CHF 患者中，测量了 GFR 和有效肾血浆流量 (ERPF)（[125I] 碘酞酸盐和 [131I]hippuran 清除率）。在 24 小时尿液收集中测定肾小管标志物中性粒细胞明胶酶相关脂质运载蛋白 (NGAL)、N-乙酰基-β-D-氨基葡萄糖苷酶 (NAG) 和肾损伤分子 1 (KIM-1) 以及尿白蛋白排泄量。平均 GFR 为 78±26 ml/min/1.73 m2。与 20 名健康对照者相比，尿液 NGAL（175（70—346）mg/g 肌酐（gCr））、NAG（12（6—17）U/gCr）和 KIM-1（277（188—537）ng/gCr）水平升高（全部 p<0.001）。尿NAG（但NGAL或KIM-1）与GFR（r=-0.34，p=0.001）和ERPF（r=-0.29，p=0.006）相关。 NAG (r=0.21，p=0.048) 和 KIM-1 (r=0.23，p=0.033) 均与血浆 N 末端脑钠肽前体水平相关。尿 KIM-1（每 100 ng/gCr 增加，HR=1.15（95% CI 1.02 至 1.30），p=0.025）和 NAG（每 5 U/gCr 增加，HR=1.42（95% CI 1.02 至 1.94），p=0.039）均与死亡或心力衰竭住院风险增加相关，与 GFR 无关。尿中 NGAL、NAG 和 KIM-1 浓度升高表明肾小管损伤在 CHF 和 GFR 轻度降低的患者中很常见。尿 KIM-1 和 NAG 均显示除 GFR 之外的预后信息。这些发现表明肾小管损伤和肾小管标志物在心力衰竭的心肾相互作用中发挥重要作用。
The prognostic impact of reduced glomerular filtration rate (GFR) in chronic heart failure (CHF) is increasingly recognised, but little is known about tubular damage in these patients. To investigate the prevalence of tubular damage, and its association with GFR, and prognosis in patients with CHF. In 90 patients with CHF, GFR and effective renal plasma flow (ERPF) were measured ([125I] iothalamate and [131I]hippuran clearances). The tubular markers neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG) and kidney injury molecule 1 (KIM-1) as well as urinary albumin excretion were determined in 24 h urine collections. Mean GFR was 78±26 ml/min/1.73 m2. Urinary NGAL (175 (70—346) mg/g creatinine (gCr)), NAG (12 (6—17) U/gCr) and KIM-1 (277 (188—537) ng/gCr) levels were increased compared with 20 healthy controls (all p<0.001). Urinary NAG, but not NGAL or KIM-1 correlated with GFR (r=−0.34, p=0.001) and ERPF (r=−0.29, p=0.006). Both NAG (r=0.21, p=0.048) and KIM-1 (r=0.23, p=0.033) correlated with plasma N-terminal pro-brain natriuretic peptide levels. Both urinary KIM-1 (HR=1.15 (95% CI 1.02 to 1.30) per 100 ng/gCr increase, p=0.025) and NAG (HR=1.42 (95% CI 1.02 to 1.94) per 5 U/gCr increase, p=0.039), were associated with an increased risk of death or heart failure hospitalisations, independent of GFR. Tubular damage, as indicated by increased urinary concentrations of NGAL, NAG and KIM-1 is common in patients with CHF and mildly reduced GFR. Both urinary KIM-1 and NAG showed prognostic information additional to GFR. These findings suggest an important role for tubular damage and tubular markers in cardiorenal interaction in heart failure.
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影响因子：
168.9
作者：
Mishra, J;Dent, C;Devarajan, P
通讯作者：
Devarajan, P
DOI：
10.1152/ajprenal.00541.2007
发表时间：
2009-05-01
影响因子：
4.2
作者：
Kramer, Andrea B.;van Timmeren, Mirjan M.;Navis, Gerjan
通讯作者：
Navis, Gerjan
影响因子：
37.8
作者：
Chade, AR;Rodriguez-Porcel, M;Lerman, LO
通讯作者：
Lerman, LO
影响因子：
8.6
作者：
Ding, Hanlu;He, Yani;Gao, Wenda
通讯作者：
Gao, Wenda
影响因子：
24
作者：
Damman, Kevin;van Deursen, Vincent M.;Hillege, Hans L.
通讯作者：
Hillege, Hans L.