Abstract
BackgroundThe aim of this study is to investigate the clinical significance of neutrophil gelatinase–associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in patients with scrub typhus.MethodsFrom 2014 to 2015, 145 patients were diagnosed with scrub typhus. Of these, we enrolled 138 patients who were followed up until renal recovery or for at least 3 months. We measured serum and urine NGAL and KIM-1 levels and evaluated prognostic factors affecting scrub typhus–associated AKI.ResultsOf the 138 patients, 25 had scrub typhus–associated AKI. The incidence of AKI was 18.1%; of which 11.6%, 4.3%, and 2.2% were classified as risk, injury, and failure, respectively, according to RIFLE criteria. Compared with patients in the non-AKI group, patients in the AKI group were older and showed higher total leukocyte counts and hypoalbuminemia or one or more comorbidities such as hypertension (72% vs 33%, p<0.01), diabetes (40% vs 14%, p<0.01), or chronic kidney disease (32% vs 1%, p<0.01). In addition, serum NGAL values (404± 269 vs 116± 78 ng/mL, P<0.001), KIM-1 values (0.80± 0.52 vs 0.33± 0.68 ng/mL, P<0.001), urine NGAL/creatinine values (371± 672 vs 27± 39 ng/mg, P<0.001) and urine KIM-1/creatinine values (4.04± 2.43 vs 2.38± 1.89 ng/mg, P<0.001) were higher in the AKI group than in the non-AKI group. By multivariate logistic regression, serum NGAL and the presence of chronic kidney disease were significant predictors of AKI.ConclusionSerum NGAL might be an additive predictor for scrub typhus–associated AKI.
Highlights
Scrub typhus, which is caused by Orientia tsutsugamushi and is transmitted by chigger bite, is an acute febrile disease that can involve many vital organs including the kidneys [1,2,3]
The aim of this study is to investigate the clinical significance of neutrophil gelatinase–associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in patients with scrub typhus
The incidence of AKI was 18.1%; of which 11.6%, 4.3%, and 2.2% were classified as risk, injury, and failure, respectively, according to RIFLE criteria
Summary
Scrub typhus, which is caused by Orientia tsutsugamushi and is transmitted by chigger bite, is an acute febrile disease that can involve many vital organs including the kidneys [1,2,3]. Acute kidney injury is a common disorder that is strongly linked to short- and long-term morbidity and mortality [12, 13]. Many investigations have sought to identify markers that can facilitate the early diagnosis, differential diagnosis, and short- and long-term prognosis of AKI. Several novel AKI biomarkers have been identified including neutrophil gelatinase–associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), cystatin C, interleukin (IL)-18, and liver-type fatty acid–binding protein [14,15,16,17]. There is no report on the relationship between scrub typhus-associated AKI and biomarkers such as NGAL and KIM-1. The aim of this study is to investigate the clinical significance of neutrophil gelatinase–associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in patients with scrub typhus
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