Importance of KIM-1 and MCP-1 in Determining the Leptospirosis-Associated AKI: A Sri Lankan Study.

Thilini Nisansala,Nilantha Ranasinghe,Chinthika Gunasekara,Manjula Weerasekera,Chamil Marasinghe,Chandika Gamage,Neluka Fernando,Marcelo A. Soares

doi:10.1155/2021/1752904

Thilini Nisansala, Nilantha Ranasinghe + Show 6 more

Open Access

https://doi.org/10.1155/2021/1752904

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Abstract

Background Acute kidney injury (AKI) is one of most prevalent and serious complications of leptospirosis, a prevalent zoonotic disease in tropical countries. Prompt diagnosis of the leptospirosis-associated AKI is a challenge as there are no proper diagnostic tools that can identify patients in the early stage. Kidney injury molecule-1 (KIM-1) and monocyte chemoattractant protein-1 (MCP-1) are widely used novel AKI biomarkers that are studied in various disease conditions with AKI, but not in leptospirosis. Thus, this study is aimed at seeking the importance of KIM-1 and MCP-1 in determining the leptospirosis-associated AKI. Methods Leptospirosis-suspected patients who were admitted to medical wards of two selected hospitals in the Western province of Sri Lanka were recruited. Leptospirosis was confirmed by three diagnostic tests: PCR, MAT, and culture, and the status of AKI was determined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results Of 170 leptospirosis-suspected patients, 79 were leptospirosis confirmed, and among them, 24.05% of patients were diagnosed to have AKI according to KDIGO criteria. Median serum KIM-1 (p < 0.0001), urine KIM-1 (0.0053), serum MCP-1 (0.0080), and urine MCP-1 (0.0019) levels in those developing AKI were significantly higher than in patients not developing AKI. The biomarker levels associated with leptospirosis AKI had AUC-ROC of 0.8565, 0.7292, 0.7024, and 0.7282 for serum KIM-1, urine KIM-1, serum MCP-1, and urine MCP-1, respectively. Conclusion This study revealed serum KIM-1 as a promising marker for leptospirosis-associated AKI among the tested biomarkers. Thus, further validation is recommended with a larger study group.

Highlights

Acute kidney injury (AKI) in leptospirosis is one of the major complications causing high morbidity and mortality among the spectra of complications associated with leptospirosis [1]
In a recent study done in the Western and Southern provinces of Sri Lanka, AKI was reported in 35.7% of patients with confirmed leptospirosis while another study done in the North Central province and Central province in Sri Lanka reported 22% and 15% of patients with confirmed leptospirosis, respectively, highlighting its wide distribution in the country [6,7,8]
Leptospirosis was confirmed in 79 patients (46.47%) by a positive Microscopic agglutination test (MAT) (n = 44), polymerase chain reaction (PCR) (n = 49), or culture (n = 2) (Figure 1)

Summary

Introduction

Acute kidney injury (AKI) in leptospirosis is one of the major complications causing high morbidity and mortality among the spectra of complications associated with leptospirosis [1]. In a recent study done in the Western and Southern provinces of Sri Lanka, AKI was reported in 35.7% of patients with confirmed leptospirosis while another study done in the North Central province and Central province in Sri Lanka reported 22% and 15% of patients with confirmed leptospirosis, respectively, highlighting its wide distribution in the country [6,7,8]. These studies done in Sri Lanka emphasize. Further validation is recommended with a larger study group

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