Value of urinary KIM-1 and NGAL combined with serum Cys C for predicting acute kidney injury secondary to decompensated cirrhosis

Lei Lei,Liang Ping Li,Jing Xi Mu,Xue Yang,Zhi Lan Wang,Hu Zhang,Zhen Zeng,Chao Zhou

doi:10.1038/s41598-018-26226-6

Abstract

Urinary kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C (Cys C) are biomarkers of acute kidney injury (AKI). However, the efficacy of combining these indices to diagnose decompensated cirrhosis is unknown. This study involved 150 patients divided into AKI and non-AKI, and healthy individuals. Urinary KIM-1 and NGAL, serum Cys and creatine, and glomerular filtration rate (GFR) were compared based on Child-Pugh liver function class. Urinary KIM-1 and NGAL concentrations and serum Cys C levels were significantly higher in patients with AKI secondary to decompensated cirrhosis than in those with AKI not secondary to decompensated cirrhosis (p < 0.01). These were significantly associated with higher kidney injury index stages (p < 0.01) and negatively correlated with GFR in secondary AKI patients. Urinary KIM-1 and NGAL and serum Cys C increased significantly and GFR decreased as Child-Pugh class of decompensated cirrhosis significantly increased (p < 0.05). SCr levels were significantly increased in Child-Pugh class C patients (p < 0.05). Urinary KIM-1, urinary NGAL, serum Cys C, and the combined detection factor, as screening indices, could aid in the early diagnosis of AKI secondary to decompensated cirrhosis.

Highlights

Cirrhosis is a chronic liver disease commonly identified in the clinic
Using patients with acute kidney injury (AKI) secondary to decompensated cirrhosis as the subjects, this study investigated the value of combined detection of urinary kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C (Cys C) for the early diagnosis of AKI secondary to decompensated cirrhosis
Urinary KIM-1, urinary NGAL, serum Cys C, serum creatinine (SCr), and glomerular filtration rate (GFR) were compared among the groups, and the results showed that as AKI clinical stage increased in severity, there were significant differences in kidney function indices at different stages

Summary

Introduction

Cirrhosis is a chronic liver disease commonly identified in the clinic. During the early stages, it can occur with no clinical presentation, but patient mortality increases significantly as soon as it progresses to a decompensated stage[1]. It is speculated that they are related to liver injury, which leads to redistribution of renal blood flow, further exacerbation of renal circulation disruption, mitochondrial damage in glomerular and tubular endothelial cells, and other factors[4] These types of kidney injury are often functional during the early stages and can be reversed with medication if discovered and treated early; they can progress to hepatorenal syndrome and even to life-threatening acute or chronic kidney failure. KIM-1 is a transmembrane protein that is not expressed in normal kidneys, but its levels increase in the urine upon kidney injury It can reflect the degree of kidney injury, and has been used in recent years as a sensitive marker for the early diagnosis of glomerular injury[6,7]. We evaluated the diagnostic efficacy of combined detection using these three indices, in addition to their relationship with disease progression and prognosis

Methods

Results

Conclusion