Laboratory parameters of cardiac and kidney dysfunction in cardio-renal syndromes

Abstract

"Cardio-Renal Syndromes" (CRS) are disorders of the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pathophysiology of CRS is complex, and there is accumulating evidence that various novel biomarkers are useful for diagnosis, prognostication, and risk stratification in patients with heart failure and chronic kidney disease (CRS). When both the heart failure (HF) and CKD occur together, it is important to have biomarkers that are able to risk stratify patients by looking at both their heart and kidney aspects. There are some promising newer renal biomarkers that may contribute to a better evaluation and prediction of prognosis in CRS patients. Most of the renal biomarkers studies in CRS have been performed in the setting of cardiac surgery, acute coronary syndrome (ACS), HF or after exposure to radiocontrast media in diagnostic and/or therapeutic percutaneous coronary procedures. Natriuretic peptides (NPs) have been validated as an important cardiac biomarker for risk stratification and prognostication in HF patients with or without CKD. However, the best cutoff values for each stage of CKD, including those on renal replacement therapy, are yet to be ascertained. In this context, it is likely that panels of multiple biomarkers will be needed for optimal evaluation, risk stratification, timely treatment initiation, and follow-up of patients with CRS.

NGAL, L-FABP, and KIM-1 in comparison to established markers of renal dysfunction

“…Furthermore, we tried to elucidate gains in information by the new markers and interferences of the diagnostic performance by leukocyturia or hematuria. Studies in children and adults have shown that uNGAL is rapidly and massively expressed in well-defined cases of AKI [8,9]. Besides predicting AKI, NGAL may be involved in the pathophysiological process of chronic renal diseases, such as polycystic kidney disease and glomerulonephritis as well as several types of renal tumors [21,22].…”

“…Urinary NGAL (uNGAL) likely plays a critical role in host defense by chelating iron-siderophore complexes and is rapidly and massively expressed in AKI as shown by numerous studies [8,9].…”

“…Many studies have shown that NGAL, L-FABP, and KIM-1 increase in AKI [8,9,[12][13][14][15][16]. The new markers have been tested in special collectives and under clinical settings like acute renal injury and contrast medium-induced nephropathy, but not extensively in patients suffering from renal diseases like diabetic nephropathy, nephroscleroses, or tubulointerstitial nephropathies combined with a normal or a decreased glomerular filtration rate (GFR).…”

Patients with Cardiorenal Syndrome Revealed Increased Neurohormonal Activity, Tubular and Myocardial Damage Compared to Heart Failure Patients with Preserved Renal Function

“…On the other hand, GFR is prone to several biases linked to the formula used for its calculation (age, body weight and patient setting). The recognition of biomarkers for the early diagnosis of kidney injury is now becoming a research priority [18]. …”

Neutrophil gelatinase-associated lipocalin as a biomarker of cardiovascular disease: a systematic review

“…Indeed, in most of these studies, there has been minimal to no adjustment for potential confounders, such as CKD. It is relevant therefore, that in AHF, discharge plasma NGAL level was a stronger predictor of 30-day outcome than BNP, the guideline-supported standard for risk prediction (42), even after adjustment for renal function. If reproduced in other studies, one could speculate that a high NGAL at the time of discharge for AHF might, at a minimum, be a signal for early follow-up.…”