Urinary and Serum Biomarkers after Cardiac Catheterization in Diabetic Patients with Stable Angina and without Severe Chronic Kidney Disease

Małyszko, Jolanta; Bachórzewska−Gajewska, Hanna; Poniatowski, Bogusław; Małyszko, J.; Dobrzycki, Sławomir

doi:10.3109/08860220903216113

Cited by 91 publications

(66 citation statements)

References 37 publications

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“…Studies including NGAL and cystatin C have suggested that NGAL had a better performance in identifying acute kidney dysfunction than cystatin C (29,30). In our patients, although those developing type 1 cardiorenal syndrome had higher levels of NGAL and cystatin C than the others, the performance of cystatin C was nonsatisfactory as expressed by an AUC of 0.68.…”

Section: Discussioncontrasting

confidence: 53%

Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

Alvelos¹,

Pimentel²,

Pinho³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The early identification of acute heart failure (HF) patients with type 1 cardiorenal syndrome should be the first step for developing prevention and treatment strategies for these patients. This study aimed to assess the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in the early detection of type 1 cardio-renal syndrome in patients with acute HF.Design, setting, participants, & measurements One-hundred nineteen patients admitted with acute HF were studied. NGAL and creatinine were measured in the first hospitalization morning; creatinine was also measured at least after 48 to 72 hours. Physicians were blinded to NGAL and cystatin C levels. Type 1 cardio-renal syndrome was defined as an increase in the creatinine level of at least 0.3 mg/dl or 50% of basal creatinine.Results Type 1 cardio-renal syndrome developed within 48 to 72 hours in 14 patients (11.8%). Admission NGAL levels were higher in these patients: 212 versus 83 ng/dl. At a cutoff value of 170 ng/L, NGAL determined type 1 cardio-renal syndrome with a sensitivity of 100% and a specificity of 86.7%. The area under the receiver-operating characteristic curve of NGAL was 0.93 and that of cystatin C was 0.68. ConclusionsAbove a cutoff value of 170 ng/L, NGAL predicts 48-to 72-hour development of type 1 cardiorenal syndrome with a negative predictive value of 100% and a positive predictive value of 50%. NGAL independently associates with type 1 cardio-renal syndrome and might be a useful biomarker in the early recognition of these patients.

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Section: Discussioncontrasting

confidence: 53%

Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

Alvelos¹,

Pimentel²,

Pinho³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Eight of them were diabetic (8 out of total 31 diabetic patients). This agreed with Malyszako et al 15 who concluded that diabetic patients are more vulnerable and prone to develop contrast nephropathy. Toprak reported that the most important and well established patient-related risk factors for CIN are CKD particularly CKD combined with diabetes mellitus and advanced age.…”

Section: Discussionsupporting

confidence: 90%

Evaluation of Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL), as an Early Biomarker and Prognostic Factor of Contrast Induced Acute Kidney Injury (CI-AKI) following Cardiac Catheterization

Nessa

Ahmed

Fakir

et al. 2016

J. Bangladesh Coll. Phys.

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Acute kidney injury (AKI) usually detected by s. creatinine, which rises after 48 hrs of insult causes delay in diagnosis and to take preventive or therapeutic measures. Hence amongst many neutrophil gelatinase associated lipocalin (NGAL) is emerging as early, sensitive, and most promising biomarker of AKI both in urine and plasma.This prospective cross sectional observational study was carried out in Combined Military Hospital (CMH) Dhaka from October 2011 to March 2012. A total of willing 100 adult patients undergoing elective coronary angiogram (CAG) with normal kidney function were included in this study. Our study defined contrast induced AKI (CI-AKI) as rise of serum creatinine by >25% or e"0.5 mg/dl from baseline after exposure to contrast media and urine NGAL e"100 ng/ml was taken as cut off value to predict AKI as calculated by ROC curve. The main outcome measures were urine NGAL at 4 hrs and serum creatinine at 48 hrs after CAG. Significant elevation of urine NGAL was noted in 9 patients after 4 hrs of CAG, of them 8 (8%) patients developed raised s. creatinine (AKI) after 48 hrs. Patient demographics and procedural factors were although statistically significant in few instances but none was predictive of AKI. Introduction:The incidence of acute kidney injury (AKI) has reached epidemic proportions worldwide, affecting about 7% of hospitalized patients. In the critical care settings, the prevalence of AKI requiring dialysis is about 6% with a mortality rate exceeding 60%. 1,2 A significant increase in morbidity and mortality associated with AKI has been demonstrated in a wide variety of clinical situations including exposure to radio contrast dye, cardiopulmonary bypass, mechanical ventilation, sepsis etc. The early diagnosis of AKI currently depends on detection of reduced kidney function by the rise in serum creatinine concentration which is a delayed and unreliable measure in acute setting.

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“…Conflicting results, regarding the time course of L-FABP, were obtained by Malyszko et al, (2009) [32]; who performed a study on 140 patients (i.e., 70 type 2 diabetic patients in comparison to 70 nondiabetic patients) with normal serum creatinine undergoing cardiac catheterization; they evaluated Serum, urinary NGAL, cystatin C, urinary KIM-1, IL-18, and L-FABP before and 2, 4, 8, 24, and 48 hours after cardiac catheterization, and observed a significant rise in L-FABP 24 and 48 hours after PCI in both groups without any significant changes 2-8 hours after the procedure (in diabetics: baseline=6.39 (0.96-7.21) pg/ml, 8h value=10.43 (2.31-51.33) pg/ml, 24h value=18.92 (5.43-112.12) pg/ml; in non-diabetics: baseline=5.32 (0.64-5.43) pg/ml, 8h value=6.38 (0.88-22.27) pg/ml, 24h value=16.01 (4.17-98.45) pg/ml); on the other hand, Serum cystatin C increased significantly after 8 hours, reaching its peak 24 hours after cardiac catheterization in both groups. In patients with CIN, Cystatin C was higher only 8 and 24 hours after cardiac catheterization, whereas L-FABP was significantly higher only 24 hours after the procedure.…”

Section: -Fasting Plasma Glucose Level By Colorimetric Methodsmentioning

confidence: 93%

Urinary Liver Type-Fatty Acid Binding Protein and Plasma Cystatin C as Early Predictors of Contrast Induced Acute Kidney Injury

Lotfy¹,

Ismail²,

Shindy³

et al. 2013

Zagazig University Medical Journal

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Background: Contrast-induced acute kidney injury (CI-AKI) continues to have an increasing incidence, representing the third most common cause of hospital acquired acute kidney injury. It is a syndrome in which an acute renal dysfunction is diagnosed after the intravascular injection of contrast media. Acute renal injury is typically diagnosed by measuring serum creatinine that is an unreliable indicator during acute changes in kidney function; thus, the need for early sensitive biomarkers to detect acute kidney injury before the rise of creatinine has emerged. Urinary Liver type fatty acid binding protein is a newly emerging biomarker that might represent an early, sensitive and non-invasive biomarker for acute renal injury. Cystatin C is a cysteine protease inhibitor that demonstrated a high diagnostic value to detect AKI on the two days before creatinine elevation. Objective: The aim of our study was to elucidate if urinary L-FABP and plasma Cystatin C can be early predictors of AKI after contrast adminstration. Subject and methods: thirty three patients were included in this study, they were divided into two main groups; Group (I): 16 patients underwent coronary angiography for dioagnostic and therapeutic purposes, Group (II): 17 patients underwent computerized tomography using IV (high-osmolar) contrast media; then classified after the procedure to AKI group and Non AKI group according to the change in serum creatinine after 24 hours. Results: the basal value of both plasma cystatin c and urinary L-FABP is significantly higher in AKI vs non AKI groups indicating predictive value of both biomarkers before contrast exposure (AUC of urinary L-FABP = 0.837 (95%CI; 0.673 -1.001); AUC of plasma Cystatin C = 0.742 (95%CI; 0.600 -0.925)). After contrast exposure, both both plasma cystatin c and urinary L-FABP showed a highly statistically significiant elevation at 6 hours in the AKI group compared to the non AKI group, while there was no statistically significiant difference in serum creatinine (mg/dl) that showed significant elevation only after 24 hours; thus, both plasma cystatin c and urinary L-FABP may serve as early predictors of AKI after contrast adminstration before any significant change in serum creatinine (AUC of urinary L-FABP =1 (95%CI; 1 -1); AUC of plasma Cystatin C =1 (95%CI; 1 -1)). Conclusion: urinary L-FABP and plasma Cystatin C can be considered as predictive biomarkers of contrast induced nephropathy before contrast exposure and as early biomarkers after contrast exposure instead of serum creatinine, as their levels start to rise about 24 hours before any significant change in serum creatinine. Further studies are recommended using large number of patient.

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Urinary and Serum Biomarkers after Cardiac Catheterization in Diabetic Patients with Stable Angina and without Severe Chronic Kidney Disease

Cited by 91 publications

References 37 publications

Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

Evaluation of Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL), as an Early Biomarker and Prognostic Factor of Contrast Induced Acute Kidney Injury (CI-AKI) following Cardiac Catheterization

Urinary Liver Type-Fatty Acid Binding Protein and Plasma Cystatin C as Early Predictors of Contrast Induced Acute Kidney Injury

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