Urinary neprilysin in the critically ill patient
Sahra Pajenda1, Karl Mechtler2, Ludwig Wagner3
1Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. sahra.pajenda@meduniwien.ac.at.
BMC Nephrology
|May 27, 2017
Summary
Neprilysin (NEP) in urine is a promising biomarker for detecting early proximal tubular cell injury in critically ill patients, aiding in timely interventions for acute kidney injury (AKI). This marker indicates kidney damage even before serum creatinine changes appear.
Area of Science:
- Nephrology
- Biomarker Discovery
- Intensive Care Medicine
Background:
- Critically ill patients, particularly those with sepsis, are at high risk for acute kidney injury (AKI).
- Early detection of kidney injury is crucial for effective intervention and preventing treatment-induced nephrotoxicity.
- Identifying specific markers for proximal tubular cell injury is essential for understanding AKI pathogenesis.
Purpose of the Study:
- To investigate neprilysin (NEP) as a potential urinary biomarker for proximal tubular cell injury.
- To assess the diagnostic value of urinary NEP in intensive care unit (ICU) patients, including those without overt AKI.
- To correlate urinary NEP levels with histological evidence of tubular damage.
Main Methods:
- Urine samples were collected from 90 ICU patients and 55 healthy controls.
- Neprilysin (NEP) was measured using dot blot, ELISA, and immunofluorescence techniques.
- Urinary casts and microvesicles were analyzed for NEP presence.
Main Results:
- Urinary NEP levels were significantly elevated in AKI patients compared to healthy controls.
- NEP was also elevated in ICU patients without overt AKI but with potential nephrotoxic insults.
- NEP presence in urinary casts and microvesicles, along with proximal tubule staining in kidney tissue, confirmed NEP as an indicator of tubular cell alteration.
Conclusions:
- Urinary Neprilysin (NEP) serves as a reliable indicator of proximal tubular cell injury.
- NEP elevation in urine reflects direct tubular cell alterations, not just serum leakage.
- This biomarker has potential for early AKI detection and monitoring, with possibilities for healing.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
397
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
397
01:20Acute Kidney Injury V: Interprofessional Care
415
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
415
01:22Acute Kidney Injury VI: Nursing Management
583
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
583
01:26Nephrotic Syndrome II : Assessment and Medical Management
281
IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
281
01:24Nephrotic Syndrome I : Introduction
779
Nephrotic Syndrome is a chronic kidney disorder defined by clinical findings such as severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. These symptoms result from damage to the glomeruli, the kidney’s filtering units, increasing their permeability to proteins.Definition and Meaning:Proteinuria, defined as the loss of more than 3.5 grams of protein per day in adults, is a crucial feature of nephrotic syndrome. This condition is often accompanied by edema, the accumulation of...
779
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
538
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
538