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Importance of KIM-1 and MCP-1 in Determining the Leptospirosis-Associated AKI: A Sri Lankan Study
Thilini Nisansala1, Manjula Weerasekera1, Nilantha Ranasinghe2
1Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.
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.
Insights
Serum KIM-1 shows promise as an early diagnostic marker for acute kidney injury (AKI) in leptospirosis patients. This finding could lead to better diagnostic tools for this serious complication in tropical regions.
Area of Science:
- Nephrology
- Infectious Diseases
- Biomarker Discovery
Background:
- Acute kidney injury (AKI) is a severe complication of leptospirosis, a widespread zoonotic disease in tropical areas.
- Early diagnosis of leptospirosis-associated AKI is challenging due to a lack of effective diagnostic tools.
- Kidney Injury Molecule-1 (KIM-1) and Monocyte Chemoattractant Protein-1 (MCP-1) are novel AKI biomarkers not yet studied in leptospirosis.
Purpose of the Study:
- To investigate the diagnostic utility of KIM-1 and MCP-1 in identifying AKI in patients with leptospirosis.
- To evaluate serum and urine levels of KIM-1 and MCP-1 as potential biomarkers for leptospirosis-associated AKI.
Main Methods:
- Recruitment of leptospirosis-suspected patients from two hospitals in Sri Lanka.
- Confirmation of leptospirosis using PCR, MAT, and culture.
- Assessment of AKI based on Kidney Disease Improving Global Outcomes (KDIGO) criteria.
Main Results:
- Of 79 confirmed leptospirosis cases, 24.05% developed AKI.
- Significantly higher median levels of serum KIM-1, urine KIM-1, serum MCP-1, and urine MCP-1 were observed in patients with AKI compared to those without.
- Area Under the Receiver Operating Characteristic Curve (AUC-ROC) values indicated potential diagnostic performance for serum KIM-1 (0.8565).
Conclusions:
- Serum KIM-1 emerged as a promising biomarker for detecting AKI associated with leptospirosis.
- Further validation with larger patient cohorts is recommended to confirm these findings.
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