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Association of Systemic Inflammatory Biomarkers (NLR, MLR, PLR, SII, SIRI) with Preeclampsia-Related Kidney Injury: A
Li-Na Gao1,2, Dong Yan2, Xiao-Hui Liu2
1The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, People's Republic of China.
Insights
Inflammation markers like monocyte-to-lymphocyte ratio (MLR) and systemic inflammation response index (SIRI) are linked to acute kidney injury (AKI) in preeclampsia (PE). Elevated MLR is a key risk factor, especially in early-onset PE.
Area of Science:
- Obstetrics and Gynecology
- Nephrology
- Immunology
Background:
- Preeclampsia (PE) affects 7-13% of pregnancies, with acute kidney injury (AKI) being a severe complication.
- PE-AKI is associated with long-term chronic kidney disease.
- Inflammation plays a critical role in PE pathogenesis and progression.
Purpose of the Study:
- To investigate the association between inflammation indices and the risk of PE-AKI.
- To evaluate the clinical utility of five inflammation markers in predicting PE-AKI.
- To identify specific inflammatory markers most strongly associated with PE-AKI.
Main Methods:
- Retrospective observational study of 4071 PE patients (2013-2023).
- Analysis of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).
- Multivariate logistic regression and restricted cubic spline models to assess associations and dose-response relationships.
Main Results:
- 7.13% of PE patients developed AKI.
- Significant positive associations were found between all tested inflammatory indices and PE-AKI risk.
- Monocyte-to-lymphocyte ratio (MLR) showed the strongest independent correlation with PE-AKI (highest tertile OR = 7.24).
- Elevated MLR was a prominent risk factor in early-onset PE and complicated cases.
Conclusions:
- MLR and SIRI are positively associated with PE-AKI risk, particularly in early-onset and complicated PE.
- These findings support the clinical utility of MLR and SIRI as predictive biomarkers for PE-AKI.
- Further research focusing on monocyte-mediated inflammatory mechanisms is warranted.
Background:
Approximately 7-13% of pregnant women with preeclampsia (PE) develop acute kidney injury (AKI), which is one of the most serious complications of PE and is linked to long-term chronic kidney disease. This retrospective observational study investigated the association between inflammation indices and PE-related acute kidney injury (PE-AKI).
Methods:
This retrospective study analyzed 4071 PE patients admitted between 2013 and 2023. Inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were derived from complete blood counts. Multivariate logistic regression assessed associations with PE-AKI risk, with nonlinear relationships characterized using restricted cubic spline models.
Results:
Among 4071 patients with PE, 290 (7.13%) developed AKI. Multivariate analysis (Model 3) revealed significant positive associations between log2-transformed inflammatory indices and PE-AKI risk, with the highest odds ratios observed for MLR (OR = 6.02, 95% CI: 4.68-7.73; P < 0.0001) and NLR (OR = 3.93, 95% CI: 3.09-5.01; P < 0.0001). MLR demonstrated the strongest independent correlation with PE-AKI (highest tertile OR = 7.24, 95% CI: 4.75-11.02), followed by SIRI (OR = 5.78, 95% CI: 3.89-8.59). All indices (NLR, MLR, PLR, SII, SIRI) exhibited linear dose-response relationships with PE-AKI risk (P-overall <0.001 for each). Subgroup analyses further identified elevated MLR as a prominent risk factor in early-onset PE (gestational age ≤32 weeks; OR = 8.81, 95% CI: 4.91-17.10) and patients with complications (OR = 7.28, 95% CI: 5.23-10.32).
Conclusion:
MLR and SIRI are positively associated with PE-AKI risk, particularly in early-onset and complicated cases. This first comprehensive assessment of five biomarkers supports clinical utility. Prospective validation is required, with focus on monocyte-mediated inflammatory mechanisms.
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