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Visceral leishmaniasis‐associated nephropathy in hospitalised Brazilian patients: new insights based on kidney injury biomarkers
Author(s) -
Meneses Gdayllon C.,
De Francesco Daher Elizabeth,
Silva Junior Geraldo B.,
Bezerra Gabriela F.,
Rocha Thaiany P.,
Azevedo Isabella E. P.,
Libório Alexandre B.,
Martins Alice M. C.
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13127
Subject(s) - medicine , acute kidney injury , gastroenterology , renal function , cystatin c , creatinine , urinary system , kidney disease , albuminuria
Objective To evaluate the usefulness of early acute kidney injury ( AKI ) biomarkers in clinical management of visceral leishmaniasis. Methods Prospective study with 50 hospitalised VL patients. AKI biomarkers, that is, serum and urinary neutrophil gelatinase‐associated lipocalin ( sNGAL , uNGAL , respectively), urinary kidney injury molecule‐1 ( uKIM ‐1) and urinary monocyte chemotactic protein‐1 ( uMCP ‐1), were quantified by immunoassay ( ELISA ). Also, interferon‐gamma ( INF ‐y) and C‐reactive protein ( CRP ) were evaluated as inflammatory biomarkers possibly related to VL severity. Results VL patients had hyponatremia, hypoalbuminemia, hypergammaglobulinemia, haematologic and hepatic disorders. AKI was found in 46%, and one death (2%) occurred. The AKI group had significant longer hospital stay, lower levels of IFN ‐y and higher levels of CRP , more clinical renal abnormalities and higher levels of sNGAL , uNGAL , uKIM ‐1 and uMCP ‐1. Overall, sNGAL , uKIM ‐1 and uMCP ‐1 showed correlations with important clinical renal abnormalities, such as proteinuria, albuminuria, serum creatinine and glomerular filtration rate using adjusted correlations with CRP and IFN ‐y. Only sNGAL showed an early association with AKI development ( OR = 2.78, 95% CI = 1.429–5.428, per each increase of 50 ng/ ml ), even after adjusting for clinical signals of VL severity and for immune biomarkers. Moreover, sNGAL showed a better performance in predicting AKI development ( AUC ‐ ROC = 0.81, 95% CI = 0.69–0.93; cut‐off = 154 ng/ ml , sensitivity = 82.6%, specificity = 74.1%, P < 0.001). Conclusions Visceral leishmaniasis‐associated nephropathy showed important proximal tubular injury and glomerular inflammation. Serum NGAL showed an early association with VL ‐associated nephropathy and may be used to improve clinical management strategies and decrease morbimortality in VL patients.