Dynamics of Urinary Calprotectin after Renal Ischaemia

• Published in: PloS one 2016-01, Vol.11 (1), p.e0146395-e0146395
• Main Authors: Ebbing, Jan, Seibert, Felix S, Pagonas, Nikolaos, Bauer, Frederic, Miller, Kurt, Kempkensteffen, Carsten, Günzel, Karsten, Bachmann, Alexander, Seifert, Hans H, Rentsch, Cyrill A, Ardelt, Peter, Wetterauer, Christian, Amico, Patrizia, Babel, Nina, Westhoff, Timm H
• Format: Article
• Language: English
• Subjects: Acute kidney failure; Acute-Phase Proteins - urine; Adult; Aged; Biological markers; Biomarkers; Biomarkers - urine; Carcinoma, Renal Cell - blood supply; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Carcinoma, Renal Cell - urine; Case-Control Studies; Diagnosis; Disease; Enzyme-linked immunosorbent assay; Female; Gelatinase; Glomerular Filtration Rate; Health aspects; Hospitals; Humans; Identification; Identification and classification; Injuries; Ischemia; Kidney - blood supply; Kidney - metabolism; Kidney - pathology; Kidney - surgery; Kidney Neoplasms - blood supply; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidney Neoplasms - urine; Kidney Transplantation; Kidneys; Leukocyte L1 Antigen Complex - urine; Lipocalin; Lipocalin-2; Lipocalins - urine; Male; Middle Aged; Neoplasm Staging; Nephrectomy; Nephrectomy - methods; Neutrophils; Patients; Population; Population studies; Proteins; Proto-Oncogene Proteins - urine; Renal artery; Renal Artery - surgery; Renal function; Reperfusion; Reperfusion Injury - diagnosis; Reperfusion Injury - pathology; Reperfusion Injury - surgery; Reperfusion Injury - urine; Rodents; Surgery; Systematic review; Time Factors; Tumors; Urine; Urology; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0146395

Urinary calprotectin has been identified as a promising biomarker for acute kidney injury. To date, however, the time-dependent changes of this parameter during acute kidney injury remain elusive. The aim of the present work was to define the time-course of urinary calprotectin secretion after ischaemia/reperfusion-induced kidney injury in comparison to neutrophil gelatinase-associated lipocalin, thereby monitoring the extent of tubular damage in nephron sparing surgery for kidney tumours. The study population consisted of 42 patients. Thirty-two patients underwent either open or endoscopic nephron sparing surgery for kidney tumours. During the surgery, the renal arterial pedicle was clamped with a median ischaemic time of 13 minutes (interquartile range, 4.5-20.3 minutes) in 26 patients. Ten retro-peritoneoscopic living donor nephrectomy patients and 6 nephron sparing surgery patients in whom the renal artery was not clamped served as controls. Urinary calprotectin and neutrophil gelatinase-associated lipocalin concentrations were repeatedly measured by enzyme-linked immunosorbent assay and assessed according to renal function parameters. Urinary concentrations of calprotectin and neutrophil gelatinase-associated lipocalin increased significantly after ischaemia/reperfusion injury, whereas concentrations remained unchanged after nephron sparing surgery without ischaemia/reperfusion injury and after kidney donation. Calprotectin and neutrophil gelatinase-associated lipocalin levels were significantly increased 2 and 8 hours, respectively, post-ischaemia. Both proteins reached maximal concentrations after 48 hours, followed by a subsequent persistent decrease. Maximal neutrophil gelatinase-associated lipocalin and calprotectin concentrations were 9-fold and 69-fold higher than their respective baseline values. The glomerular filtration rate was only transiently impaired at the first post-operative day after ischaemia/reperfusion injury (p = 0.049). Calprotectin and neutrophil gelatinase-associated lipocalin can be used to monitor clinical and sub-clinical tubular damage after nephron sparing surgery for kidney tumours. Urinary calprotectin concentrations start rising within 2 hours after ischaemia/reperfusion-induced kidney injury.