Kidney Injury Molecule-1 Level is Associated with the Severity of Renal Interstitial Injury and Prognosis in Adult Henoch–Schönlein Purpura Nephritis

• Published in: Archives of medical research 2017-07, Vol.48 (5), p.449-458
• Main Authors: Zhang, Yuanyuan, Li, Aiju, Wen, Jiliang, Zhen, Junhui, Hao, Qiufa, Zhang, Yidan, Hu, Zhao, Xiao, Xiaoyan
• Format: Article
• Language: English
• Subjects: Adult; Cellular/fibrocellular crescents; Child; Female; Henoch-Schönlein purpura nephritis (HSPN); Hepatitis A Virus Cellular Receptor 1 - metabolism; Humans; Kidney - metabolism; Kidney - pathology; Kidney injury molecules-1 (KIM-1); Male; Nephritis - diagnosis; Nephritis - metabolism; Nephritis - pathology; Prognosis; Proteinuria - diagnosis; Proteinuria - metabolism; Purpura, Schoenlein-Henoch - diagnosis; Purpura, Schoenlein-Henoch - metabolism; Purpura, Schoenlein-Henoch - pathology; Tubulointerstitial damage
• ISSN: 0188-4409; 1873-5487
• DOI: 10.1016/j.arcmed.2017.10.005

Kidney injury molecule-1 (KIM-1) was identified the most highly upregulated protein in chronic kidney diseases and prolonged KIM-1 expression may be maladaptive. The present study was aimed to investigate urinary, renal and plasma KIM-1 levels and to analyze association between KIM-1 levels with clinical and pathological indexes in adult Henoch-Schönlein purpura (HSP) patients. Twenty healthy individuals, 20 HSP patients without nephritis and 35 HSP patients with nephritis were recruited. Urinary and plasma KIM-1 levels were determined by ELISA and Luminex, respectively. Renal KIM-1 expression was evaluated by immunohistochemistry. HSP patients with nephritis were characterized as elevated levels of urinary, renal and plasma KIM-1. Those with more severe tubular injury of renal biopsy tissues presented significantly higher urinary and renal KIM-1 levels compared to control and patients without nephritis. Urinary and renal levels of KIM-1 were positively correlated with blood urea nitrogen and proteinuria, while they were negatively correlated with eGFR at both baseline and after two years follow-up. Moreover, plasma KIM-1 levels were associated with blood urea nitrogen and proteinuria as well. Further univariate correlation analysis indicated urinary and renal KIM-1 levels were positively correlated with interstitial inflammation index and tubulointerstitial chronicity index. Only urinary KIM-1 levels were associated with interstitial inflammation index, tubulointerstitial chronicity index and extracapillary glomerular activity index, after logistic regression analysis. The area under the curve (AUC) for urinary KIM-1/Cr predicting progression of renal damage was significantly greater than the AUC for proteinuria. This finding suggests that measurement of urinary and renal KIM-1 level may be helpful to evaluate severity of renal pathological damage and prognosis in adult HSP patients with nephritis.