Title: Performance of Urinary Liver Type Fatty Acid Binding Protein in Predicting Acute Kidney Injury in Post Cardiac Catheterization

Authors: Heba El-Shair, Rania Swelem, Sherif Wagdy

 DOI:  http://dx.doi.org/10.18535/jmscr/v3i9.49

Abstract

Acute kidney injury (AKI) is a common medical problem and is significantly associated with increasing morbidity and mortality. Contrast media (CM) is increasingly used in diagnostic and interventional procedures which results in the rising incidence of iatrogenic renal function impairment caused by the exposure to CM, a condition known as contrast induced nephropathy (CIN). The fatty acid-binding proteins (FABPs) are small cytoplasmic proteins abundantly expressed in tissues with active fatty acid metabolism. Nine distinct types have been identified, with each named after the tissue in which they were first identified.The urinary excretion of L-FABP reflects stress of proximal tubular epithelial cells, correlating with severity of ischemic tubular injury. The performance of urinary L-FABP as an early detection marker of AKI has shown promise in various clinical settings. We aim in this study to assess the feasibility of urinary L-FABP as very early marker of CI-AKI after cardiac catheterization in patient with stage 3or 4 CKD. A prospective study on 40 patients comparing urinary L-FABP excretion in group I (10 control subjects with normal renal functions) and group II (30 adult patients with chronic kidney disease stage 3or 4 and established AKI after elective cardiac catheterization at the Cardiology and Angilogy department. Measuring urinary L-FABP the day before and 6 hours after catheterization.There was a statistically significant positive correlation between u-LFABP/Cr0 and   u-LFABP/Cr6 withCr0, Cr24, Cr48 ,Cr72. There was a statistically significant negative correlation between eGFR and u-LFABP.

Keywords: U-LFABP,acute kidney injury, cardiac catheterization

References

1.      Liangos O, Wald R, O’Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survery. Clin J Am Soc Nephrol. 2006;1:43–51. 

2.      Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–818. 

3.      Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930–936. 

4.      Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005;352:15–35. 

5.      Wang G, Gong Y, Anderson J, et al. Antioxidative function of L-FABP in L-FABP stably transfected Chang liver cells. Hepatology. 2005;42:871–879. 

6.      Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr. 2011 Apr;23(2):194–200. 

7.      Kratz A,Ferraro M ,Sluss PM et al,laboratory reference value . N Engl J Med 2004;351:2461.

8.      Noiri E,Tsukahara H.parameters of measurements of oxidative stress in diabetes mellitus  :applicability of  ELISA for clinical evaluation J investing Med 2005;4167-75.

9.      Schrier RW, Wang W, Poole B, et al. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004;114:5–14.

10.  Yamamoto T, Noiri E, Ono Y, et al. Renal L-type fatty acid binding protein in acute ischemic injury. J Am Soc Nephrol. 2007;18:2894–2902. 

11.  Portilla D, Dent C, Sugaya T, et al. Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2007;73:465–472.

12.  Nakamura T, Sugaya T, Node K, et al. Urinary excretion of liver-type fatty acid-binding protein in contrast medium-induced nephropathy. Am J Kidney Dis. 2006;47:439–444.

13.    Michael A. FergusonVishal S. et al. Urinary liver-type fatty acid-binding protein predicts adverse outcomes in acute kidney injury Kidney Int. 2010 Apr; 77(8): 708–714.

14.   Paweena Susantitaphong, , Monchai Siribamrungwong, , Kent Doi, et al.Performance of Urinary Liver-Type Fatty Acid–Binding Protein in Acute Kidney Injury: A Meta-analysis Am J Kidney Dis. 2013 Mar; 61(3): 430–439.

15.  Stevens MA, McCullough PA, Tobin KJ et al. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.C.E. Study: Prevention of Radiocontrast Induced Nephropathy Clinical Evaluation. J Am Coll Cardiol 1999; 33: 403–411. 

16.  Katholi RE, Taylor GJ, Woods WT et al. Nephrotoxicity of nonionic low-osmolarity versus ionic high-osmolarity contrast media: a prospective double-blind randomized comparison in human beings. Radiology 1993;186: 183–187. 

17.  Harris KG, Smith TP, Cragg AH, et al. Nephrotoxicity from contrast material in renal insufficiency: ionic versus nonionic agents. Radiology1991; 179: 849–852. 

18.  Schwab SJ, Hlatky MA, Pieper KS et al. Contrast nephrotoxicity: a randomized controlled trial of a nonionic and an ionic radiographic contrast agent. N Engl J Med 1989; 320: 149–153. 

19.  Laskey WK, Jenkins C, Selzer F, et al. NHLBI Dynamic Registry Investigators Volume-to-creatinine clearance ratio: pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. J Am Coll Cardiol. 2007August;50(7):584-590 .

Corresponding Author

Heba Elshair

Lecturer of Internal Medicine, Faculty of Medicine

University of Alexandria, Egypt

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Tel  02 01227466650