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      Bedside biomarkers in pediatric cardio renal injuries in emergency

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          Abstract

          Point of care testing (POCT) using biomarkers in the emergency department reduces turnaround time for clinical decision making. An ideal biomarker should be accurate, reliable and easy to measure with a standard assay, non-invasive, sensitive and specific with defined cutoff values. Conventional biomarkers for renal injuries include rise in serum creatinine and fluid overload. Recently, neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), cystatin C, interleukin-18 (IL-18) and liver fatty acid binding protein (L-FABP) have been studied extensively for their role in acute kidney injury associated with various clinical entities. Biochemical markers of ischaemic cardiac damage commonly used are plasma creatine kinase and cardiac troponins (cTn). Clinically valuable cardiac markers for myocardial injury in research at present comprise BNP/NT-proBNP and to a lesser extent, CRP, which are independent predictors of adverse events including death and heart failure. Current status of point of care biomarkers for diagnosis and prognostication of renal and cardiac injuries in pediatric emergency care is appraised in this review.

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          Direct proinflammatory effect of C-reactive protein on human endothelial cells.

          V Pasceri, J T Willerson, E Yeh (2000)
          The acute-phase reactant C-reactive protein (CRP) is an important risk factor for coronary heart disease. However, the possible effects of CRP on vascular cells are not known. We tested the effects of CRP on expression of adhesion molecules in both human umbilical vein and coronary artery endothelial cells. Expression of vascular cell adhesion molecule (VCAM-1), intercellular adhesion molecule (ICAM-1), and E-selectin was assessed by flow cytometry. Incubation with recombinant human CRP (10 microg/mL) for 24 hours induced an approximately 10-fold increase in expression of ICAM-1 and a significant expression of VCAM-1, whereas a 6-hour incubation induced significant E-selectin expression. Adhesion molecule induction was similar to that observed in endothelial cells activated with interleukin-1beta. In coronary artery endothelial cells, induction of ICAM-1 and VCAM-1 was already present at 5 microg/mL and reached a maximum at 50 microg/mL, at which point a substantial increase in expression of E-selectin was also evident. The CRP effect was dependent on presence of human serum in the culture medium, because no effect was seen in cells cultured with serum-free medium. In contrast, interleukin-1beta was able to induce adhesion molecule expression in the absence of human serum. CRP induces adhesion molecule expression in human endothelial cells in the presence of serum. These findings support the hypothesis that CRP may play a direct role in promoting the inflammatory component of atherosclerosis and present a potential target for the treatment of atherosclerosis.
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            Dual action of neutrophil gelatinase-associated lipocalin.

            Kai M Schmidt-Ott, Kiyoshi Mori, Jau Yi Li … (2007)
            Neutrophil gelatinase-associated lipocalin (NGAL) is expressed and secreted by immune cells, hepatocytes, and renal tubular cells in various pathologic states. NGAL exerts bacteriostatic effects, which are explained by its ability to capture and deplete siderophores, small iron-binding molecules that are synthesized by certain bacteria as a means of iron acquisition. Consistently, NGAL deficiency in genetically modified mice leads to an increased growth of bacteria. However, growing evidence suggests effects of the protein beyond fighting microorganisms. NGAL acts as a growth and differentiation factor in multiple cell types, including developing and mature renal epithelia, and some of this activity is enhanced in the presence of siderophore:iron complexes. This has led to the hypothesis that eukaryotes might synthesize siderophore-like molecules that bind NGAL. Accordingly, NGAL-mediated iron shuttling between the extracellular and intracellular spaces may explain some of the biologic activities of the protein. Interest in NGAL has been sparked by the observation that NGAL is massively upregulated after renal tubular injury and may participate in limiting kidney damage. This review summarizes the current knowledge about the dual effects of NGAL as a siderophore:iron-binding protein and as a growth factor and examines the role of these effects in renal injury.
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              Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury.

              Dana Rapoport, H. Lee, Kiyoshi Mori … (2005)
              Neutrophil gelatinase-associated lipocalin (Ngal), also known as siderocalin, forms a complex with iron-binding siderophores (Ngal:siderophore:Fe). This complex converts renal progenitors into epithelial tubules. In this study, we tested the hypothesis that Ngal:siderophore:Fe protects adult kidney epithelial cells or accelerates their recovery from damage. Using a mouse model of severe renal failure, ischemia-reperfusion injury, we show that a single dose of Ngal (10 microg), introduced during the initial phase of the disease, dramatically protects the kidney and mitigates azotemia. Ngal activity depends on delivery of the protein and its siderophore to the proximal tubule. Iron must also be delivered, since blockade of the siderophore with gallium inhibits the rescue from ischemia. The Ngal:siderophore:Fe complex upregulates heme oxygenase-1, a protective enzyme, preserves proximal tubule N-cadherin, and inhibits cell death. Because mouse urine contains an Ngal-dependent siderophore-like activity, endogenous Ngal might also play a protective role. Indeed, Ngal is highly accumulated in the human kidney cortical tubules and in the blood and urine after nephrotoxic and ischemic injury. We reveal what we believe to be a novel pathway of iron traffic that is activated in human and mouse renal diseases, and it provides a unique method for their treatment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Crit Illn Inj Sci
                Journal ID (iso-abbrev): Int J Crit Illn Inj Sci
                Journal ID (publisher-id): IJCIIS
                Title: International Journal of Critical Illness and Injury Science
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2229-5151
                ISSN (Electronic): 2231-5004
                Publication date (Print): Jul-Sep 2014
                Volume: 4
                Issue: 3
                Pages: 238-246
                Affiliations
                [1]Department of Pediatrics, Division of Pediatric Nephrology, Postgraduate Institute of Medical Education and Research Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
                Author notes
                Address for correspondence: Dr. Abhijeet Saha, Department of Pediatrics, Division of Pediatric Nephrology, Room no 406, PGIMER Building, PGIMER and Dr RML Hospital, New Delhi - 201 010, India. E-mail: drabhijeetsaha@ 123456yahoo.com
                Article
                Publisher ID: IJCIIS-4-238
                DOI: 10.4103/2229-5151.141457
                PMC ID: 4200551
                SO-VID: 4ff93afd-ec2d-4bd0-b482-358c48504b8d
                Copyright © Copyright: © International Journal of Critical Illness and Injury Science
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Symposium: Critical Point of Care Biomarkers in Emergency Care

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: biomarkers,cardiac,children,emergency,renal
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: biomarkers, cardiac, children, emergency, renal

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