Please use this identifier to cite or link to this item:
Full metadata record
DC FieldValueLanguage
dc.contributor.authorFahim Mohameden_US
dc.contributor.authorNicholas A. Buckleyen_US
dc.contributor.authorJohn W. Pickeringen_US
dc.contributor.authorKlintean Wunnapuken_US
dc.contributor.authorSandamali Dissanayakeen_US
dc.contributor.authorUmesh Chathurangaen_US
dc.contributor.authorIndika Gawarammanaen_US
dc.contributor.authorShaluka Jayamanneen_US
dc.contributor.authorZoltan H. Endreen_US
dc.description.abstract© 2017 The Author(s). Background: Paraquat ingestion is frequently fatal. While biomarkers of kidney damage increase during paraquat-induced acute kidney injury (AKI), significant concurrent proteinuria may alter diagnostic thresholds for diagnosis and prognosis to an unknown extent. This study evaluated the effect of albuminuria on biomarker cutoffs for diagnosis and outcome prediction. Methods: This was a multi-centre prospective clinical study of patients following acute paraquat self-poisoning in 5 Sri Lankan hospitals. Biomarker concentrations were quantified using ELISA and microbead assays and correlated with urinary albumin. Functional-AKI was defined by the Acute Kidney Injury Network serum creatinine definition and alternatively by a ≥50% increase in serum cystatin C. Albuminuria was defined as albumin-creatinine ratio >30 mg/g. The study outcomes were compared with a retrospective analysis of a pre-clinical study of paraquat-induced nephrotoxicity with appropriate controls. Results: Albuminuria was detected in 34 of 50 patients, and increased with functional-AKI severity. The concentrations of uNGAL, uCysC, uClusterin, uβ2M, and uKIM-1 were higher in albuminuric compared to non-albuminuric patients (p < 0.001). Albuminuria correlated with biomarker concentration (r > 0.6, p < 0.01) and was associated with death (p = 0.006). Optimal biomarker cutoffs for prediction of death were higher in the albuminuric group. Similar outcomes with more detailed analysis were obtained in experimental paraquat nephrotoxicity. Conclusion: Albuminuria was associated with paraquat-induced nephrotoxicity and increased excretion of low-molecular weight protein biomarkers. AKI biomarker cutoffs for diagnosis, outcome prediction and AKI stratification increased in the presence of albuminuria. This may lead to over-diagnosis of AKI in conditions independently associated with proteinuria.en_US
dc.titleNephrotoxicity-induced proteinuria increases biomarker diagnostic thresholds in acute kidney injuryen_US
article.title.sourcetitleBMC Nephrologyen_US
article.volume18en_US of Peradeniyaen_US of New South Wales (UNSW) Australiaen_US of Sydney Faculty of Medicineen_US of Otagoen_US Hospital New Zealanden_US Mai Universityen_US
Appears in Collections:CMUL: Journal Articles

Files in This Item:
There are no files associated with this item.

Items in CMUIR are protected by copyright, with all rights reserved, unless otherwise indicated.