Urinary Calprotectin and the Distinction between Prerenal and Intrinsic Acute Kidney Injury
Open Access
- 1 October 2011
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 6 (10), 2347-2355
- https://doi.org/10.2215/cjn.02490311
Abstract
Background and objectives To date there is no reliable marker for the differentiation of prerenal and intrinsic acute kidney injury (AKI). We investigated whether urinary calprotectin, a mediator protein of the innate immune system, may serve as a diagnostic marker in AKI. Design, setting, participants, & measurements This was a cross-sectional study with 101 subjects including 86 patients with AKI (34 prerenal, 52 intrinsic including 23 patients with urinary tract infection) and 15 healthy controls. Assessment of urinary calprotectin concentration was by ELISA and immunohistochemistry of kidney biopsy specimens using a calprotectin antibody. Inclusion criteria were: admission to hospital for AKI stage 1 to 3 (Acute Kidney Injury Network); exclusion criteria were: prior renal transplantation and obstructive uropathy. Results Median urinary calprotectin was 60.7 times higher in intrinsic AKI (1692 ng/ml) than in prerenal AKI (28 ng/ml, p p = 0.25). Receiver operating curve curve analysis revealed a high accuracy of calprotectin (area under the curve, 0.97) in predicting intrinsic AKI. A cutoff level of 300 ng/ml provided a sensitivity of 92.3% and a specificity of 97.1%. Calculating urinary calprotectin/creatinine ratios did not lead to a further increase of accuracy. Immunostainings of kidney biopsies were positive for calprotectin in intrinsic AKI and negative in prerenal AKI. Conclusions Accuracy of urinary calprotectin in the differential diagnosis of AKI is high. Whereas calprotectin levels in prerenal disease are comparable with healthy controls, intrinsic AKI leads to highly increased calprotectin concentrations.Keywords
This publication has 20 references indexed in Scilit:
- Mrp8 and Mrp14 are endogenous activators of Toll-like receptor 4, promoting lethal, endotoxin-induced shockNature Medicine, 2007
- Enzymes in feces: Useful markers of chronic inflammatory bowel diseaseClinica Chimica Acta; International Journal of Clinical Chemistry, 2007
- Incidence and Mortality of Acute Renal Failure in Medicare Beneficiaries, 1992 to 2001Journal of the American Society of Nephrology, 2006
- Technology Insight: calprotectin, lactoferrin and nitric oxide as novel markers of inflammatory bowel diseaseNature Clinical Practice Gastroenterology & Hepatology, 2005
- Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal diseaseGastroenterology, 2002
- Faecal markers in the assessment of activity in inflammatory bowel diseaseAlimentary Pharmacology & Therapeutics, 2002
- Evidence that calgranulin is produced by kidney cells and is an inhibitor of calcium oxalate crystallizationAmerican Journal of Physiology-Renal Physiology, 1998
- Distribution of macrophages and granulocytes expressing L1 protein (calprotectin) in human Peyer's patches compared with normal ileal lamina propria and mesenteric lymph nodes.Gut, 1993
- Interpreting the fractional excretion of sodiumAmerican Journal Of Medicine, 1984
- Immunoenzymatic labeling of monoclonal antibodies using immune complexes of alkaline phosphatase and monoclonal anti-alkaline phosphatase (APAAP complexes).Journal of Histochemistry & Cytochemistry, 1984