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Relationship of Urinary Biomarkers NAG, NGAL and KIM-1 to Kidney Transplantation Complications

Tabernero Fernandez, Guadalupe G.1; Martinez Diaz, ANA A.1; Casonova, Alfredo A.2; Vicente Vicente, Laura L.2; Sanchez Hernandez, Teresa T.2; Pescador, Moises M.2; Ruiz Ferreras, Elena E.1; Morales, Ana Isabel AI2; Prieto, Marta M.2

doi: 10.1097/

1Nephrology Department, University Clinical Hospital, Salamanca, Spain; 2Phisiology and Pharmacology Department, Salamanca Universtity, Salamanca, Spain.

Teranostica de enfermedades renales y cardiovasculares. IBSAL.

Introduction: Kidney transplantation (KT) is the best choice for patients that suffer End Stage Renal Disease (ESRD), because of the better survival rate compared to patients under dialysis. Our objective should be to improve allograft survival by acting in a preemptive way.

Methods: We analysed the urinary biomarkers NAG (N-acetyl glucosaminidase), NGAL (Neutrophil Gelatinase associated Lipocaine) and KIM-1 (Kidney Injury Molecule-1) in urine samples from 70 kidney or kidney and pancreas transplant patients. The samples were taken at post-transplant days +1, +3, +5, +7, and the day of renal stabilisation in the first 3 months. The biomarker levels were related to the different complications after KT, such as acute rejection, delayed graft function (DGF), cold ischemia time, toxic drugs for kidney and the renal function on the day of stabilisation. The statistical test used was Pearson c2. The 70th percentile was taken and a significant value was established if p < 0.05. The statistical program used was IBM SPSS version 20.

Results: During the first week after KT, in theory renal function improves as measured by creatinine levels. However, increasing levels of the urinary biomarkers NAG, NGAL and KIM-1 indicate possible tubular damage or other pathology of the kidney. NGAL has shown to be a more sensitive marker than NAG and KIM-1 because it increases more than the other markers from the first day after KT. Urinary values of NGAL at post-transplant day 7 predict statistically significant probability of suffering DGF. Low NAG values at post-transplant day 3 have been related to a cold ischemia time of between 120 and 900 minutes, while high values in the first week post-transplant predict more renal function stabilisation time; the same occurs with NGAL. In this study KIM-1 did not show any relationship with the events described above.

Conclusions: The use of the urinary biomarkers NAG and NGAL can help us act in a preemptive way to avoid the complications of KT. This could improve the global results of renal transplantation.




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2. Fonseca I, Research highlights. J Transplant. 2013; 2013:650123.

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