Novel Diagnostic Marker for Acute Kidney Injury Previewed at Abbott-Sponsored Scientific Workshop
2008年7月30日 - 9:00AM
PRニュース・ワイアー (英語)
Data Presented at American Association for Clinical Chemistry
(AACC) Meeting Show Urine NGAL Can Potentially Save Lives by
Enabling Faster Detection of Acute Kidney Injury WASHINGTON, July
29 /PRNewswire-FirstCall/ -- A new diagnostic marker, called urine
NGAL, for early detection of acute kidney injury (AKI) in
hospitalized patients can distinguish AKI from other forms of
kidney dysfunction and save lives by preventing kidney failure,
according to research presented today at the American Association
for Clinical Chemistry (AACC) annual meeting. The research was
presented by Prasad Devarajan, M.D., director of nephrology and
hypertension, Cincinnati Children's Hospital Medical Center, at a
scientific workshop hosted by Abbott. AKI is a common and
potentially devastating illness in hospitalized patients. Onset is
rapid and can result from trauma, sepsis or administration of
medications toxic to the kidneys. AKI can also present following
cardiothoracic surgery or as a complication of diabetes and other
chronic conditions. AKI quickly reduces the ability of the kidneys
to filter waste and leads to renal failure. Many patients with a
severe form of AKI face extensive time on dialysis. The mortality
rate for patients with AKI ranges up to more than 80 percent in
post-operative settings, according to a study reported recently in
the Annals of Internal Medicine. "Unfortunately, the current
testing procedure for AKI -- a blood test to measure the ability of
the kidneys to filter creatinine into the urine -- is unable to
identify the problem in the first 48 hours when time is critical
for preventing kidney failure," said Dr. Devarajan. "The incidence
of this common complication has risen by 11 percent in recent
years, and we need better ways to diagnose and treat the condition
and lower the risk of death or needing dialysis," he said.
Devarajan reported today the results of clinical studies conducted
for a new diagnostic biomarker for acute AKI, called urine NGAL
(neutrophil gelatinase-associated lipocalin). The protein is
produced by the kidney tubules and appears in urine just two to
four hours following AKI, up to 46 hours sooner than biomarkers
detected by current testing methods. "The urine NGAL marker has the
potential to represent a major advance in identifying patients at
risk for developing AKI after surgery or trauma and in other
situations commonly seen in critically ill patients," Devarajan
said. He noted that delayed diagnosis of AKI with currently-used
creatinine tests may prevent physicians from using hydration or
blood pressure support in a timely manner to lower the risk for
patient harm. The costs of AKI are a substantial $10 billion a
year, mainly from lengthy hospital stays and expensive
interventions, according to Chirag Parikh, M.D., Ph.D., associate
professor of medicine, Yale University Medical School. "Serum
creatinine testing is inadequate. It is a non-specific marker that
delays diagnosis of AKI. New biomarkers are needed to stimulate
testing of new therapies and significantly decrease the mortality
in AKI and costs associated with it," he said. In his research,
Devarajan analyzed urine samples from children with congenital
heart defects who had cardiopulmonary bypass surgery. The procedure
is a major risk factor for AKI. Half of the children developed AKI,
based on results of creatinine tests reported two to three days
after surgery. However, their NGAL levels began to increase within
a few hours. "Rises in urine NGAL levels at two hours identified 90
percent of children who later developed AKI. Urine NGAL, therefore,
was highly predictive of AKI risk, and we found those with higher
levels were more likely to die or need dialysis," Devarajan said.
He added that these findings have been confirmed in adult
populations. About 65 percent of patients with the highest increase
in urine NGAL will require immediate care by a nephrologist and a
third will go on dialysis. "Clinically, there is no comparison
since NGAL provides specific and rapid diagnosis of AKI while
creatinine blood tests are not able to distinguish AKI from chronic
kidney disease," Devarajan said. "From the single drop of urine, we
obtain essential information when time is critical to help prevent
kidney failure and save lives. With close monitoring, the early
information provided by the NGAL test could make treatments more
effective if started at the beginning of AKI," he said. Devarajan
presented his findings during a symposium at AACC titled
Translational Medicine and the Clinical Laboratory: Emerging
Biomarkers for Acute Kidney Injury. The marker has been the subject
of recent articles published in Lancet, Annals of Internal Medicine
and the Clinical Journal of the American Society of Nephrology.
Devarajan's research was supported, in part, by a restricted
research grant from Abbott. Abbott is developing a unique urine
NGAL test and has initiated international clinical trials. About
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