Inflammation-Associated Tubulopathy in Patients with Acute Bacterial Infections

Abstract

Tal Levinson,1– 3 Shani Shenhar-Tsarfaty,1,4 Ayelet Grupper,1,5,6 Tamar Witztum,1,7 Shlomo Berliner,1,8 Moshe Shtark1,9 1Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 3Department of Internal Medicine H, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 4Department of Internal Medicine C, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 5Department of Nephrology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 6Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 7Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 8Department of Internal Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 9Clinical Laboratory Services, Tel Aviv Sourasky Medical Center, Tel Aviv, IsraelCorrespondence: Tal Levinson, Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel, 6423906, Tel [phone], Fax [phone], Email [email protected]: Acute kidney injury associated with the underlying inflammatory process of an acute bacterial infection affects patient morbidity and mortality. Clinicians use creatinine and estimated glomerular filtration rate (EGFR) to assess this renal injury, however, these measures may lag behind and change only once significant kidney injury has occurred. Neutrophil gelatinase-associated lipocalin (NGAL) is up-regulated by inflammation and infection and may serve as an early detection biomarker of kidney injury.Methods: Patients hospitalized with bacterial infections were assessed demographically, clinically and had their creatinine levels, EGFR and inflammatory biomarker levels, including urinary NGAL measured. Findings were compared between controls and patients across different EGFRs.Results: Fifty-one participants were included in the study. Among this cohort, 31 suffered bacterial infection. Inflammatory biomarkers including urinary NGAL were found to be higher in the infection group compared to the control group. Urinary NGAL level was significantly higher across all EGFRs of patients diagnosed with infection, including those with normal EGFR.Conclusion: Urinary NGAL identifies early kidney damage associated with bacterial infection even at normal EGFR and alerts the treating physician to undertake the necessary measures to mitigate the renal injury.Keywords: acute kidney injury, bacterial infection, estimated glomerular filtration rate, inflammation, urinary NGAL

Keywords

• acute kidney injury
• bacterial infection
• estimated glomerular filtration rate
• inflammation
• urinary ngal