Correlation Analysis Of Urinary KIM-1 And NGAL With Patients Of Chronic Kidney Disease With Tubulointerstitial Lesion

Objective:Urinary KIM-1 and urinary NGAL were detected in patients with chronic kidney disease(CKD)tubulointerstitial injury and healthy control group.To investigate the difference and correlation between KIM-1 and NGAL in patients with tubulointerstitial injury.To clarify the clinical significance and value of KIM-1 and NGAL in patients with tubulointerstitial injury of chronic kidney disease.Methods:A total of 103 patients with chronic kidney disease diagnosed by renal biopsy at the Department of Nephrology,Shengjing Hospital,during February 2017 to September 2017,was enrolled in the study.There were 56 males and 47 females with an average age of 45.15�13.58 years in the test group.The experimental group was divided into mild injury,mild to moderate injury,severe injury group according to the criteria of Banff pathological classification criteria.At the same period we choose 17 normal physical person as healthy controls group,including 8 males and 9 females,aged 25 to 58 years,average age is 39.18�12.76 years old.Used Enzyme-linked immunosorbent assay(ELISA)to detect the expression of urinary KIM-1 and NGAL respectively.Clinical indicators collected in the experimental group included: age,gender,serum creatinine,blood urea,serum uric acid,serum cystatin C,plasma albumin,blood glucose,triglycerides,cholesterol,hemoglobin,and 24-hour urinary protein.All data using SPSS22.0 software for statistical analysis.Results:1.There was no significant difference in age and sex between the experimental groups and the control group;There was no difference between the three experimental groups in albumin,triglyceride and blood glucose.The differences in other clinical indicators were statistically significant.2.The more serious renal interstitial injury,the high levels of Urinary KIM-1 and urinary NGAL.Urinary KIM-1 was compared with the control group and the mild group(p =0.32),the mild group and the mild-moderate group(p = 0.21),the mild-moderate group and severe group(p = 0.89),these difference was not statistically significant.The remaining two groups were statistically significant differences(p <0.01).There was no significant difference in urinary NGAL between mild group and mild-moderate group(P= 0.08).The remaining two groups were statistically significant differences(p <0.01).3.Urinary levels of KIM-1 in patients with tubulointerstitial lesions of chronic kidney disease was positively correlated with urinary protein(r = 0.22,p <0.05),and serum creatinine(r = 0.26,p <0.01),and Cystatin C(r = 0.26,p <0.01)and the degree of tubulointerstitial lesions(r =0.6,p <0.01),and negatively correlated with eGFR(r =-0.33,p <0.01)and hemoglobin(r =-0.25,p <0.01);Urinary levels of NGAL in patients with tubulointerstitial lesions of chronic kidney disease was positively correlated with blood urea nitrogen(r=0.62,p<0.01),and serum creatinine(r = 0.63,p <0.01),and Cystatin C(r =0.37,p<0.01)and the degree of tubulointerstitial lesions(r =0.76 p <0.01),and negatively correlated with eGFR(r =-0.64,p <0.01)and hemoglobin(r =-0.43,p<0.01);4.Draw ROC curve analysis showed that urinary KIM-1 and NGAL assess the renal tubular interstitial lesion.The KIM-1 of area under the ROC curve to diagnosis the renal tubular interstitial injury of primary chronic kidney disease(CKD)was 0.88,the optimal threshold value was 2.13ng/ml,the sensitivity was 80%,and the specificity was 88%.The NGAL of area under the ROC curve was 0.97,the optimal threshold value was4.62ng/ml,the sensitivity was 96%,and the specificity was 88%.The two combined diagnosis of area under the ROC curve was 0.98,the sensitivity was 94%,and the specificity was 94%.5.Draw ROC curve analysis showed that urinary KIM-1 and NGAL assess the renal tubular interstitial lesion in the mild group.The KIM-1 of area under the ROC curve to diagnosis the renal tubular interstitial injury of primary chronic kidney disease(CKD)was0.8,the optimal threshold value was 2.13ng/ml,the sensitivity was 68%,and the specificity was 88%.The NGAL of area under the ROC curve was 0.94,the optimal threshold value was 4.62ng/ml,the sensitivity was 95%,and the specificity was 88%.The two combined diagnosis of area under the ROC curve was 0.96,the sensitivity was 98%,and the specificity was 82%.Conclusions:Urinary KIM-1 and NGAL increased with the severity of tubulointerstitial injury in patients who were diagnosed chronic kidney disease,which were positively correlated with the degree of interstitial injury and could be used as valuable markers of CKD of tubulointerstitial injury.Urinary NGAL was significantly better than urinaryKIM-1 to diagnosis of chronic tubulointerstitial injury.Combined diagnosis is more meaningful for detecting early tubulointerstitial injury.