Evidence map›Paper›PMID 28372541›Full record

Observational studyBMC nephrology2017

Nephrotoxicity-induced proteinuria increases biomarker diagnostic thresholds in acute kidney injury.

Fahim Mohamed, Nicholas A Buckley, John W Pickering, Klintean Wunnapuk, Sandamali Dissanayake, Umesh Chathuranga, Indika Gawarammana, Shaluka Jayamanne, Zoltan H Endre

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC nephrology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.2field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 14 citations in OpenAlex.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 4 countries.

Fahim MohamedSouth Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka. fahim.cader@gmail.com.
Nicholas A BuckleySouth Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
John W PickeringDepartment of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
Klintean WunnapukDepartment of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Sandamali DissanayakeSouth Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
Umesh ChathurangaSouth Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
Indika GawarammanaSouth Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
Shaluka JayamanneSouth Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
Zoltan H EndreDepartment of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia.
University of Peradeniya · LKUniversity of Otago · NZChiang Mai University · THSouth Asian Clinical Toxicology Research Collaboration · LK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundParaquat ingestion is frequently fatal. While biomarkers of kidney damage increase during paraquat-induced acute kidney injury (AKI), significant concurrent proteinuria may alter diagnostic thresholds for diagnosis and prognosis to an unknown extent. This study evaluated the effect of albuminuria on biomarker cutoffs for diagnosis and outcome prediction.

methodsThis was a multi-centre prospective clinical study of patients following acute paraquat self-poisoning in 5 Sri Lankan hospitals. Biomarker concentrations were quantified using ELISA and microbead assays and correlated with urinary albumin. Functional-AKI was defined by the Acute Kidney Injury Network serum creatinine definition and alternatively by a ≥50% increase in serum cystatin C. Albuminuria was defined as albumin-creatinine ratio >30 mg/g. The study outcomes were compared with a retrospective analysis of a pre-clinical study of paraquat-induced nephrotoxicity with appropriate controls.

resultsAlbuminuria was detected in 34 of 50 patients, and increased with functional-AKI severity. The concentrations of uNGAL, uCysC, uClusterin, uβ2M, and uKIM-1 were higher in albuminuric compared to non-albuminuric patients (p < 0.001). Albuminuria correlated with biomarker concentration (r > 0.6, p < 0.01) and was associated with death (p = 0.006). Optimal biomarker cutoffs for prediction of death were higher in the albuminuric group. Similar outcomes with more detailed analysis were obtained in experimental paraquat nephrotoxicity.

conclusionAlbuminuria was associated with paraquat-induced nephrotoxicity and increased excretion of low-molecular weight protein biomarkers. AKI biomarker cutoffs for diagnosis, outcome prediction and AKI stratification increased in the presence of albuminuria. This may lead to over-diagnosis of AKI in conditions independently associated with proteinuria.

Indexed as

Acute Kidney InjuryAdultAlbuminuriabeta 2-MicroglobulinBiomarkersCase-Control StudiesClusterinCreatinineCystatin CFemaleHepatitis A Virus Cellular Receptor 1HerbicidesHumansLipocalin-2MaleNew South Walesbeta 2-MicroglobulinBiomarkersCLU protein, humanClusterinCreatinineCystatin CHAVCR1 protein, humanHepatitis A Virus Cellular Receptor 1HerbicidesLCN2 protein, humanLipocalin-2ParaquatAlbuminuriaBiomarkersNephrotoxicityParaquatPoisoning

Identifiers

PMID28372541
PMCPMC5379711
OpenAlexW2604122775

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.