nuclear factor kappa b in urine sediment
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Nuclear factor kappa B in urine sediment: a useful indicator to detect
acute kidney injury in Plasmodium falciparum malaria
Author: Chuchard Punsawad and Parnpen Viriyavejakul Malaria Journal 2014, 13:84 doi:10.1186/1475-2875-13-84
speaker:邱以涵advisor:張永宗Date: 2015.04.07
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CONTENTS
• ABSTRACT• MALARIA LABORTARY DIAGNOSIS• INTRODUCE ACUTE KIDNEY INJURY• BIOMARKERS OF RENAL FUNCTION
• METHODS• RESULTS• CONCLUSIONS• TAKE HOME MESSAGE
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ABSTRACT
• Acute kidney injury (AKI) is one of the major complications of Plasmodium falciparum malaria.
• Activation of transcription factor nuclear factor kappa B (NF-κB) involved in the development of progressive renal inflammatory diseases.
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THE AIM of THE STUDY was to determine whether urinary sediment NF-κB p65 can act as a biomarker for AKI in patients with P. falciparum malaria.
NF-κB P65
P. falciparum
malaria
biomarker
acute kidney injury
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MALARIA LABORTARY DIAGNOSIS
• Microscopy (morphologic analysis) This technique remains the gold standard for
laboratory confirmation of malaria.
• Molecular Diagnosis PCR is for confirming the species of malaria after the
diagnosis either smear microscopy or RDT.
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• Antigen Detection Rapid Diagnostic Test(RDTs)
• Serology Using either indirect immunofluorescence (IFA) or
enzyme-linked immunosorbent assay (ELISA).
Rapid Diagnostic Test(RDTs)
1) accuracy: >99%2) read Time: 5-10 minutes3) easy to use and carry4) competitive price
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Disadvantages
• The RDT may not be able to detect some infections with lower numbers of malaria parasites.
ACUTE KIDNEY INJURY
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CAUSES OF ACUTE KIDNEY INJURY
hypoperfusion
30~60%
20~40%
1~10%
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• Renal tubular epithelial cells and muddy brown casts(granular casts) suspect acute tubular necrosis.
Possible Urine Sediment Findings in Acute Kidney Injury
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Possible Urine Sediment Findings in Acute Kidney Injury
• Urinary eosinophils suggest acute interstitial nephritis.
• RBC casts indicate glomerulonephritis or vasculitis.
Biomarkers of Renal Function
Biomarker Type Biomarker
Functional marker Serum creatinine
Up-regulated proteins Neutrophil gelatinase-associated lipocalin (NGAL)Kidney injury molecule 1 (KIM-1)Interleukin 18 (IL-18)
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Creatinine
• At present, serum creatinine, which is used to measure the glomerular filtration rate (GFR), is the most commonly used marker of renal function.
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Why we search for new biomarker?
• Serum creatinine is a delayed and unreliable indicator of acute kidney injury (AKI).
a) The creatinine level is influenced by multiple non-renal factors.
b) Serum creatinine measurement does not allow differentiation between hemodynamically mediated changes in renal function.
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THE AIM of THE STUDY was to determine whether urinary sediment NF-κB p65 can act as a biomarker for AKI in patients with P. falciparum malaria.
NF-κB P65
P. falciparum
malaria
biomarker
acute kidney injury
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NF-κB P65
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METHODSMEASUREMENT OF URINARY SEDIMENT NF- p65 LEVELS
Phospho NF-κB P65 mouse monoclonal antibody
Phospho NF-κB P65 rabbit monoclonal antibody
OD:450nm
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STATISTICAL ANALYSISWITH AKI
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WITH AKI
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RESULTSLEVELS OF NF-KB P65 IN THE URINARY
SEDIMENT CELLSWITH AKI
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DAY 0 DAY 7
CREATININE
BLOOD UREA NITROGEN
URINE WBC
Positive correlation
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• A significant positive correlation was found between NF-κB p65 in the urinary sediment cells and serum Cr.
DAY 0 DAY 7Rs:0.9000; p:0.037 Rs: 0.975; p:<0.005
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CONCLUSIONS
• the urinary level of NF-κB p65 has a potential role as a disease biomarker for renal tubular epithelial cells and AKI among complicated P. falciparum malaria patients.
• Early diagnosis and prompt management including dialysis can reduce mortality .
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Research associated with Plasmodium falciparum
andNF-κB p65
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Liver changes in severe Plasmodium falciparum malaria: histopathology, apoptosis and nuclear
factor kappa B expressionParnpen Viriyavejakul12*, Vasant Khachonsaksumet1 and Chuchard Punsawad3
Malaria Journal 2014, 13:106 doi:10.1186/1475-2875-13-106
• ResultsHyperplastic Kupffer cells and portal tract inflammation are two main features found in the liver tissues of severe P. falciparum malaria cases. In addition, NF-κB is associated with Kupffer cells and lymphocyte apoptosis in severe P. falciparum malaria.
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Take home messagethe urinary level of NF-κB p65 has a potential role as a disease biomarker in AKI among complicated P. falciparum malaria patients.
NF-κB P65
P. falciparum
malaria
biomarker
acute kidney injury
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ACUTE KIDNEY INJURY腎臟病理標本顯示已標記的皮質為蒼白色、對比於尚存的髓質組織的暗色區。
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Recent studies show that NF-κB p65 activation has also been detected in peripheral blood mononuclear cells (PBMCs) from
complicated P. falciparum malaria patients.
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