Detection of kidney damage

Highly specific and sensitive chemical and immunologic techniques for identifying biological substances in urine provide a variety of tests of "tubular proteinuria" for the early detection of kidney damage. Patterns of biomarkers excretion characterize both specific toxins and the anatomical sites of damage within... 

Sundberg A, Appelkvist EL, Dallner G, Nilson R. Glutathione transferases in the urine sensitive methods for detection of kidney damage induced by environmental agents in humans. Environm Flealth Persp 1994 102 (Suppi 3) 293-296. 

Kaedtisukc S., Dhcranetra, W., and Fukuo. T. R. (1989). Detection of kidney damage by malathion impurities using a microdissection technique. Toxicol. Lett. 47,53-59. 

A number of clinical tests are available to detect kidney damage. The clinician examining a patient or the toxicologist monitoring an animal toxicity stndy collects urine and blood samples. Indications of kidney damage (which, of course, for the human patient could be related to many factors other then chemical toxicity) include urinary excretion of excessive amonnts of proteins and glucose, and excessive levels in the blood of unexcreted waste products such as urea and creatine. A number of additional kidney function tests are available to help pin down the location of kidney dysfunction. 

Kidney Disease. - Zhong and colleagues have detected carbon-centred radical adducts of POBN in urine from rats subjected to IR of the kidney. Animals given glycine sustained lower levels of kidney damage than the control-treated animals. Glycine also caused a dramatic reduction in the concentration of radical adducts detected in the urine.346... 

Rental Effects. Workers exposed chronically to 0.01-05 mg/m of vanadium dusts had normal serum levels of 18 enzymes and other substances commonly used to detect possible kidney damage (Kiviluoto et al. 1981b). Workers in other studies of chronic exposure to vanadium had normal urine levels of substances used to detect kidney disease (casts, protein levels, urea) (Sjoeberg 1950 Vintinner et al. 1955). 

Chronic Carbon tetrachloride can also cause damage to the kidneys and liver in the long term it is more toxic than trichloroethylene. An early sign of kidney damage may be detected by urine examination for protein and cells. Liver damage may be indicated early by special tests or later by the appearance of jaundice. It is also under suspicion as a carcinogen. 

Derived from lowest observable adverse effect level (LOAEL) of 42 pg Hg/kg BW daily of phenylmercuric acetate tor detectable kidney damage in rats after 2 years and an uncertainty factor of 5 (USPHS 1994). 

There are a variety of ways in which kidney damage can be detected ranging from simple qualitative tests to more complex biochemical assays. 

The practice nurse is concerned by Kevin s symptoms, especially since she notices that Kevin s ankles are swollen. She suspects that Kevin has developed a kidney problem. If this is quickly detected and treated, further damage and loss of kidney function may be prevented or at least slowed. Care in the control of blood glucose and blood pressure is very important for diabetic patients and can reduce kidney problems, such as loss of albumin in the urine. Urine and blood samples are taken, with the following results ... 

Another important and widespread fungal toxin is ochratoxin, which is also found in cereals and, to a lesser extent, in coffee and cocoa beans. The toxin Ochratoxin A is the most commonly found and is produced by the Aspergillus t5rpe of fungus. Exposure occurs in many countries in Europe and affects farm animals as well as humans. The major toxic effect in both humans and animals is kidney damage and cancer of the kidney. The available epidemiological evidence indicates that the disease called Balkan nephropathy is associated with consumption of food contaminated with ochratoxin, and the toxin has been detected in the blood of people living... 

Cystatin C is nearly completely metabolized by proximal renal tubular cells. As a consequence, under ordinary circumstances there is little to no detectable cystatin C present in the urine. Thus, a true clearance of cystatin C cannot be determined. However, in the presence of tubular damage, cystatin C may be detected in the urine [147,148] and may be more sensitive to early and mild changes of kidney function compared with creatinine [149,150]. In this regard, elevation in serum cystatin C consistent with AKI, defined by at least a 50% increase from baseline, was evident 1-2 days prior to changes in SCr [151]. Finally, in patients with AKI, elevated urinary cystatin C was highly predictive of subsequent need for acute renal replacement therapy and outperformed several other urinary biomarkers in some studies [152]., but not in others [152a]... 

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