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Renal Markers

Cheryl
Overseas Technical
Support
GP Biotech, Inc.

Kidney disease death in Viet Nam


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Product catalogue

Product name

Associated
disease

Sample

Package

mAlb

Diabetic
nephropathy

Urine

25T

2-MG

Kidney damage for


diabetic &
hypertensive
patients

CysC

Kidney disease &


kidney damage

Urine

NGAL

AKI

W.B/S/P

W.B/S/P

25T

25T
25T

Background of AKI

Introduction
Diverse Causes
Decreasedrenal blood flow
(e.g.low blood pressure)
Exposure tosubstances harmful
to the kidney
Aninflammatoryprocess in the
kidney
Obstruction of theurinary
tractwhich impedes the flow of
urine

Definition

1). An abrupt loss ofkidney functionthat develops within 7 days, previously


calledacute renal failure(ARF)
2). May lead to a number of complications, includingmetabolic
acidosis,high potassium levels, uremia, changes in bodyfluid balance, and
effects to otherorgan systems.

Diagnosis of Kidney Diseases

1). Blood pressure


measurement

2). spot check for


protein or albumin in
the urine

3). Glomerular filtration


rate (GFR) based on
serum creatinine
measurement

Specific Biomarkers

Nephron segment-specific biomarker of kidney


injury
Bonventre JV et al. (2010) Next-generation biomarkers for detecting kidney toxicity. Nature Biotechnology, 28: 436-440

Microalbuminuria (mAlb)

Introduction

A. Structure of mAlb

B. Significance of
mAlb

mAlb Level and Diseases

Stage

Characteristic

Urine
Dipstick
for
Protein

Normal albumin
level

Normal excretion of urinary albumin


(<20mg/L)

Negative

Reversible

Micro albuminuria
early phase of
Diabetic
nephropathy(DN)

Increase excretion of urinary albumin


(20-200mg/L),sustained
microalbuminuria increasing along with
hypertension

Negative

Reversible

Early diabetic
nephropathy(DN)

Clinical proteinuria(test urinary


albumin excretion within six months ,
there are twice > 200mg / L between 3
times), Hypertension

Positive

No

Late-stage
diabetic renopathy

Progressive proteinuria ,Hypertension,


Decreased glomerular filtration
rate(GFR)

Positive

No

End-stage Renal
Disease(ESRD)

Uremia,T nephrotic syndrome,requiring


dialysis or a kidney transplant

Positive

No

Reversi
ble or
Not

Clinical Applications

Glomerular injury
Pregnancy-induced renal disease
An early indicator of changes in renal and cardiovascular
system
Diabetic nephropathy, hypertensive nephropathy and early
renal damage

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GP: One Step Test for mAlb (Colloidal


Gold)

Test item

Analytical
sensitivity

Sample

Cut-off
value

Measuring
range

mAlb

10.0mg/L

Urine

20.0mg/L

10.0-200.0mg/L

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Cystatin C (CysC)

Introduction
Characteristics
1). Low molecular weight basic protein
(13KDa)
2). Freely filtered and catabolized in the
kidney
3). Widely distributed, lowest in urine

A. Structure of CysC

NOTE Cys C is reabsorbed by the tubulus cells and thereby rapidly degraded.
In the case of tubulus dysfunction, absorption is impaired and Cys C is
eliminated with the urine. Therefore, urinary Cystatin C levels can be used as a
marker of tubulus dysfunction.
Jahan N, Ferdousi S. Cystatin C-a Promising Marker of Glomerular Filtration Rate[J]. Bangladesh Journal of Medical Biochemistry, 2013, 6(1): 26-30.

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Distribution of creatinine and CysC in


AKI

A. Distribution of creatinine and CysC in AKI

Murty M S N, Sharma U K, Pandey V B, et al. Serum cystatin C as a marker of renal function in detection of early acute kidney injury[J]. Indian journal of nephrology, 2013,
23(3): 180.
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CysC vs Creatinine

Features

CysC

Scr

Filtered from kidney

concentration in blood
decided by glomerular
filtration

tubular secretion increase by 30%


when GFR decreased

Enter into the blood


circulation or not

no

yes

Mild to moderate GFR


reduction sensitivity

yes

no

Rapid GFR change


sensitivity

high

no

Muscle mass influence

no

yes

Age/Gender /race influence

no

yes

Jahan N, Ferdousi S. Cystatin C-a Promising Marker of Glomerular Filtration Rate[J]. Bangladesh Journal of Medical Biochemistry, 2013, 6(1): 26-30.

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Clinical Applications

Early diagnosis of
kidney disease

Kidney transplant

Chronic Kidney
Disease (CKD)

CysC

Observe the development of


kidney disease

High-risk of AKI

Kidney cirrhosis

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2

GP: One Step Test for CysC (Colloidal


Gold)

Test item

Analytical
sensitivity

Sample

Cut-off
value

Measuring
range

CysC

0.5 mg/L

W.B/S/P

0.8-3.0 mg/L

0.5-20.0 mg/L

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NGAL)
Neutrophil gelatinase-associated lipocalin(

Introduction

A. Structure of CysC

B. Significance of
CysC

Characteristics
1). 25KDa protein covalently bound to gelatinase from human neutrophils
2). Expressed in low levels in diverse human issues, including kidney
3). Increases in blood and urine within 2~4 hours after injury
4). Easily detected in uine
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NGAL trafficking along the nephron in


AKI

A. Low levels of NGAL are detected


in plasma and urine

B. During AKI, plasma and urinary


NGAL levels elevated

NOTE Also, proximal tubular uptake


is compromised, which potentiates
urinary NGALexcretion.
Schmidt-Ott K M. Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injurywhere do we stand today?[J]. Nephrology Dialysis
Transplantation, 2011, 26(3): 762-764.

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Clinical Applications

As an aid in the early diagnosis of AKI


Evaluating the severity of kidney injury
Predicting the development of Chronic Kidney Disease, CPS,
etc

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GP: One Step Test for NGAL (Colloidal


Gold)

Test item

Analytical
sensitivity

Sample

Cut-off
value

Measuring
range

NGAL

50 ng/ml

Urine

135 ng/ml

50-1500 ng/ml

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2-microglobulin(2MG)

Introduction
Characteristics
1). A small molecular presenting on all
nucleated cells.
2). Circulating 2M is cleared almost
exclusively by the kidney, where it is
freely filtered by the glomeruli, and
reabsorbed and metabolized in the
proximal tubules.

A. Structure of 2MG

Concentration of 2M in the blood has been proposed as a


measure of glomerular filtration rate (GFR).
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Clinical Applications
Evaluation of the kidney diseases
Assessing the hypertension and kidney injury caused by
diabetic nephropathy(DN)
The evaluation for prognosis and therapeutic effect of
malignancies
Posttransplantation lymphoproliferative disease(PTLD)
Glomerular filtration function
Dynamic observation and diagnosis of the kidney
transplant rejection
Multiple myeloma (MM)
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GP: One Step Test for 2-MG (Colloidal


Gold)

Test item

Analytical
sensitivity

Sample

Cut-off value

Measuring
range

2-MG

0.5mg/L

W.B/S/P

0.8-3.0mg/L

0.5-20.0mg/L

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FOR YOUR LISTENING!

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