Cells secrete around 30- 100 nm membrane-enclosed vesicles that are released into the extracellular spaceis termed exosomes(EXs). EXs widely present in body fluids and incorporated proteins,nucleic acids that reflect the physiological state of their cells of origin and they may play an important role in cell-to-cell communication in various physiological and disease processes. In this article we review the recent basic and clinical studies in urinary EXs in renal diseases,focusing on their biological characteristics and potential roles as new biological markers,intervention treatment goals,and targeted therapy vectors in renal diseases.However,some issues still exist;in particular,the clinical application of EXs as a liquid biopsy technique warrants further investigations.
Biomarkers ; urine ; Cell Communication ; Exosomes ; Humans ; Kidney Diseases ; diagnosis

Adult ; Genetic Background ; Gout ; diagnosis ; genetics ; urine ; Humans ; Hyperuricemia ; diagnosis ; genetics ; urine ; Kidney Diseases ; diagnosis ; genetics ; urine ; Male ; Uric Acid ; urine ; Young Adult

This study was aimed to evaluate renal dysfunction during three weeks after the burn injuries in 12 patients admitted to the Hallym University Hankang Medical Center with flame burn injuries (total body surface area, 20-40%). Parameters assessed included 24-hr urine volume, blood urea nitrogen, serum creatinine, creatinine clearance, total urinary protein, urinary microalbumin, 24-hr urinary N-acetyl--D-glucosaminidase (NAG) activity, and urinary malondialdehyde (MDA). Statistical analysis was performed using repeated measures ANOVA test. The 24-hr urine volume, creatinine clearance, and urinary protein significantly increased on day 3 post-burn and fell thereafter. The urine microalbumin excretion showed two peak levels on day 0 post-burn and day 3. The 24-hr urinary NAG activity significantly increased to its maximal level on day 7 post-burn and gradually fell thereafter. The urinary MDA progressively increased during 3 weeks after the burn injury. Despite recovery of general renal function through an intensive care of burn injury, renal tubular damage and lipid peroxidation of the renal tissue suggested to persist during three weeks after the burn. Therefore, a close monitoring and intensive management of renal dysfunction is necessary to prevent burn-induced acute renal failure as well as to lower mortality in patients with major burns.
Acetylglucosaminidase/*urine ; Adult ; Aged ; Albuminuria/etiology ; Biological Markers ; Burns/*complications ; Female ; Human ; Kidney Diseases/*diagnosis/urine ; Kidney Failure, Acute/diagnosis ; Lipid Peroxidation ; Male ; Malondialdehyde/*urine ; Middle Age

Changes in renal function are one of the most common manifestations of severe illness. There is a clinical need to intervene early with proven treatments in patients with potentially deleterious changes in renal function. Unfortunately progress has been hindered by poor definitions of renal dysfunction and a lack of early biomarkers of renal injury. In recent years, the definitional problem has been addressed with the establishment of a new well-defined diagnostic entity, acute kidney injury (AKI), which encompasses the wide spectrum of kidney dysfunction, together with clearer definition and sub-classification of the cardio-renal syndromes. From the laboratory have emerged new biomarkers which allow early detection of AKI, including neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C. This review describes the new concepts of AKI and the cardio-renal syndromes as well as novel biomarkers which allow early detection of AKI. Panels of AKI biomarker tests are likely to revolutionise the diagnosis and management of critically ill patients in the coming years. Earlier diagnosis and intervention should significantly reduce the morbidity and mortality associated with acute kidney damage.
Acute Kidney Injury/*diagnosis ; Biological Markers/analysis/blood/urine ; Cystatin C/blood/urine ; Heart Failure/complications/etiology ; Humans ; Kidney Diseases/complications/*diagnosis/etiology ; Lipocalins/blood/urine ; Syndrome

The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis (RA) were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.
Amyloidosis ; diagnosis ; pathology ; Biopsy ; Humans ; Immunoglobulins ; blood ; urine ; Kidney Diseases ; diagnosis ; pathology ; Prognosis

OBJECTIVETo study the significance of urine screening for school-age children by analyzing urine screening results of school-age children from Zhucheng City, Shandong Province, China, in 2013.

METHODSA total of 37 344 school-age children were randomly selected from children 6 to 12 years of age in Zhucheng City. Morning urine was tested by routine screening test, and the children who tested positive were re-tested after two weeks.

RESULTSThere were 2 388 children (6.39%) tested positive in the first screening, and 388 children (1.04%) tested positive again in the second screening. The positive rates in the first and second screening tests were 9.52% and 2.01%, respectively, in girls, which were significantly higher than those in boys (3.79% and 0.23%, respectively; P<0.05). Among the children who had positive test results in the second screening, 302 (0.81%) were diagnosed with urinary system diseases.

CONCLUSIONSUrine screening is an effective way for the early detection of some occult kidney diseases, which provides great benefits for early prevention and treatment of kidney diseases in children.

Child ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Kidney Diseases ; diagnosis ; urine ; Male ; Urinalysis

OBJECTIVETo investigate the value of serum cystatin C (Cys-C), urinary Cys-C, urinary retinol binding protein (RBP) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the early assessment of multiple myeloma (MM) and their characteristic changes in different pathological types of renal impairment.

METHODSAccording to glomerular filtration rate (eGFR), the patients were divided into two groups, of which marked group A with normal renal function, the other marked group B with abnormal renal function. Sixty healthy subjects were chosen as control. Detection of the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL, serum creatinine (Scr), urinary microalbumin (MAU) and urinary α1-microglobulin (α1-MG) were performed. Renal biopsy was carried out for patients who had abnormal serum Cys-C, urinary Cys-C, urinary RBP, urinary NGAL and were willing to accept further test.

RESULTSCompared with healthy controls, the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL of group A were significantly higher than that of healthy controls. Six group A patients received renal biopsy, and varying degrees of renal damage were discovered. The serum Cys-C, urinary RBP, urinary Cys-C and urinary NGAL positive rate were 66.7%, 66.7%, 66.7% and 83.3%, respectively. Of twenty-four cases received biopsy after abnormal examination results were shown, six turned out to be amyloidosis, twelve cast nephropathy (CN) and 6 monoclonal immunoglobulin deposition disease (MIDD). Compared with MIDD and amyloidosis, the urinary Cys-C and NGAL of the CN group are significantly higher (P < 0.05). Compared with CN and amyloidosis, urinary RBP of MIDD is significantly higher (P = 0.043). Compared with MIDD and CN, the MAU of amyloidosis is significantly higher (P = 0.006).

CONCLUSIONCompared with the conventional indicators, serum Cys-C, urinary Cys-C, RBP and NGAL are more sensitive in early assessment of MM patients with renal damage. The MAU is higher in amyloid, the urinary Cys-C and urinary NGAL are significantly elevated in CN, the urinary RBP is significantly elevated in MIDD.

Acute-Phase Proteins ; urine ; Adult ; Aged ; Case-Control Studies ; Cystatin C ; blood ; urine ; Female ; Humans ; Kidney ; pathology ; Kidney Diseases ; blood ; diagnosis ; urine ; Kidney Function Tests ; Lipocalin-2 ; Lipocalins ; urine ; Male ; Middle Aged ; Multiple Myeloma ; blood ; pathology ; urine ; Proto-Oncogene Proteins ; urine ; Retinol-Binding Proteins ; urine

OBJECTIVETo analyze the characteristics of TCM syndrome distribution and its correlation with urinary protein in patients with early chronic kidney diseases (CKD), for the sake of providing a basis for clarifying the rules of TCM syndrome differentiation in CKD.

METHODSAdopting traditional epidemiological retrospective method, the TCM syndrome and urinary protein related indexes, including 24 h urinary protein (Upro), urinary albumin (UAlb), urinary beta2-microglobulin (Ubeta2-MG), urinary N-acetyl-beta-D-glucosaminidase (UNAG), urinary beta-galactosidase (UGAL), etc, were collected from 199 patients with early CKD, and a multiple factor regression analysis between them was conducted.

RESULTSIn patients with early stage CKD, the TCM symptoms, as independent factors closely related to urinary protein, were aching loins, poor appetite and indigestion, yellow and brownish urine, regurgitation acid, profuse nocturnal urine, edema, foamy urine, cough, aversion to cold and cold limbs, etc; the elevation of UAlb with the factors of Pi-Shen qi-deficiency as aching loins, poor appetite and indigestion was correlated; elevation of UNAG with edema, foamy urine, profuse nocturnal urine, cough; UGAL with Pi-Shen yang-deficiency factors as aching loins, aversion to cold and cold limbs; and elevation of Ubeta2-MG with edema were correlated respectively as well. Levels of UAlb and UNAG in patients of Pi-Shen qi-deficiency type were significantly higher than those in patients of Gan-Shen yin-deficiency type, Fei-Shen qi-deficiency type, and Pi-Shen yang-deficiency type, respectively (all P < 0.05).

CONCLUSIONFor early stage CKD patients, Shen and Pi are the major organs related to the appearance of urinary protein; Pi-Shen deficiency is the basic pathogenesis. Level of UAlb, which is associated with Pi-Shen qi-deficiency type, could be taken as one of microcosmic syndrome factors for the syndrome type; UNAG also be related with that syndrome to certain extent; and heat-damp syndrome might be an independent type.

Adult ; Diagnosis, Differential ; Female ; Humans ; Kidney Diseases ; diagnosis ; urine ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Proteins ; Proteinuria ; diagnosis ; Retrospective Studies ; Urine ; chemistry

This study was purposed to evaluate the clinical significance of low molecular weight urinary proteins for diagnosis of early renal damage in patients with multiple myeloma (MM). Medical records of 278 patients with MM in Nanjing School of Clinical Medicine from January 2004 to May 2012 were analyzed retrospectively. These patients were divided into 3 groups: glomerular damage group (n = 143), tubular damage group (n = 114) and normal group (n = 21). The clinical and laboratorial data were compared among them. The correlations of urinary retinol-binding protein (RBP) or urinary N-acetyl-β-D-amino-glucosaminidase (NAG) with blood urea nitrogen (BUN), Scr, blood cystatin-C (Cys-C), clearance of creatinine (Ccr), 24 h protein uria and 24 h urine light chains were further analyzed, and the correlation of renal tubulointerstitial lesion scores with low molecular weight urinary proteins in 61 patients were also analyzed. The area under curve (ROC curve) was used to evaluate and compare the discrimination of urinary RBP and urinary NAG. The results showed that glomerular damage group had higher urinary RBP than tubular damage group. However, glomerular damage group had lower urinary NAG than tubular damage group. The two groups had higher urinary RBP and urinary NAG than that in normal group. Urinary RBP related positively to the level of Scr, BUN, Cys-C, 24 h proteinurias and related negatively to the level of Ccr. Urinary NAG related positively to the level of 24 h proteinurias, Ccr and related negatively to the level of Cys-C. Renal tubulointerstitial lesions were significantly correlated with urinary RBP, but weakly correlated with urinary NAG. It is concluded that urinary RBP significantly correlates with renal tubular damage. Compared with urinary NAG, urinary RBP can better assess the extent of renal damage, and has higher specificity.
Acetylglucosaminidase ; urine ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney ; pathology ; Kidney Diseases ; diagnosis ; pathology ; Kidney Tubules ; pathology ; Male ; Middle Aged ; Molecular Weight ; Multiple Myeloma ; pathology ; urine ; Proteinuria ; Retinol-Binding Proteins ; urine ; Retrospective Studies

OBJECTIVETo study the value of apolipoprotein H (apoH) gene expression in peripheral blood mononuclear cell (PBMC) and urinary N-Acetyl-beta-D-Glucosaminidase (NAG) and retinal-binding protein (RBP) in the early diagnosis of renal function damage in neonates.

METHODSSixty sick neonates who renal function damage probably occurred were enrolled. The blood and urinary samples were collected twice within 48 hrs following admission, with an interval of 12-24 hrs. Expression of apoH gene in PBMC was determined with RT-PCR. The levels of blood urea nitrogen (BUN) and creatinine, and urinary activities of NAG and RBP were measured with enzymatic reaction.

RESULTSThe abnormal rates of blood apoH and urinary NAG and RBP were 73.3%, 83.3% and 76.7%, respectively in the first detection. The second detection for blood apoH and urinary NAG and RBP showed abnormal rates of 70.0%, 66.7% and 76.7%, respectively. There were no significant differences in the abnormal rates between the three markers either in the first or the second detection (P>0.05). Beside there were no significant significances in the abnormal rates between urinary NAG and blood BUN in the second detection, the abnormal rates of blood apoH and urinary NAG and RBP in both detections were significantly higher than those of BUN or creatinine (P<0.01 or 0.05).

CONCLUSIONSThere are identical values of blood apoH gene expression and urinary NAG and RBP in the early diagnosis of renal function damage in neonates. The above three markers are more sensitive to early renal function damage than blood BUN and creatinine.

Acetylglucosaminidase ; urine ; Blood Urea Nitrogen ; Creatinine ; blood ; Female ; Humans ; Infant, Newborn ; Kidney Diseases ; diagnosis ; physiopathology ; Male ; Retinol-Binding Proteins ; urine ; beta 2-Glycoprotein I ; blood ; genetics