BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) has recently been introduced as a renal biomarker and an increase in its level suggests tubular injury. Diabetic nephropathy, a leading cause of end-stage renal disease, causes typical changes characterized by glomerulosclerosis and eventual tubular damage in the kidney. In the present study, we attempted to validate the usefulness of plasma NGAL (pNGAL) as a biomarker for tubular damage in diabetic nephropathy. METHODS: The plasma NGAL levels of 260 diabetes mellitus patients and 50 healthy individuals werewas measured by means of fluorescent immunoassay using with the Triage NGAL test (Biosite, USA). The patients were divided into 3 groups on the basis of their urinary albumin excretion (UAE) levels, and the pNGAL differences among each group were analyzed. The degree of albuminuria and cystatin C-based glomerular filtration rate (GFR) were also compared with the pNGAL levels. RESULTS: The mean pNGAL levels of the normal subjects and diabetic patients were 61.9 +/- 4.81 ng/mL and 93.4 +/- 71.78 ng/mL, respectively. pNGAL level was significantly increased in patients with severe albuminuria (P < 0.001). The pNGAL level was found to be positively correlated with the degree of albuminuria (R2 = 0.218, P < 0.001) and inversely correlated with GFR (R2 = 0.269, P < 0.001). Particularly, the pNGAL level of patients with diabetic nephropathy was found to be associated with the renal damage and independent of other factors influencing the renal damage (R2 = 0.218). CONCLUSIONS: pNGAL level independently reflects renal damage in patients with diabetic nephropathy. Measurement of pNGAL level combined with UAE would help enable to detect both glomerular and tubular damage in diabetic nephropathy patients.
Albuminuria ; Diabetes Mellitus ; Diabetic Nephropathies ; Glomerular Filtration Rate ; Humans ; Immunoassay ; Kidney ; Kidney Failure, Chronic ; Lipocalins ; Neutrophils ; Plasma ; Triage

Objective: To evaluate the perspective of healthcare professionals towards the 2019 European Alliance of Associations for Rheumatology (EULAR) vaccination guideline in patients with autoimmune inflammatory rheumatic diseases (AIIRD). Methods: Healthcare professionals who care for patients with AIIRD were invited to participate in an online survey regarding their perspective on the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. Level of agreement and implementation of the 6 overarching principles and 9 recommendations were rated on a 5-point Likert scale (1~5). Results: Survey responses of 371 healthcare professionals from Asia (42.2%) and North America (41.6%), Europe (13.8%), and other countries were analyzed. Only 16.3% of participants rated their familiarity with the 2019 EULAR guideline as 5/5 (“very well”). There was a high agreement (≥4/5 rating) with the overarching principles, except for the principles applying to liveattenuated vaccines. There was a high level of agreement with the recommendations regarding influenza and pneumococcal vaccinations; implementation of these recommendations was also high. Participants also reported a high level of agreement with the remaining recommendations but did not routinely implement these recommendations. Conclusion The 2019 update of EULAR recommendations for the vaccination of adult patients with AIIRD is generally thought to be important by healthcare professionals, although implementation of adequate vaccination is often lacking. Better education of healthcare providers may be important to optimize the vaccination coverage for patients with AIIRD.

Background/Aims: The pathophysiology of lean nonalcoholic fatty liver disease (NAFLD) is unclear but has been shown to be associated with more diverse pathogenic mechanisms than that of obese NAFLD. We investigated the characteristics of genetic or metabolic lean NAFLD in a health checkup cohort. Methods: This retrospective cross-sectional study analyzed single nucleotide polymorphism data for 6,939 health examinees. Lean individuals were categorized according to a body mass index cutoff of 23 kg/m 2 . Single nucleotide polymorphisms were analyzed using genotyping arrays. Results: The prevalence of lean NAFLD was 21.6% among all participants with NAFLD, and the proportion of lean NAFLD was 18.5% among lean participants. The prevalence of metabolic syndrome and diabetes among lean patients with NAFLD was 12.4% and 10.4%, respectively.Lean NAFLD appeared to be metabolic-associated in approximately 20.1% of patients. The homozygous minor allele (GG) of PNPLA3 (rs738409) and heterozygous minor alleles (CT, TT) of TM6SF2 (rs58542926) were associated with lean NAFLD. However, the prevalence of fatty liver was not associated with the genetic variants MBOAT7 (rs641738), HSD17B13 (rs72613567), MARC1 (rs2642438), or AGXT2 (rs2291702) in lean individuals. Lean NAFLD appeared to be associated with PNPLA3 or TM6SF2 genetic variation in approximately 32.1% of cases. Multivariate risk factor analysis showed that metabolic risk factors, genetic risk variants, and waist circumference were independent risk factors for lean NAFLD. Conclusions In a considerable number of patients, lean NAFLD did not appear to be associated with known genetic or metabolic risk factors. Further studies are required to investigate additional risk factors and gain a more comprehensive understanding of lean NAFLD.