Avaliação de perda de massa muscular em paciente com injúria renal aguda através de biomarcadores séricos

Abstract

Acute Kidney Injury (AKI) is a serious and prevalent critical condition and its development significantly increases mortality, length of hospital stay, and hospital costs. It has a high prevalence rate in developed countries, reaching 45% of patients in Intensive Care Units (ICU) and 20% in patients in clinic. Due to the high mortality rate, early diagnosis is important for the outcome. The pathophysiology of AKI is inflammatory and results from a balance between an inflammatory and an anti-inflammatory response. Increased inflammatory mediators and decreased concentrations of anabolic substances may result in loss of muscle mass. The aim of this study was to investigate muscle mass loss through serum markers in patients with AKI. A total of 77 critical patients without AKI and 83 AKI patients, all admitted to the ICU. Patients with AKI were characterized by AKIN criteria that used an increase of 0.3 mg / dL in serum creatinine within seven days starting from hospital admission. Serum markers of muscle loss: growth factors such as insulin-1 (IGF-1), myostatin, interleukin-6 (IL-6), TNF-α and Interleukin-15 (IL-15) and dehydrogenase lactate (DHL) were studied by enzyme-linked immunosorbent assay (ELISA). We observed significant increases in serum levels of TNF-α in the AKI group 7,46 (4,91 - 33,28). CONT 6.96 (4,75 -11,38) p 0.01; Myostatin 36,95 (5,71- 46,5) vs. 25,5 (7,14 - 88) p 0,01; IL-6 17.6 (3,22 - 31,69) vs 10.69 (2,54 - 31,69) p 0.03, DHL 173.5 (52 - 984) vs. 146 (74 - 563) p 0.02. There were no significant differences between the level of IGF-1 AKI 0,26 (0 – 0,83) vs CONT 0,28 (0,06 – 1,13) p 0,66 and IL-15 4,89 (0,09 – 55,56) vs 4,87 (0,76 – 7,79) p 0,41. Patients with AKI had higher values of inflammatory markers and there was a significant increase in myostatin values in the AKI group.