The relationship between serum and urine angiotensinogen levels and the prognosis of the disease in acute ki̇dney i̇njury

Aim : Acute kidney injury (AKI) is a heterogeneous disease with high morbidity and mortality. Serum creatinine value used in the diagnosis of AKI increases after kidney damage. Late increase in creatinine may cause delay in the diagnosis of AKI. In addition, although the renal functions are poor, the creatinine level is not parallel with the severity of the disease, causing delays in follow-up and treatment. In this study, it is planned to examine the relationship between serum and urine angiotensinogen levels and the prognosis of renal functions in patients diagnosed with AKI during diagnosis and follow-up. In this way, it is aimed to identify those who are more risky than patients with AKI and to follow up and treat these patients more closely. Materıals and Methods: Patients over the age of 18 who were diagnosed with AKI who were followed up and treated by Gaziosmanpaşa University Internal Medicine Clinic were included in this study. Serum BUN, creatine, electrolytes, and urine creatinine, which were routinely studied in patients with AKI, were recorded for etiology and evaluation of complications. At the time of the diagnosis of AKI, serum and urine angiotensinogen levels were measured in the increased samples from the serum and urine samples. Urine angiotensinogen levels were measured on the 15th and 30th days of the followed-up patients. Patients who could be followed up from the beginning date were re-evaluated 3 months later and the status of renal functions was recorded by measuring serum creatinine level. For the study, residual samples from serum and urine samples taken for routine tests were used. In this study, pregnant women, patients with angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB), aldesteron receptor antagonist drug use at the time of diagnosis, patients with postrenal AKI, patients with malignancy, chronic liver disease or multiorgan failure, patients with a diagnosis of sepsis patients were not included. Findings: Seventy nine patients with AKI were included in the study. Of them, 44 (56%) were male and 35 (44%) were female. When the patients were divided according to the stage of KDIGO, 54 patients were stage 1, 17 patients were stage 2, and 8 patients were stage 3. The number of patients who died during the study period was 46 (58%). In our study, urinary angiotensinogen/urinary creatinine (UAGT /UCr) levels at the diagnosis of AKI were found to be statistically significantly higher in KDIGO stage 3 compared to KDIGO stage 1 and 2 patients (p <0.001). Although UAGT / UCr levels were higher in patients who received hemodialysis and those who died, the differences were not statistically significant (p> 0.05). It was observed that there was a positive correlation between UAGT/ UCr level at the diagnosis and creatinine level at 3 months (r = 0.408, p = 0.053). Results: The results of our study suggest that urinary angiotensinogen levels can be used as an indicator of acute kidney injury severity. In order to better demonstrate the early diagnosis and prognostic importance of urinary angiotensinogen in acute kidney injury, clinical studies involving a large number of cases are needed. Key Words: Acute Kidney Injury, Creatinine, Urinary Angiotensinogen, NGAL, KIM-1, IL-18