ASSOCIATION OF URINARY GLYCINE AMIDINOTRANSFERASE MITOCHONDRIAL (GATM) AND GLUTATHIONE S-TRANSFERASE A1(GSTA1) WITH RENAL OUTCOME IN COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY

 

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ASSOCIATION OF URINARY GLYCINE AMIDINOTRANSFERASE MITOCHONDRIAL (GATM) AND GLUTATHIONE S-TRANSFERASE A1(GSTA1) WITH RENAL OUTCOME IN COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY

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JASKIRAN
KAUR
JASKIRAN KAUR jaskiran265@gmail.com Postgraduate Institute of Medical Education and Research Department of Experimental Medicine and Biotechnology Chandigarh India *
VIVEK KUMAR enigma165@gmail.com Postgraduate Institute of Medical Education and Research Department of Nephrology Chandigarh India -
ASHOK K. YADAV mails2ashok@gmail.com Postgraduate Institute of Medical Education and Research Department of Experimental Medicine and Biotechnology Chandigarh India -
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Community-acquired acute kidney injury (CA-AKI) is a major contributor to chronic kidney disease in low- and middle-income countries. Serum creatinine, the current standard biomarker, is often unreliable due to its dependence on factors like age, sex, and muscle mass, highlighting the need for more accurate biomarkers. In this study we evaluated the association of urinary GATM and GSTA1 with renal recovery from CA-AKI. 

The study was conducted on subjects enrolled in the CA-AKI cohort at PGIMER, Chandigarh. Individuals of either sex, aged 18 to 70 years, and without underlying CKD were enrolled. Patients were followed up 4 months post-discharge to assess renal outcomes and categorized based on eGFR (CKDEPI-2009): ≥60 or <60 mL/min/1.73 m². Differentially expressed proteins were screened from LC/MS-based urinary proteomic profiles of CA-AKI patients (Kaur H et al), and GATM and GSTA1 were selected for further validation based on their expression scores. GATM and GSTA1 were analysed in stored urine samples collected at the time of hospital discharge using ELISA. Urine Biomarker levels after normalized with urine creatinine were compared between the recovery and non-recovery groups.

A total 225 patients were included, 51.1% were male, and the mean age was 38 ± 14 years. At 4-month follow-up, 72.4% were recovered, while 27.6% failed to recover from CA-AKI. Urinary GSTA1/Cr levels were significantly higher in the non-recovered group compared to the recovered (5.4[0.8,13.9] vs 2.1[0.7,6.2]ng/mg, p=0.013). While urinary GATM/Cr levels did not differ significantly between groups (2.2[1.3,3.6] vs 1.9[1.1,2.9]ng/mg, p=0.13). Receiver Operating Characteristic curve analysis showed that uGSTA1/Cr modestly predicted renal outcome in CA-AKI patients (AUC = 0.62,95% CI: 0.52–0.73,p = 0.011), but performed less effectively than the spot urine protein-creatinine ratio (uPCR) at discharge (AUC = 0.81,95% CI: 0.74–0.88,p < 0.001) (Figure1). In the univariable logistic regression model, an analysis showed that higher uGTA1/Cr levels were associated with renal non recovery  (OR 1.22; 95% CI: 1.00-1.48; P=0.05). However, this association was attenuated after adjustment for serum creatinine, spot uPCR and other covariates (Table1).


Urinary GSTA1/Cr levels were elevated in patients with non-recovery of renal function after CA-AKI. Urinary GSTA1/Cr levels showing a potential association with renal recovery in univariate analysis, but this was not sustained in multivariate analysis. Further, longitudinal studies are needed to elucidate its role in CKD progression.

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