Chronic renovascular hypertension is associated with elevated levels of neutrophil gelatinase-associated lipocalin

Alfonso Eirin, Monika L. Gloviczki, Hui Tang, Andrew D. Rule, John R. Woollard, Amir Lerman, Stephen C. Textor, Lilach O. Lerman

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

BackgroundRenovascular hypertension (RVH) is characterized by chronic inflammation of the stenotic kidney and progressive renal dysfunction. Neutrophil gelatinase-associated lipocalin (NGAL), an acute phase protein induced in inflammatory conditions and ischemia, is a novel biomarker for acute kidney injury. We hypothesized that chronic RVH would be associated with increased renal and circulating NGAL levels.MethodsWe prospectively measured renal vein and inferior vena cava (IVC) levels of NGAL and inflammatory cytokines in essential hypertensive (EH) and RVH patients, during constant sodium intake and anti-hypertensive regimens, and compared them with systemic levels in age-matched normotensive subjects (n 22 each). In addition, we measured urinary NGAL and kidney injury molecule (KIM)-1 in all patients.ResultsBlood pressure, serum creatinine, estimated glomerular filtration rate (eGFR), lipid panels and medications were similar in RVH and EH. Systemic, stenotic and contralateral renal vein levels of NGAL were all similarly elevated in RVH versus normal hypertension and EH (P < 0.05), as were renal vein levels of inflammatory markers like tumor necrosis factor-α. Furthermore, renal vein NGAL levels inversely correlated with eGFR, and directly with renal vein (but not systemic) levels of inflammatory markers. Urinary levels of NGAL and KIM-1 were elevated in both EH and RVH, as were systemic levels of C-reactive protein.ConclusionsChronic RVH is associated with elevated NGAL levels, likely due to ongoing kidney and systemic inflammation and ischemia. These findings may also imply the occurrence of the inflammation process in chronic RVH, which might contribute to the poorer outcomes of RVH compared with EH patients.

Original languageEnglish (US)
Pages (from-to)4153-4161
Number of pages9
JournalNephrology Dialysis Transplantation
Volume27
Issue number11
DOIs
StatePublished - Nov 2012

Keywords

  • KIM-1
  • NGAL
  • cytokines
  • inflammation
  • renovascular hypertension

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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