Korean J Intern Med.  2015 Jul;30(4):489-495. 10.3904/kjim.2015.30.4.489.

Renal Klotho expression in patients with acute kidney injury is associated with the severity of the injury

• Seo MY
• Yang J
• Lee JY
• Kim K
• Kim SC
• Chang H
• Won NH
• Kim MG
• Jo SK
• Cho W
• Kim HK

• KMID: 2366009
• DOI: http://doi.org/10.3904/kjim.2015.30.4.489

Abstract

BACKGROUND/AIMS
The potential physiologic roles of Klotho in acute kidney injury (AKI) have recently been demonstrated in animal models. However, to date, there have been no human studies investigating the expression of renal Klotho in AKI.
METHODS
We retrospectively collected biopsy specimens and clinical data of AKI patients between January 2001 and December 2012. Klotho expression was determined by immunohistochemical staining, and the clinical-pathological correlation was examined.
RESULTS
Among the 34 patients diagnosed with acute tubular necrosis or acute tubulointerstitial nephritis, 21 patients without chronic histological lesions were included. The mean age was 37.3 +/- 18.5 years and the mean peak creatinine level was 8.2 +/- 5.5 mg/dL. In total, 10 patients (47.6%) received temporary renal replacement therapy (RRT); however, 17 patients (81%) showed functional recovery with creatinine levels of < 1.3 mg/dL after 1 month. The intensity of Klotho expression was scored as a percentage of Klotho-positive area. The renal Klotho score showed a significant negative correlation with the initial or peak creatinine level. When the patients were divided into three groups according to the Klotho score (low, middle, high), the low group had a significantly higher peak creatinine level and a more frequent requirement for RRT. However, the Klotho score was not a significant predictor of renal recovery.
CONCLUSIONS
The results demonstrated that renal Klotho expression in humans decreased significantly according to the severity of AKI, regardless of the etiology, and that low expression was associated with a poor short-term outcome.

Keyword

Acute kidney injury; Acute tubular necrosis; Klotho

MeSH Terms

Acute Kidney Injury/diagnosis/etiology/*metabolism/physiopathology/therapy
Adolescent
Adult
Biomarkers/analysis
Biopsy
Down-Regulation
Female
Glucuronidase/*analysis
Humans
Immunohistochemistry
Kidney/*chemistry/pathology/physiopathology
Kidney Tubular Necrosis, Acute/diagnosis/etiology/*metabolism/physiopathology/therapy
Male
Middle Aged
Necrosis
Predictive Value of Tests
Recovery of Function
Renal Replacement Therapy
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Young Adult
Biomarkers
Glucuronidase