ATN International

In a recent issue of Kidney International, Han et al1, regarding kidney injury molecule-1 (KIM-1) as a urinary biomarker for human proximal tubule injury, requires clarification. First, the selection of biopsied patients with putative acute tubular necrosis (ATN) is problematic. The authors include "ischemia" with minimal change, interstitial nephritis, and membranous nephropathy [with nonsteroidal anti-inflammatory drugs (NSAIDs)] and state that all patients had a confirmed pathologic diagnosis of ATN. Interstitial nephritis, membranous nephropathy (with NSAIDs), and minimal change disease are not commonly associated with ATN. Even in renal biopsies done within days after transplantation, changes of overt tubular necrosis are usually very limited2.

Second, the expression of KIM-1 in these patients' biopsies, as illustrated in Figure 1B of Han et al's article, is in the proximal convoluted tubules (S1/S2) not the pars recta (S3), the tubule in which KIM-1 has been demonstrated in experimental ischemia reflow1. Furthermore, there are no biopsy controls from patients that the authors did not consider to have ATN.

Third, the control group for urinary KIM-1 concentration was much younger than patients with ATN. The urine collections occurred at various times in relationship to peak creatinine and levels of KIM-1 were "normalized" for this variation. Can one correct for incremental differences in KIM-1 excretion without extensive data concerning the pattern of excretion of this protein? Interestingly, the patient who underwent repair of an aortic aneurysm (represented in Figure 4 of Han et al's article) had very high levels of urinary KIM-1 without clinical ATN.

Finally, the patients considered to have contrast nephropathy have limited KIM-1 excretion consistent with the experimental contrast nephropathy model showing predominantly distal nephron injury2. This underscores the limitation of KIM-1 as a marker for ATN that may involve nephron segments other than the proximal tubule.
ATN International Limited a Company which was originally incorporated under the Companies Act, 1956 in the year 1983 under the name “Arihant Consultants Private Limited” and registered with the Registrar of Companies at Delhi & Haryana and subsequently transferred its registered office to the State of West Bengal. At present, the management of the Company is mainly engaged in Investment Banking & Satellite TV Channel. The Equity Shares of the Company are at present listed at NSE, BSE and CSE. The Company’s Authorised Share Capital is Rs. 40 crores and Paid-up Capital is Rs. 39.45 crores. The Registered Office of the Company is situated at 10, Princep Street, 2nd Floor, Kolkata 700072.

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