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. 2020 Dec 7:12:1756287220974133.
doi: 10.1177/1756287220974133. eCollection 2020 Jan-Dec.

Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections

María-Fernanda Lorenzo-Gómez  1 , María-Carmen Flores-Fraile  2 , Magaly Márquez-Sánchez  3 , Javier Flores-Fraile  4 , Ignacio González-Casado  3 , Bárbara Padilla-Fernández  5 , Sebastián Valverde-Martínez  6 , Teresa Hernández Sánchez  7 , Carlos Muller-Arteaga  8 , María-Begoña García-Cenador  2
Affiliations

Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections

María-Fernanda Lorenzo-Gómez et al. Ther Adv Urol. .

Abstract

Objective: To characterize the impact on kidney injury of recurrent urinary tract infections (RUTI) in the frail elderly.

Methods: Prospective observational study in 200 frail elderly subjects for 1 year. Groups: GA (n = 100): subjects without RUTI, GB (n = 100): subjects with RUTI. Variables: age, concomitant diseases, glomerular filtration rate (GFR), urine neutrophil gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end (NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning (NAG-1) and the end (NAG-2) of the study, urine transforming growth factor-beta 1 (TGFβ-1). Descriptive statistics, Mann-Whitney test, Chi-squared test, Fisher's exact test, and multivariate analysis were used.

Results: Mean age was 84.33 (65-99) years old, with no difference between GA and GB. Mean NGAL-1 was 1.29 ng/ml (0.04-8). There was lower in GA than in GB. Mean NGAL-2 was 1.41 ng/ml (0.02-9.22). NGAL-2 was lower in GA than in GB. Mean NAG-1 was 0.38 UU.II/ml (0.01-2.63. NAG-1 in GA was lower than in GB. Mean NAG-2 was 0.44 UU.II/ml (0-3.41). NAG-2 was lower in GA compared with GB. Mean TGFβ-1 was 23.43 pg/ml (0.02-103.76). TGFβ-1 was lower in GA than GB. There were no differences in the presence of secondary diagnoses between GA and GB. NAG-2 and NGAL-1 were the most determining factors of renal function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1, followed by NAG-2.

Conclusion: Frail elderly with RUTI have higher urinary levels of renal injury markers, specifically NGAL, NAG, and TGFβ-1, chronically in periods between urinary tract infection (UTI). Urinary markers of renal injury, specifically NGAL, NAG, and TGFβ-1, identify early deterioration of renal function, compared with serum creatinine, or albuminuria, in frail elderly with recurrent urinary infections.

Keywords: NAG; NGAL; RUTI; TFG-beta 1; elderly; glomerular filtration.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 4.
Figure 4.
Figure 1.
Figure 1.
Most important variables in the clusters of the general group. GFR, glomerular filtration rate; NAG, N-acetyl glucosaminidase; NGAL, neutrophil gelatinase-associated lipocalin; Pr Urine, proteins in urine.
Figure 2.
Figure 2.
Most important variables in the clusters of GA. GA, group A; GFR, glomerular filtration rate; NAG, N-acetyl glucosaminidase; NGAL, neutrophil gelatinase-associated lipocalin.
Figure 3.
Figure 3.
Most important variables in the clusters of GB. GB, group B; GFR, glomerular filtration rate; NAG, N-acetyl glucosaminidase; NGAL, neutrophil gelatinase-associated lipocalin; Pr Urine, proteins in urine.
See this image and copyright information in PMC

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