Increased Circulating Calprotectin and Renal Impairment in Patients with Kidney Stones
Keywords:
Circulating Calprotectin, Renal Impairment, Kidney StonesAbstract
Background: Diagnosis of kidney stone relies on clinical imaging and manifestation of flank pain or gross hematuria or urinary tract infection. To date, there is no reliable biomarker for screening or diagnosing of kidney stone. Calprotectin, an inflammatory protein produced by activated leukocytes, is present in the matrix of stones and has been suggested to play an important role in stone formation. Increased plasma calprotectin is reported in various inflammatory-mediated disorders. We investigated whether plasma calprotectin was increased in patients with kidney calculi. Its clinical usefulness is also evaluated.
Methods: A total of 190 subjects divided into kidney stone (n=103) and healthy control (n=87) groups were recruited for the study, a cross-sectional study. Blood and spot urine samples of the patients were collected preoperatively. Plasma calprotectin was determined by enzyme-linked immunosorbent assay. Plasma creatinine and eGFR were also measured.
Result: Concentration of plasma calprotectin in kidney stone patients was significantly higher than that in controls. Likewise, urinary calprotectin of the patient group was significantly greater than the control. Positive correlation between plasma and urinary calprotectin was observed. Overall renal function of kidney stone patients was impaired, as indicated by increased plasma creatinine and decreased eGFR. Plasma creatinine was positively, while eGFR was negatively, correlated with plasma calprotectin. ROC analysis of plasma calprotectin revealed an area under curve of 0.739 (95%CI; 0.663-0.815). At 430 ng/ml cutoff, the test imparted sensitivity and specificity of 84% and 50%, respectively.
Conclusion: This study reports for the first time that circulating calprotectin in patients with renal calculi is elevated compared to healthy population. Additionally, elevated plasma calprotectin is associated with worse renal function. We hypothesize that increased plasma calprotectin in the patients might be due to inflammatory reaction in the stone-forming kidneys. Our data suggest that plasma calprotectin could be used as an adjunct marker for diagnosing kidney stone and assessing renal impairment.
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