title: Increased total cytokeratin-18 serum and urine levels in chronic kidney disease.
abstract: BACKGROUND
  Increased cell death in chronic kidney disease (CKD) by either necrosis or apoptosis has been confirmed by a variety of studies. Possible sources are an inadequate persistent inflammation and ischemia as a consequence of CKD or caused by the underlying renal disease. Detection of total or caspase cleaved cytokeratin 18 (CK-18) is a novel and elegant method to determine necrosis or apoptosis of epithelial cells in the patients' sera and urine.
  
  
  METHODS
  120 patients with CKD stages 1 to 5 were included in the study. Twenty healthy volunteers served as controls. Total and caspase cleaved CK-18 urine and serum concentrations were determined by ELISA.
  
  
  RESULTS
  The concentration of serum total CK-18 was significantly higher in CKD stages 3-5 as compared to the healthy controls. Urinary total CK-18 excretion was increased in patients with CKD 5 compared to controls. A significant correlation between urine total CK18 and urine protein and albumin levels was found. Moreover, ROC curve analysis showed the potential of serum and especially urine total CK-18 levels to predict various CKD stages.
  
  
  CONCLUSIONS
  We provide evidence for increased total CK-18 serum and urine levels in CKD patients, possibly indicating that epithelial cell necrosis is prevalent in CKD.
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria. georg.roth@meduniwien.ac.at
authors.forename: Georg A
authors.initials: GA
authors.lastname: Roth
authors.forename: Diana
authors.initials: D
authors.lastname: Lebherz-Eichinger
authors.forename: Hendrik Jan
authors.initials: HJ
authors.lastname: Ankersmit
authors.forename: Stefan
authors.initials: S
authors.lastname: Hacker
authors.forename: Hubert
authors.initials: H
authors.lastname: Hetz
authors.forename: Thomas
authors.initials: T
authors.lastname: Vukovich
authors.forename: Andrea
authors.initials: A
authors.lastname: Perne
authors.forename: Thomas
authors.initials: T
authors.lastname: Reiter
authors.forename: Alexander
authors.initials: A
authors.lastname: Farr
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Martin
authors.initials: M
authors.lastname: Haas
authors.forename: Claus G
authors.initials: CG
authors.lastname: Krenn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020169:Caspases / Q000378:metabolism; D005260:Female; D006801:Humans; D053538:Keratin-18 / Q000097:blood* / Q000378:metabolism / Q000652:urine*; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000201:enzymology / Q000503:physiopathology / Q000652:urine*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D055815:Young Adult
chemical_list: D053538:Keratin-18; D020169:Caspases