title: Nuclear factor kappa B in urine sediment: a useful indicator to detect acute kidney injury in Plasmodium falciparum malaria.
abstract: BACKGROUND
  Acute kidney injury (AKI) is one of the major complications of Plasmodium falciparum malaria, especially among non-immune adults. It has recently been revealed that activation of transcription factor nuclear factor kappa B (NF-κB) induces pro-inflammatory gene expression involved in the development of progressive renal inflammatory diseases. The aim of this study was to determine whether urinary sediment NF-κB p65 can act as a biomarker for AKI in patients with P. falciparum malaria.
  
  
  METHODS
  Urinary sediments from malaria patients, including Plasmodium vivax malaria, uncomplicated P. falciparum malaria, complicated P. falciparum malaria without AKI (serum creatinine-Cr <3 mg/dl) and complicated P. falciparum malaria with AKI (Cr ≥3 mg/dl) were used to determine NF-κB p65 level by sandwich enzyme-linked immunosorbent assay (ELISA). Urinary sediments obtained from healthy controls were used as a normal baseline. Correlations between levels of urinary sediment NF-κB p65 and pertinent clinical data were analysed.
  
  
  RESULTS
  Urinary sediment NF-κB p65 levels were significantly increased on the day of admission (day 0) and on day 7 post-treatment in complicated P. falciparum malaria patients with AKI, compared with those without AKI (p=0.001, p <0.001, respectively), P. vivax patients (all p <0.001) and healthy controls (all p <0.001). NF-κB p65 levels in urinary sediment cells showed a significant positive correlation with serum Cr (Day 0: rs=0.792; p <0.001, Day 7: rs=0.605; p <0.001) and blood urea nitrogen (BUN) (Day 0: rs=0.839; p <0.001, Day 7: rs=0.596; p <0.001).
  
  
  CONCLUSIONS
  Urinary sediment NF-κB p65 level is a useful indicator for estimating renal tubular epithelial cell damage and subsequent development of AKI among patients with P. falciparum malaria.
authors.forename: Chuchard
authors.initials: C
authors.lastname: Punsawad
authors.affiliation: Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, Thailand. parnpen.vir@mahidol.ac.th.
authors.forename: Parnpen
authors.initials: P
authors.lastname: Viriyavejakul
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D004847:Epithelial Cells / Q000737:chemistry*; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000473:pathology; D016780:Malaria, Vivax / Q000473:pathology; D008297:Male; D051996:Transcription Factor RelA / Q000032:analysis*; D014556:Urine / Q000166:cytology*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D051996:Transcription Factor RelA