title: Effect of N-acetyl cysteine and vitamin C on kidney allograft function biomarkers interleukin-18 and neutrophil gelatinase-associated lipocalin.
abstract: BACKGROUND
  Delayed graft function (DGF) is a consequence of ischemia-reperfusion injuries in kidney allografts, for which no definite treatment is available. The neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) are introduced as the most promising urine biomarkers to detect DGF. N-acetylcysteine (NAC) and vitamin C, well-known potent antioxidants that scavenge free radicals, may alleviate kidney injury. This study investigated the protective effects of NAC alone and in combination with vitamin C on DGF, by measuring IL-18 and NGAL in living donor kidney transplantations.
  
  
  METHODS
  Patients transplanted between January 2011 and February 2013 were randomly divided into 3 groups to receive routine anti-rejection medication only (n = 32), NAC plus routine immunosuppressive regimen (NAC group; n = 33), and NAC and vitamin C plus routine regimen (NAC and vitamin C group; n = 19). Urine samples were taken 4 hours and 24 hours after transplantation. Enzyme-linked immunosorbent assay kits were utilized for measuring urine NGAL and IL-18.
  
  
  RESULTS
  There were no significant differences in the DGF prevalence and its duration between the study arms. Although the levels of NGAL and IL-18 decreased in the NAC and NAC and vitamin C groups, these reductions were not significant. Glomerular filtration rate at 30 and 60 days after transplantation were not significantly different between study groups, either.
  
  
  CONCLUSIONS
  Our results showed that NAC is a safe drug without significant adverse effects in kidney transplant recipients; however, its potential useful effects on urinary biomarkers of DGF were not illustrated in the present study.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sahraei
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. j.salamzadeh@yahoo.com.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Salamzadeh
authors.forename: Mohsen
authors.initials: M
authors.lastname: Nafar
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D000328:Adult; D064591:Allografts; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D015415:Biomarkers / Q000652:urine; D051799:Delayed Graft Function / Q000175:diagnosis / Q000517:prevention & control* / Q000652:urine; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000652:urine*; D007492:Iran; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000652:urine*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D000975:Antioxidants; D015415:Biomarkers; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D001205:Ascorbic Acid; D000111:Acetylcysteine