Kidney injury molecule-1 identifies antemortem injury in postmortem adult and fetal kidney

• Published in: American journal of physiology. Renal physiology Vol. 315; no. 6; pp. F1637 - F1643
• Main Authors: Yin, Wenqing, Zhang, Ping L., Macknis, Jacqueline K., Lin, Fan, Bonventre, Joseph V.
• Format: Journal Article
• Language: English
• Published: United States American Physiological Society 01.12.2018
• Series: Precision Medicine in Kidney Disease and Injury
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - embryology; Acute Kidney Injury - metabolism; Age Factors; Autolysis; Autopsy; Biomarkers - blood; Creatinine - blood; Gestational Age; Hepatitis A Virus Cellular Receptor 1 - analysis; Humans; Immunohistochemistry; Infant, Newborn; Innovative Methodology; Kidney Tubules, Proximal - chemistry; Kidney Tubules, Proximal - embryology; Postmortem Changes; Predictive Value of Tests; Retrospective Studies; KIM-1; acute renal failure; autopsy kidney; acute kidney injury; biomarker; TIM-1; kidney hypoxia
• ISSN: 1931-857X; 1522-1466; 1522-1466
• DOI: 10.1152/ajprenal.00060.2018

There is currently no technique to unambiguously diagnose antemortem kidney injury on postmortem examination since postmortem tissue damage and autolysis are common. We assessed the ability to detect kidney injury molecule-1 (KIM-1) expression in adult and fetal kidneys examined at autopsy. In adult kidneys ( n = 52 subjects), we found that the intensity of KIM-1 staining significantly correlated with the antemortem level of serum creatinine, and this was independent of the extent of tissue autolysis. In addition, kidneys from a total of 52 fetal/neonatal subjects, 30 stillborns and 22 liveborns, were assessed for KIM-1 staining. Given that serum creatinine is unreliable and often unavailable in fetuses and newborns, we assessed preterminal hypoxia in fetuses by the presence of squames in pulmonary alveoli and by required intubation. KIM-1 expression correlated with these clinical indexes of hypoxia. The expression of KIM-1 was seen in a majority of the fetal and neonatal autopsy kidneys (77%, 40/52) as early as 16 wk of gestation, even in the presence of autolysis. Thus KIM-1 is a specific and stable marker of antemortem tubular injury in kidneys of adults and fetuses despite postmortem autolysis.