TY - JOUR T1 - Rapid decline of kidney function in diabetic kidney disease is associated with high soluble Klotho levels JO - Nefrología T2 - AU - Bob,Flaviu AU - Schiller,Adalbert AU - Timar,Romulus AU - Lighezan,Daniel AU - Schiller,Oana AU - Timar,Bogdan AU - Bujor,Cristiana Georgeta AU - Munteanu,Mircea AU - Gadalean,Florica AU - Mihaescu,Adelina AU - Grosu,Iulia AU - Hategan,Andreea AU - Chisavu,Lazar AU - Pusztai,Agneta-Maria AU - Covic,Adrian SN - 02116995 M3 - 10.1016/j.nefro.2018.08.004 DO - 10.1016/j.nefro.2018.08.004 UR - https://revistanefrologia.com/es-rapid-decline-kidney-function-in-articulo-S0211699518301516 AB - BackgroundKlotho is found in two forms: a transmembrane form and a soluble form (s-Klotho). In order to be excreted, s-Klotho, that is too large to be filtered, will probably reach the proximal convoluted tubule by a transcytosis process. The aim of our study was to show the relationship between the levels of s-Klotho and tubular injury in patients with diabetic kidney disease (DKD), using as tubular injury marker the kidney injury molecule-1 (KIM-1). MethodsOur study included 63 DKD patients (stages 1–5, mean eGFR 65.15±32.45ml/min) with a mean age 58.13±12 years. In all patients we determined serum levels of: KIM-1 and s-Klotho using ELISA, urinary albumin/creatinine ratio (UACR) and reduction in the estimated glomerular filtration rate (eGFR) per year. ResultsWe found a strong statistically significant correlation of s-Klotho with the rate of reduction of eGFR/year (r=0.714, p=0.0004) and with the tubular injury marker KIM-1 (r=0.758, p=0.005) and strong correlations of UACR with the rate of reduction of eGFR/year (r=0.53, p<0.01), KIM-1 (r=0.49, p<0.05) and s-Klotho (r=0.52, p<0.01). ConclusionDespite previous published data, that shows a decrease of s-Klotho in chronic kidney disease, in our study the rapid annual decline of kidney function but not the level of eGFR was associated with increased s-Klotho. A possible explanation could be a more severe proximal tubule injury that could lead to a reduction of tubular excretion of s-Klotho as suggested by the correlation of s-Klotho levels with the serum levels of KIM-1. ER -