Diagnosing acute kidney injury remains a challenge since the established renal biomarkers, serum creatinine (sCr) and symmetric dimethylarginine (SDMA) reflect glomerular function and not tubular injury. Sensitive tubular markers such as urinary clusterin (uClust) and cystatin B (uCysB) have been proposed to detect AKI at an earlier stage. Since envenomation by the European adder (Vipera berus berus) could serve as a spontaneous disease model of AKI we investigated these new biomarkers in affected dogs. Concentrations of uClust and uCysB as well as sCr and SDMA were analyzed retrospectively in stored samples from 26 dogs with snake envenomation and 13 healthy controls. Higher concentrations of uClust (P < 0.012) and uCysB (P < 0.001) were observed in the snake-envenomed group. Normalization of uClust and uCysB to urinary creatinine did not alter the results. No differences were observed in sCr and SDMA between the snake-envenomed group and the healthy control group. Spearman rank correlation analysis revealed a strong association of uClust with uCysB in the snake-envenomed dogs (r = 0.75 P < 0.001) but not in the healthy controls. The high percentage of snake-envenomed dogs with increased uClust and uCysB concentrations in the absence of increased sCr and SDMA suggests renal tubular injury in the affected dogs. Larger prospective case-controlled studies are warranted to evaluate the clinical utility and prognostic value of these biomarkers.

由于已建立的肾脏生物标志物，血清肌酐（sCr）和对称二甲基精氨酸（SDMA）反映肾小球功能而不是肾小管损伤，因此诊断急性肾损伤仍然是一个挑战。已经提出了敏感的肾小管标记物，例如尿簇蛋白（uClust）和胱抑素B（uCysB），可以在早期检测AKI。由于欧洲加法器（Vipera berus berus）的毒化可以作为AKI的自发疾病模型，因此我们在患病犬中研究了这些新的生物标记。回顾性分析了来自26只有蛇毒的狗和13个健康对照的储存样品中的uClust和uCysB以及sCr和SDMA的浓度。uClust（P  <0.012）和uCysB（P <0.001）在蛇毒组中观察到。将uClust和uCysB标准化为尿肌酐不会改变结果。蛇毒组和健康对照组之间的sCr和SDMA没有差异。Spearman等级相关分析显示，在蛇毒犬中uClust与uCysB有很强的关联（r  = 0.75 P  <0.001），但在健康对照组中则没有。在没有增加sCr和SDMA的情况下，uClust和uCysB浓度增加的蛇毒狗的百分比很高，这表明患狗的肾小管损伤。有必要进行更大规模的前瞻性病例对照研究，以评估这些生物标志物的临床效用和预后价值。