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  • Author: Wiwat Chancharoenthana x
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Open access

Asada Leelahavanichkul, Wiwat Chancharoenthana and Somchai Eiam-Ong



Biomarkers for the early diagnosis of chronic kidney disease (CKD) will lead to its better management. Rodent models will be helpful for biomarker discovery. Urinary exosomes, membrane bound vesicles, may contain interesting biomarkers.


To produce a mouse model of CKD with sufficient urine volume for exosome studies.


We characterized a mouse models of CKD induced by 55 min ischemia–reperfusion injury and contralateral nephrectomy at 1 wk after the chronic ischemia–reperfusion injury (Chr IR) in 7 mice and other 7 sham-operated control mice. We collected 24 h urine for urine exosome extraction.


Blood urea nitrogen, serum creatinine, and proteinuria increased as early as 2 wk, and reciprocally lower hematocrit. The renal injury, proteinuria, and anemia persisted 12 wk after nephrectomy as consistent with uremic symptoms. The mouse model of CKD showed renal histopathology of interstitial fibrosis with mild glomerular injury, and failure to grow. At 12 wk, the volume of urine collected in 24 h was sufficient for exosome extraction. Urinary exosomes were demonstrated by western blots showing tumor susceptibility gene 101 protein.


Mice with renal injury induced by Chr IR showed renal injury and proteinuria as early as 2 wk with uremic symptoms and tubulointerstitial fibrosis. Most importantly, the 24 h volume of urine at 12 wk was sufficient for exosome extraction.

Open access

Wiwat Chancharoenthana, Talerngsak Kanjanabuch, Wipawee Kittikowit, Nattachai Srisawat, Khajohn Tiranathanagula, Kearkiat Praditpornsilpa, Kriang Tungsanga and Somchai Eiam-Ong


Background: Percutaneous renal biopsy (PRB) is an essential tool in diagnosis and management of various renal diseases. Conventional ultrasound-guided free-hand approaches to the lower pole of the kidney for PRB yield marginal tissue adequacy and causes a certain incidence of bleeding complications.

Objective: To describe a novel ultrasound-guided approach to the middle part of the kidney for PRB to obtain better tissue sampling.

Patients and methods: The plane angle between the renal biopsy needle and the skin was set at 30° for patients in the novel middle part approach group (n = 15) and 45° for patients in the conventional lower pole approach group (n = 15).

Results: The perpendicular distance between the needle tip and renal capsule in the middle part approach was significantly shorter than the lower pole approach group (0.92 ± 0.6 vs. 1.49 ± 0.4 cm, p = 0.005). The middle part approach to PRB yielded a significantly higher number of glomeruli (22.8 ± 7.2 vs. 15.3 ± 4.1, p = 0.002) and arcuate arteries (0.9 ± 0.6 vs. 0.5 ± 0.1, p = 0.02). The bleeding complications in the middle part approach seemed to be less than in the lower pole approach technique. Pain scores between the two methods as assessed using a visual analog scale were not different.

Conclusion: This novel approach to the middle part of the kidney for PRB provides comparable patient satisfaction and a superior adequacy of renal tissue when compared with the conventional lower pole approach with its consequent lower post biopsy bleeding complications. Larger studies to confirm this finding are warranted.