Integrated urinary biomarkers can predict early acute kidney injury in children undergoing chemotherapy

Abstract

Background Acute kidney injury (AKI) is a common complication in pediatric oncology patients, most often caused by nephrotoxic drugs. We aimed to assess whether levels of urinary kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), liver fatty acid binding protein (L-FABP) and Vanin-1 (VNN-1) could be early biomarkers for cytotoxic treatment induced AKI. Material and methods Children with different malignant diseases treated with cisplatin (CIS) or ifosfamide (IFO) were included. AKI was defined as at least 25% decrease in the estimated glomerular filtration rate (eGFR) by comparing baseline pretreatment eGFR value with the value acquired at 48h after the first or second chemotherapy cycle. Five serum and four urine samples were obtained immediately before and at 2h, 6h, 24h and 48h after treatment. Results Out of 38 patients, 12 (31.58%) experienced AKI within 2 days following the chemotherapy. A model of integrated parameters measured in urine showed significant diagnostic accuracy of pretreatment urine biomarkers (AUC 0.753), urine biomarkers measured 24 h after chemotherapy (AUC 0.712), as well as the ratio of urinary biomarkers measured 24h after chemotherapy adjusted according to urine creatinine concentrations compared to baseline (24 h/baseline ratios) (AUC 0.718) towards AKI prediction. Conclusion Our study suggests that the changes in urinary NGAL/creatinine, KIM-1/creatinine, L-FABP/creatinine and VNN-1/creatinine ratios, 24 h after CIS and/or IFO administration can be utilized to predict AKI in children undergoing chemotherapy. The use of model of integrated urine biomarkers could be a promising to predict AKI in patients receiving CIS and/or IFO containing chemotherapy.