Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery

Abstract

Acute kidney injury (AKI) is a major complication of cardiac bypass surgery. We examined whether levels of liver fatty acid-binding protein (L-FABP) can be an early biomarker for ischemic injury by measuring this protein in the urine of 40 pediatric patients prior to and following cardiopulmonary bypass surgery. AKI was defined as a 50% increase in the serum creatinine from baseline, which was normally not seen until 24-72 h after surgery. Enzyme-linked immunosorbent assay analysis showed increased L-FABP levels (factored for creatinine excretion) of about 94- and 45-fold at 4 and 12 h, respectively, following surgery in the 21 patients who developed AKI with western blot analysis, confirming L-FABP identity. Univariate logistic regression analyses showed that both bypass time and urinary L-FABP were significant independent risk indicators for AKI. After excluding bypass time from the model and using a stepwise multivariate logistic regression analysis, urinary L-FABP levels at 4 h after surgery were an independent risk indicator with the area under the receiver-operating characteristic curve 0.810, sensitivity 0.714, and specificity 0.684 for a 24-fold increase in urinary L-FABP. Our study shows that urinary L-FABP levels represent a sensitive and predictive early biomarker of AKI after cardiac surgery.

Serum Cystatin C Is an Early Predictive Biomarker of Acute Kidney Injury after Pediatric Cardiopulmonary Bypass

“…Given this, it has become increasingly evident that a single biomarker for AKI may not provide complete information and that simultaneous examination of other serum and urinary biomarkers may be ideal (21). Recent studies have uncovered other AKI biomarkers such as neutrophil gelatinaseassociated lipocalin (NGAL) (5), IL-18 (22), liver-type fatty acid binding protein (23), and kidney injury molecule-1 (18) in similar clinical cohorts. However, all biomarkers have their individual strengths and weaknesses.…”

Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

“…These adult data are in contrast to pediatric TRIBE AKI data (n=294), which showed no association between preoperative ACR and the development of postoperative AKI (defined as either AKIN stage 1 or a doubling of serum creatinine or receipt of renal replacement therapy [RRT]) (23). The adult ACR data represent an additional biomarker to aid in cardiac surgery AKI prediction models and supplement other recent data that point to proteinuria/albuminuria serving as a biomarker of AKI in the pre-and postoperative settings (17,24).…”

“…For this reason, several blood urinary proteins have been investigated in this setting and found to serve as biomarkers of AKI after cardiac surgery, including neutrophil gelatinaseassociated lipocalin (NGAL) (10)(11)(12)(13)(14), , cystatin C (CysC) (13,16), kidney injury molecule-1 (KIM-1) (12,16), and liver fatty acid binding protein (17). Many of these previously published studies are limited in that they are small single-center studies with low severe AKI event rates (10)(11)(12)(13)(14)(15)(16)(17). However, within the last year, data from the first large international, prospective observational study investigating biomarkers after cardiac surgery have been published (18)(19)(20)(21)(22).…”

Urinary kidney injury molecules in children with febrile seizures

“…Neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-b-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) have been used as early biomarkers of renal damage in many studies, and urinary concentrations of these markers have been shown to increase, especially after hypoxia. [8][9][10] We found no studies in the literature that investigated renal damage in FS using urinary kidney injury biomarkers. Therefore, this preliminary study was planned to evaluate whether simple FS causes any renal damage detected by early kidney injury molecules, for the first time.…”