Renal L-Type Fatty Acid Binding Protein: Possible Stress Reducer and Biomarker for Human Renal Microcirculation

Yamamoto, Takahiro; Noiri, Eisei; Sugaya, Ken; Yamada, Shin; Katoh, Osamu; Hirabayashi, Satoshi; Oshima, Satoshi; Hattori, Ryohei; Gotoh, Momokazu

doi:10.1016/s0022-5347(08)62021-2

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“…The discrepancy in the urinary levels of L-FABP between two distinct types of AKI we believe relates to the presence of ischemic injury in patients undergoing cardiac surgery. As demonstrated in a recent study done in Japan, 16 urinary L-FABP levels correlated well to the level of renal ischemia (peritubular capillary ischemia). Therefore, we believe that the degree of ischemia seen in patients undergoing CPB is probably not seen in patients receiving contrast media.…”

Section: Discussionsupporting

confidence: 62%

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

Portilla

Dent

Sugaya

et al. 2008

Kidney International

353

259

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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.

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Section: Discussionsupporting

confidence: 62%