Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery

Han, Won Kon; Wagener, Gebhard; Zhu, Yanqing; Wang, Shuang; Lee, H. Thomas

doi:10.2215/cjn.04810908

Cited by 350 publications

(287 citation statements)

References 38 publications

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“…However, if so, patients without AKI who receive furosemide may have a marked diuresis, diluting urinary NGAL, whereas patients with evolving AKI may have a blunted response with less urinary dilution, thus enhancing the apparent discriminant ability of urinary NGAL for AKI. Although adjusting NGAL values for urinary creatinine may have been instructive in this regard, urinary creatinine was not measured, and several previous authors have reported limited incremental benefit in doing so (8,11). Additionally, data on perioperative diuretic administration or urine Figure 1.…”

Section: Discussionmentioning

confidence: 99%

“…Five milliliters of urine was collected after induction of general anesthesia and before surgical incision, on completion of cardiopulmonary bypass and again at 3, 18, and 24 hours later. Samples were processed immediately and stored at Ϫ20°C for up to 3 months, a period for which NGAL has been reported to be stable (11). Urinary NGAL level was determined by ELISA assay using a commercially available ELISA kit (Antibodyshop, Gentofte, Denmark).…”

Section: Methodsmentioning

confidence: 99%

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Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury after Cardiac Surgery

McIlroy¹,

Wagener²,

Lee³

2010

Clinical Journal of the American Society of Nephrology

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102

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Background and objectives: Neutrophil Gelatinase-Associated Lipocalin (NGAL) is rapidly released by renal tubules after injury, potentially allowing early identification of acute kidney injury (AKI) after cardiac surgery. However, the diagnostic performance of NGAL has varied widely in clinical studies, and it remains unknown what factors modify the relationship between NGAL and AKI. We hypothesized the relationship between urinary NGAL and AKI would vary with baseline renal function, allowing a stratified analysis to improve diagnostic performance of this novel biomarker.Design, setting, participants, & measurements: We performed a prospective observational study in 426 adult cardiac surgical patients. Urinary NGAL was serially determined, commencing preoperatively and continuing 24 hours postoperatively. AKI was defined as increase in serum creatinine from baseline by either >50% or >0.3 mg/dl within 48 hours postoperatively. Patients were stratified by baseline estimated GFR (eGFR). NGAL levels were compared between patients with and without AKI and diagnostic characteristics determined according to baseline eGFR.Results: In patients with baseline eGFR >60 ml/min, urinary NGAL was higher at all postoperative time points in patients who developed AKI compared with those who did not. In patients with baseline eGFR <60 ml/min, urinary NGAL did not differ at any time between those who did and those who did not develop AKI. Postoperative NGAL best identified AKI in patients with baseline eGFR 90 to 120 ml/min. Conclusions: The relationship between urinary NGAL and AKI after cardiac surgery varies with baseline renal function, with optimal discriminatory performance in patients with normal preoperative function.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury after Cardiac Surgery

McIlroy¹,

Wagener²,

Lee³

2010

Clinical Journal of the American Society of Nephrology

Self Cite

180

102

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“…ELISA methods were performed as described previously for NGAL (21), KIM-1 (22), and IL-18 (23), with intra-and interassay variability for all biomarkers documented at Ͻ10%. Standard hospital laboratory systems were used to measure urine sodium and urea.…”

Section: Biomarker Measurementsmentioning

confidence: 99%

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

Hall

Coca

Perazella³

et al. 2011

Clinical Journal of the American Society of Nephrology

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107

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SummaryBackground and objectives Studies have evaluated acute kidney injury (AKI) using biomarkers in various settings, but their prognostic utility within current practice is unclear. Thus, we sought to determine the prognostic utility of newer biomarkers or traditional markers (fractional excretion of sodium [FeNa] and urea [FeUrea] and microscopy) over clinical assessment alone.Design, setting, participants, & measurements This is a prospective cohort study of adults on the first day of meeting AKI criteria. We measured urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and IL-18 and determined FeNa, FeUrea, and microscopy score for casts and tubular cells. Primary outcome was worsened AKI stage from enrollment to peak serum creatinine or in-hospital death.Results In 249 recipients, 57% were Ն65 years old, 48% were from intensive care, and mean baseline GFR was 69 Ϯ 30 ml/min per 1.73 m 2 . AKI was considered prerenal in 164 (66%), acute tubular necrosis (ATN) in 51 (20%), and "other" in 34 (14%). All mean protein biomarker concentrations, FeNa, FeUrea, and microscopy scores were statistically different between prerenal and ATN. Seventy-two patients (29%) developed the primary outcome. There was an approximate three-fold increase in adjusted risk for the outcome for upper versus lower values of NGAL, KIM-1, IL-18, and microscopy score (P values Ͻ0.05). Net reclassification improved after adding these to baseline clinical assessment. FeNa and FeUrea were not useful. ConclusionsOn the first day of AKI, urine protein biomarkers and microscopy significantly improve upon clinical determination of prognosis, indicating their potential utility in current practice.

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“…Underscoring this continuum is a recent article examining NGAL and other urinary biomarkers after cardiac surgery. 3 In that study, regardless of whether the patient was considered to have or have not experienced AKI (using the same definitions used by Siew et al 1 ), a rise from the baseline value with subsequent fall back to baseline was seen over time. Stated another way, even patients without any significant change in creatinine experienced a rise and fall in their urinary NGAL.…”

mentioning

confidence: 93%

The Development of Urinary Biomarkers for Kidney Disease Is the Search for Our Renal Troponin

Szczech¹

2009

Journal of the American Society of Nephrology

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Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery

Abstract: Background and objectives: Serum creatinine (Scr) does not allow for early diagnosis of acute kidney injury (AKI).

Cited by 350 publications

References 38 publications

Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury after Cardiac Surgery

Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury after Cardiac Surgery

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

The Development of Urinary Biomarkers for Kidney Disease Is the Search for Our Renal Troponin

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