Urinary Calprotectin as a Marker to Distinguish Functional and Structural Acute Kidney Injury in Pediatric Population

Abstract

Background: Acute kidney injury (AKI) is a serious, common and occasionally under-recognized condition. To date, the clinical and some laboratory parameters are routinely applied to distinguish between functional and structural AKI which can be challenging in certain occasions. In the present paper, we investigate the accuracy of urinary calprotectin as a diagnostic biomarker in this dubious situation.

Comparative analysis between urinary calprotectin and serum creatinine for early detection of intrinsic acute kidney injury

“…[ 2 9 10 11 12 13 14 ] Detecting calprotectin in urine before its detection or its elevation in serum is much more helpful in clinical practice. [ 15 ] In gastrointestinal problems, fecal calprotectin level differentiate between inflammatory bowel disease from functional intestinal problems as this marker is raised only in inflammatory intestinal problems. Therefore, we planned to use urinary calprotectin in comparison with serum BUN and creatinine and GFR to detect its sensitivity and specificity in detecting early stages of AKI in children admitted in our PICU unit.…”

“…The previous studies focused on the value of calprotectin in the differentiation of prerenal from intrinsic AKI. [ 15 ] In 2011, Heller et al . performed such a study and resulted that calprotectin has a high diagnostic value in intrinsic AKI and at a 300 ng/mL level has 92.3% sensitivity and 97.1% specificity.…”

“…In this study, calprotectin at the level of 230 ng/mL has the highest sensitivity and specificity (95.6% sensitivity and 100% specificity). [ 15 ] Furthermore, Seibert evaluated urinary calprotectin to differentiate between prerenal and intrinsic acute renal allograft failure and showed urinary calprotectin as a promising biomarker to differentiate prerenal and intrinsic acute renal allograft failure. [ 13 ] The pRIFLE classification system has been suggested as an accurate marker for increased morbidity and mortality in pediatrics[ 16 17 18 19 ] but we need a more sensitive biomarker than serum creatinine or urine output to diagnose AKI much earlier enabling us to start our treatments in critical time to reduce long-term consequences of AKI.…”

Accuracy of urine calprotectin for diagnosis of acute kidney injury in neonates

“…They found that urine calprotectin in renal group was higher than pre renal and calprotectin level correlated with severity of renal failure. Hence, Calprotectin with cut off value of 230 ng/ml with 95.6% sensitivity and 100% specificity can use to differentiate renal from prerenal AKI [3]. Seibert et al in 2016 assessed the power of calprotectin in differentiation of pre-renal and renal acute allograft.…”

“…Acute renal failure is a common morbidity in neonates who are admitted in neonatal intensive care units (30% worldwide) [1]. Mortality and hospital stay lengths in neonates with AKI is higher than those without AKI [2] and the risk of chronic renal failure in adulthood increased in pediatrics with AKI [3]. It is obvious that prognosis of AKI is highly depended on early diagnosis and onset of treatment.…”