Urinary Kidney Injury Molocule-1 Level in Preterm Neonates with Respiratory Distress Syndrome

Abstract

Background: Despite recent advances in perinatal and neonatal care in respiratory distress syndrome (RDS) prevention and treatment, a considerable number of these neonates suffer from acute kidney injury (AKI), and it is associated with poor outcome as an independent risk factor. KIM-1 mRNA and protein are expressed at a low level in normal kidney but are increased in post ischemic kidney. Aim: The aim is to detect the value of urinary KIM-1 measurement as an early predictor marker of acute kidney injury in preterm neonates with respiratory distress syndrome. Patients and methods: The study included 30 preterm newborn with (RDS) ≤36 weeks during the period from October 2014 to March 2015. Also the study included 30 apparently healthy newborn ≤36 weeks as controls. They were selected from NICU of Manshiate Elbakry hospital Cairo, Egypt. uKIM-1 along with serum creatinine levels and eGFR were assessed in days 1 of life for both groups and in day 3 for cases. Results: In day one of life, we found a significant increase in uKIM-1 levels in preterm newborn with RDS compared to their controls (2.88 ± 1.01 ng/ml and 0.95 ± 0.52 ng/ml respectively (p = 0.001)). There is no significant difference between both groups regarding serum creatinine and eGFR. In day 3 of life, preterm with RDS had significant decrease in uKIM-1 levels compared to day 1 of life with significant increase in non-survivor compared to survivor group ( 2.30 ± 1.56 ng/ml and 1.30 ± 0.90 ng/ml respectively (p = 0.03)). The sensitivity and specificity of uKIM-1 and serum creatinine was calculated (100.00%, 86.67% and 33.33%; 95.00%) respectively. Conclusion: Preterm neonate with RDS is at high risk of developing AKI. Early and serial uKIM-1 measurements can be used as a non-invasive indicator of kidney injury in premature newborn with RDS.

eGFR values and selected renal urine biomarkers in preterm neonates with uncomplicated clinical course

“…33 Finally, in the studies by Askenazi et al 10,34 and Genc et al 35 addressing the hKIM1 and hKIM1/mgCr levels in preterm neonates, the values of these biomarkers are comparable to those found in this study, but there are also reports which published higher values. 36,37 Only in 1 study concerning term infants were the hKIM1 and hKIM1/mgCr values lower than the values found in the present study. 31 The causes of such disparities can mainly be found in the days of life in which the urine samples were collected from the newborns for measuring particular biomarkers.…”

“…23,25,30 The available literature is quite unambiguous in stating that there is no correlation and no effect of gender on the values of hKIM1. [35][36][37] In the present study, gender exerts a highly significant effect of several score percent on the values of the 3 investigated tubular markers. Table 7.…”

“…The same correlation concerning only hKIM1 was found by Sarafidis et al, 31 but this study was performed in term infants. Nevertheless, there are studies which proved no correlation between hKIM1 and GA 35,36 ; likewise, BW has been reported not to correlate with this marker. 35,37 On the other hand, in a study that was performed in a population of term infants, GA correlated positively with hKIM1.…”

“…In the remaining studies, the concentration values of the given biomarkers were determined within a much shorter timeframe -most often in the very first 7 days of life. 10,[31][32][33][35][36][37] Analyzing the importance and effect of gender on the values of the markers under discussion, one realizes that data from the subject literature are fairly scarce and ambiguous. There are reports stating that there is a higher level and increased variability of uNGAL in girls, 17 as well as other papers claiming that there is no significant association with gender.…”