Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: a prospective cohort study

Abstract

IntroductionChildren admitted to a pediatric intensive care unit (ICU) are at high risk of developing acute kidney injury (AKI). Although serum creatinine (SCr) levels are used in clinical practice, they are insensitive for early diagnosis of AKI. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are novel AKI biomarkers whose performance in pediatric ICU patients is largely unknown. In this study, we aimed to characterize uNGAL and KIM-1 patterns in children following ICU admission and to assess their properties in relation to identifying children at risk for AKI development.MethodsFrom June 2010 until January 2014, we conducted a prospective observational cohort study of term-born children ages 1 day to 1 year on mechanical ventilation. Blood and urine samples were obtained every 6 to 12 hours up to 72 hours post-admission. Blood samples were assayed for SCr, and urine samples were assayed for uNGAL and KIM-1. The RIFLE (risk, injury, failure, loss, end-stage renal disease) classification as 150%, 200% or 300% of median SCr reference values was used to define AKI.ResultsA total of 100 children were included (80 survived). Their median age at admission was 27.7 days (interquartile range (IQR), 1.5 to 85.5). The median duration of mechanical ventilation was 5.8 days (IQR, 3.1 to 11.4). Thirty-five patients had evidence of AKI within the first 48 hours post-admission, of whom 24 (69%) already had AKI when they entered the ICU. uNGAL and KIM-1 concentrations in AKI peaked between 6 to 12 hours and between 12 to 24 hours post-admission, respectively. The maximal area under the receiver operating characteristic curve (AUC) for uNGAL was 0.815 (95% confidence interval (CI), 0.685 to 0.945, P <0.001) at 0 to 6 hours post-admission. The discriminative ability of KIM-1 was moderate, with a largest AUC of 0.737 (95% CI, 0.628 to 0.847; P <0.001) at 12 to 24 hours post-admission. At the optimal cutoff point (126 ng/ml), uNGAL concentration predicted AKI development correctly in 16 (84%) of 19 children, up to 24 hours before a rise in SCr became apparent.ConclusionsLevels of uNGAL and KIM-1 increase in patients with AKI following ICU admission and peak at 6 to 12 hours and 12 to 24 hours post-admission, respectively. uNGAL seems to be a reliable marker for identifying children who will develop AKI 24 hours later.

Urinary NGAL and KIM-1 Are the Early Detecting Biomarkers of Preterm Infants with Acute Kidney Injury

“…Zwiers AJ et al [39] conducted a prospective observational cohort study of 100 term-born infants ages 1 day to 1 year on mechanical ventilation. Thirty-five patients had evidence of AKI within the first 48 hours post-admission, of whom 24 (69%) already had AKI when they entered the PICU.…”

Intraoperative biomarkers in renal transplantation

“…[45][46][47][48] It can be easily detected in the blood and urine within hours after AKI, starting to rise at 1-2 h after injury, peaking at hours 6-48 and decreasing afterwards in contrast-induced AKI. 49 Furthermore it was found to be a reliable predictor of AKI in numerous severe conditions [50][51][52][53][54] as well as after cardiac surgery. 8,55,56 Additionally, its concentrations in blood and urine were shown to correlate with those of serum creatinine and severity of renal impairment in acute renal injury in both, rodents and humans.…”

Korelasi antara Kadar Neutrophil Gelatinase Associated Lipocaline Urin dengan Laju Filtrasi Glomerulus pada Variasi Waktu untuk Mendeteksi Dini Gangguan Ginjal Akut pada Anak Sepsis

“…Hasil ini sesuai dengan penelitian pada tahun 2010-2014 yang menyimpulkan bahwa puncak peningkatan kadar NGALu terjadi pada jam ke-6 sampai 12 dengan nilai NGALu>126 ng/ml dapat mendeteksi GgGA. 17 Penelitian Zappitelli tahun 2007 menyimpulkan kadar NGALu 20,9±28,1/11,6 (27,5) ng/ml menunjukkan adanya GgGA. 16 Penelitian yang dilakukan di Iran pada tahun 2012 terhadap pasien anak yang dirawat di PICU menyimpulkan nilai optimum NGALu untuk mendeteksi GgGA pada hari perawatan ke-1 hingga ke-3 adalah 65,82 ng/ml-66,81 ng/ml.…”

“…15,16 Puncak peningkatan kadar NGALu pada anak sakit kritis terjadi pada jam ke-6 sampai 12 sejak pasien masuk perawatan. 17 Penelitian yang dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) pada tahun 2014 menunjukkan adanya peningkatan kadar NGALu dan kreatinin serum pada pasien anak sepsis berat. 18 Para peneliti sebelumnya telah menganalisis korelasi antara kadar NGALu dengan LFG pada anak sakit kritis.…”