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Ability of urinary neutrophil gelatinase-associated lipocalin to predict acute kidney injury in pediatric patients with heterogeneous critical illnesses
Ken Ishikawa, MD
Department of Pediatrics, Iwate Medical University, Morioka, Japan
Background and aim: Urinary neutrophil gelatinase associated lipocalin (uNGAL) has proven useful to predict acute kidney injury (AKI) with a homogeneous etiology developing after pediatric cardiac surgery. However, the significance of uNGAL has not been established in pediatric patients with various heterogeneous critical illnesses. Therefore, we examined the whether uNGAL could serve as an early biomarker to predict AKI arising in pediatric patients in the intensive care unit (ICU).
Methods: We evaluated 24 pediatric patients (age, 6 months to 10 years; weight, 6.7 ~ 42 kg) who were admitted to the ICU between August 2011 and June 2012. Their serum and urine samples were consecutively collected every day while in the ICU. We defined AKI based on the modified RIFLE criteria for critically ill children using estimated creatinine clearance (eCCl) calculated from serum creatinine. Risk (R), injury (I) and failure (F) were defined when eCCl decreased by 25%, 50% and 75%, respectively, during the acute phase. When no previous data were available, we assumed that the baseline eCCl was 100mL/min/1.73m2. Correlations between uNGAL in urine samples collected during the first day in the ICU and the clinical course as well as AKI grade were investigated.
Results: Ten of the 24 patients had extant diseases and the patients were admitted to the ICU because of infection (n = 10), burns (n = 4), hemolytic uremic syndrome (n = 3), intoxication (n = 2), external injury (n = 2), inborn error (n = 2) and heart failure (n = 1). Eleven of the patients developed AKI including those who were defined as R (n = 3 patients), I (n = 3 patients) and F (n = 5) upon admission. Levels of uNGAL were significantly higher in patients with, than without AKI (median, 549 vs. 31; range, 4 ~ 6,018 vs. 13 ~ 286 ng/mL; p < 0.05). Among 11 patients with AKI, uNGAL was significantly higher in six patients who needed renal replacement therapy (RRT) than in five who did not (median, 3,008 vs. 34; range, 34 ～ 6,018 vs. 4 ~609 ng/mL; p < 0.05. Levels of uNGAL were significantly higher in all patients who needed RRT or whose AKI grade worsened than in others (median 1419 vs. 32; range 34 ~ 6,018 vs. 4 ~549 ng/mL).
Conclusion: Urinary NGAL might serve as a useful biomarker to predict the need for RRT or AKI exacerbation even in pediatric patients with various heterogeneous critical illnesses in the ICU.
Ken Ishikawa, MD
Department of Pediatrics, Iwate Medical University, Morioka, Japan