Abstract
BackgroundCritically ill children and neonates are at high risk of developing acute kidney injury (AKI). AKI is associated with short- and long-term renal impairment and increased mortality. Current methods of diagnosing AKI rely on measurements of serum creatinine, which is a late and insensitive marker. Few studies to date have assessed AKI biomarkers in a heterogeneous patient cohort.MethodsWe conducted a prospective feasibility study in a paediatric intensive care setting over a 6-month period to describe the relationship between AKI (defined according to pRIFLE criteria) and new AKI biomarkers.ResultsIn total, 49 patients between the ages of 16 days and 15 years were recruited for measurement of plasma cystatin C (Cys-C) and neutrophil gelatinase-associated lipocalin (pNGAL) concentrations, as well as for urinary kidney injury molecule-1 (KIM-1) and urinary NGAL (uNGAL) concentrations. Almost one-half (49 %) of the patient cohort experienced an AKI episode, and Cys-C and pNGAL were the strongest candidates for the detection of AKI. Our data suggest that the widely used estimated baseline creatinine clearance value of 120 mL/min/1.73 m2 underestimates actual baseline function in patients admitted to paediatric intensive care units.ConclusionsThis investigation demonstrates the feasibility of new AKI biomarker testing in a mixed patient cohort and provides novel biomarker profiling for further evaluation.Electronic supplementary materialThe online version of this article (doi:10.1007/s00467-015-3089-3) contains supplementary material, which is available to authorized users.
Highlights
Acute kidney injury (AKI) is a serious condition characterized by the sudden onset of renal dysfunction, leading to impaired control of acid–base, electrolyte and fluid balance
For the three groups we considered, we found that plasma neutrophil gelatinase-associated lipocalin (pNGAL) (p=0.027) and urinary NGAL (uNGAL) (p=0.0079) levels were significantly higher in periods of pRIFLE I/F (Fig. 4) and that cystatin C (Cys-C) levels were significantly higher in periods of both pRIFLE R and pRIFLE I/F (p
As 24/49 (49.0 %) of our patients were admitted to the paediatric intensive care unit (PICU) with either sepsis or pneumonia, we examined whether pNGAL was a valid acute kidney injury (AKI) biomarker in sepsis in our patient cohort
Summary
Acute kidney injury (AKI) is a serious condition characterized by the sudden onset of renal dysfunction, leading to impaired control of acid–base, electrolyte and fluid balance. AKI is a common problem in children admitted to the paediatric intensive care unit (PICU). The most comprehensive longitudinal paediatric follow-up study currently available was limited by follow-up rates of less than 50 %, but it reported overall 3- to 5-year post-AKI patient survival of only 57 %, with 9 % of surviving children developing end-stage renal disease by 5 years [1]. Despite the clinical significance of AKI, current diagnosis and treatment strategies remain suboptimal. Ill children and neonates are at high risk of developing acute kidney injury (AKI). AKI is associated with short- and long-term renal impairment and increased mortality. Few studies to date have assessed AKI biomarkers in a heterogeneous patient cohort
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