Urine Biomarkers Predict Acute Kidney Injury in Newborns

• Published in: The Journal of pediatrics Vol. 161; no. 2; pp. 270 - 275.e1
• Main Authors: Askenazi, David J., MD, MSPH, Koralkar, Rajesh, MPH, Hundley, Hayden E., MPH, Montesanti, Angela, MPH, Parwar, Pushkar, MBBS, MPH, Sonjara, Srdjan, BS, BA, Ambalavanan, Namasivayam, MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.08.2012; Mosby, Inc; Elsevier
• Subjects: Acute Kidney Injury - diagnosis; Acute-Phase Proteins - urine; albumins; Biological and medical sciences; biomarkers; Biomarkers - blood; Biomarkers - urine; birth weight; blood serum; Case-Control Studies; creatinine; Creatinine - blood; Cystatin C - urine; Epidermal Growth Factor - urine; Female; General aspects; Hepatitis A Virus Cellular Receptor 1; Humans; Infant, Newborn; Kidneys; Lipocalin-2; Lipocalins - urine; Male; Medical sciences; Membrane Glycoproteins - urine; neonates; Nephrology. Urinary tract diseases; osteopontin; Osteopontin - urine; Pediatrics; Predictive Value of Tests; Proto-Oncogene Proteins - urine; Receptors, Virus; Urinary system involvement in other diseases. Miscellaneous; urine; Uromodulin - urine; NGAL; β 2 microglobulin; SCr; EGF; Acute kidney injury; Serum creatinine; Cys C; Osteopontin; UMOD; Uromodulin; Kidney injury molecule 1; OPN; AUC; KIM-1; Area under the receiver operating characteristic curve; CV; B2mG; Cystatin C; Confidence of variability; Epithelial growth factor; Neutrophil gelatinase–associated lipocalin; AKI; Human; Kidney disease; Urine; Pediatrics; Urinary system disease; Newborn; Prediction; Biological marker; Predictive factor
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.02.007

Objective To identify urine biomarkers predictive of acute kidney injury (AKI) in infants admitted to level 2 and 3 neonatal intensive care units with birth weight >2000 g and 5-minute Apgar score ≤7. Study design A nested case-control study was performed comparing 8 candidate urine AKI biomarkers in infants with AKI (defined as a rise in serum creatinine of at least 0.3 mg/dL or a serum creatinine elevation ≥1.7 mg/dL persisting for 3 days) and 24 infants from the described cohort without AKI. Urine was analyzed for neutrophil gelatinase–associated lipocalin, osteopontin, cystatin C, albumin, β2 microglobulin, epithelial growth factor, uromodulin (UMOD), and kidney injury molecule 1. Results Compared with the infants without AKI, those with AKI had higher levels of urine cystatin C (1123 pg/mL [95% CI, 272-4635 pg/mL] vs 90 pg/mL [95% CI, 39-205 pg/mL]; P < .004; area under the receiver operating characteristic curve [AUC] = 0.82), lower levels of UMOD (11.0 pg/mL [95% CI, 5.7-21.4 pg/mL] vs 26.2 pg/mL [95% CI, 17.4-39.4 pg/mL]; P < .03; AUC = 0.77), and lower levels of epithelial growth factor (6.7 pg/mL [95% CI, 4.0-11.3 pg/mL] vs 17.4 pg/mL [95% CI, 12.7-23.8 pg/mL; P = .003; AUC = 0.82). Although the differences were not statistically significant, levels of urine neutrophil–associated gelatinase lipocalin, kidney injury molecule 1, and osteopontin trended higher in infants with AKI. Conclusion Urinary biomarkers can predict AKI in neonates admitted to level 2 and 3 neonatal intensive care units.