By Kristina Rebelo
SAN DIEGO -- November 4, 2009 -- Combining a pair of putative urinary biomarkers in paediatric patients with acute kidney injury (AKI) may assist physicians in the emergency care setting in predicting the extent of injury with increased precision, according to study presented here at the American Society of Nephrology (ASN) Renal Week 2009.
Earlier identification of AKI has historically been elusive because serum creatinine increases only after substantial injury.
"Our ultimate goal was fluid responsiveness; these biomarkers will tell you if the kidneys will shut down," said Stuart Goldstein, MD, Baylor College of Medicine, Houston, Texas, on October 29. "Creatinine is a very late marker, and our hope is that these new biomarkers provide a therapeutic target."
"Fluid overload in paediatric patients with kidney injury is independently associated with mortality, and currently in the ICU, clinical judgment is terrible because there is no way to predict if kidney function will get better," he continued.
For the study, researchers tested the ability of several biomarkers to predict AKI. They assayed one urine sample from 252 hospitalised paediatric patients aged 7 to 15 years (50% male). AKI was defined by pRIFLE (Risk, Injury, Failure) and patients without AKI were controls.
The researchers assayed urinary neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, KIM-1, beta-2 microglobulin, and osteopontin.
"We were able to predict who had AKI [by the level of] combined NGAL and IL-18," explained Dr. Goldstein. Each biomarker was helpful on its own, but when they were combined, predictive values started to go up, so the severity of the injury could be known.
Both NGAL and IL-18 were higher for patients with pRIFLE than for patients with no AKI and pRIFLE combined (P < .05).
Study limitations included a 15% variability between test centres.
Dr. Goldstein said that in the future, up to 20 biomarkers may be identified and "statisticians will combine many, many more biomarkers for this population."
Funding for this study was provided by Gambro Renal Products.
[Presentation title: Urinary Biomarkers Obtained in the Emergency Center (EC) Can Predict AKI in Children. Abstract F-PO1065]
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