Urinary aprotinin as a predictor of acute kidney injury after cardiac surgery in children receiving aprotinin therapy

Pediatr Nephrol. 2008 Aug;23(8):1317-26. doi: 10.1007/s00467-008-0827-9. Epub 2008 May 28.


Proteomic analysis has revealed potential early biomarkers of acute kidney injury (AKI) in children undergoing cardiopulmonary bypass (CPB), the most prominent one with a mass-to-charge ratio of 6.4 kDa. The objective of this study was to identify this protein and test its utility as a biomarker of AKI. Trypsin-digested protein bands were analyzed by tandem mass spectrometry (MS/MS) to identify the protein in urine samples. Surface-enhanced laser desorption/ionization time-of-flight analysis and a functional activity assay were performed to quantify urinary levels in a pilot study of 106 pediatric patients undergoing CPB. The protein was identified as aprotinin. Urinary aprotinin levels 2 h after initiation of CPB were predictive of AKI (for functional assay: 92% sensitivity, 96% specificity, area under the curve of 0.98). By multivariate analysis, the urinary aprotinin level 2 h after CPB was an independent predictor of AKI (beta = 0.001, P < 0.0001). The 2 h urinary aprotinin level correlated with serum creatinine, duration of AKI, and length of hospital stay. We concluded that urinary aprotinin levels 2 h after initiation of CPB predict the development of AKI and adverse clinical outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / urine
  • Aprotinin / therapeutic use*
  • Aprotinin / urine*
  • Biomarkers / urine
  • Cardiopulmonary Bypass*
  • Child
  • Child, Preschool
  • Female
  • Hemostatics / therapeutic use*
  • Hemostatics / urine*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / urine
  • Predictive Value of Tests
  • ROC Curve
  • Risk Factors
  • Sensitivity and Specificity


  • Biomarkers
  • Hemostatics
  • Aprotinin