Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass

Biomarkers. 2009 Sep;14(6):423-31. doi: 10.1080/13547500903067744.


The purpose of this study was to compare the performance of six candidate urinary biomarkers, kidney injury molecule (KIM)-1, N-acetyl-beta-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, cystatin C and alpha-1 microglobulin, measured 2 h following cardiopulmonary bypass (CPB) for the early detection of acute kidney injury (AKI) in a prospective cohort of patients undergoing cardiac surgery. A total of 103 subjects were enrolled; AKI developed in 13%. Urinary KIM-1 achieved the highest area under-the-receiver-operator-characteristic curve (AUC 0.78, 95% confidence interval 0.64-0.91), followed by IL-18 and NAG. Only urinary KIM-1 remained independently associated with AKI after adjustment for a preoperative AKI prediction score (Cleveland Clinic Foundation score; p = 0.02), or CPB perfusion time (p = 0.006). In this small pilot cohort, KIM-1 performed best as an early biomarker for AKI. Larger studies are needed to explore further the role of biomarkers for early detection of AKI following cardiac surgery.

Publication types

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

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / etiology
  • Acute-Phase Proteins / urine
  • Biomarkers / urine
  • Cardiopulmonary Bypass / adverse effects*
  • Cohort Studies
  • Cystatin C / urine
  • Hepatitis A Virus Cellular Receptor 1
  • Humans
  • Interleukin-18 / urine
  • Lipocalin-2
  • Lipocalins / urine
  • Membrane Glycoproteins / urine*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / urine
  • Prospective Studies
  • Proto-Oncogene Proteins / urine
  • Receptors, Virus
  • alpha-Macroglobulins / urine


  • Acute-Phase Proteins
  • Biomarkers
  • Cystatin C
  • HAVCR1 protein, human
  • Hepatitis A Virus Cellular Receptor 1
  • Interleukin-18
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Membrane Glycoproteins
  • Proto-Oncogene Proteins
  • Receptors, Virus
  • alpha-Macroglobulins