Some Biomarkers of Acute Kidney Injury Are Increased in Pre-Renal Acute Injury

Kidney Int. 2012 Jun;81(12):1254-62. doi: 10.1038/ki.2012.23. Epub 2012 Mar 14.

Abstract

Pre-renal acute kidney injury (AKI) is assumed to represent a physiological response to underperfusion. Its diagnosis is retrospective after a transient rise in plasma creatinine, usually associated with evidence of altered tubular transport, particularly that of sodium. In order to test whether pre-renal AKI is reversible because injury is less severe than that of sustained AKI, we measured urinary biomarkers of injury (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), γ-glutamyl transpeptidase, IL-18, and kidney injury molecule-1 (KIM-1)) at 0, 12, and 24 h following ICU admission. A total of 529 patients were stratified into groups having no AKI, AKI with recovery by 24 h, recovery by 48 h, or the composite of AKI greater than 48 h or dialysis. Pre-renal AKI was identified in 61 patients as acute injury with recovery within 48 h and a fractional sodium excretion <1%. Biomarker concentrations significantly and progressively increased with the duration of AKI. After restricting the AKI recovery within the 48 h cohort to pre-renal AKI, this increase remained significant. The median concentration of KIM-1, cystatin C, and IL-18 were significantly greater in pre-renal AKI compared with no-AKI, while NGAL and γ-glutamyl transpeptidase concentrations were not significant. The median concentration of at least one biomarker was increased in all but three patients with pre-renal AKI. Thus, the reason why some but not all biomarkers were increased requires further study. The results suggest that pre-renal AKI represents a milder form of injury.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Acute Kidney Injury / blood
  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / therapy
  • Acute Kidney Injury / urine
  • Acute-Phase Proteins / urine
  • Adult
  • Aged
  • Analysis of Variance
  • Biomarkers / blood
  • Biomarkers / urine
  • Chi-Square Distribution
  • Creatinine / blood
  • Critical Illness
  • Cystatin C / urine
  • Disease Progression
  • Female
  • Hepatitis A Virus Cellular Receptor 1
  • Humans
  • Interleukin-18 / urine
  • Least-Squares Analysis
  • Lipocalin-2
  • Lipocalins / urine
  • Male
  • Membrane Glycoproteins / urine
  • Middle Aged
  • New Zealand
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Proto-Oncogene Proteins / urine
  • Receptors, Virus
  • Renal Replacement Therapy
  • Time Factors
  • Up-Regulation
  • gamma-Glutamyltransferase / urine

Substances

  • Acute-Phase Proteins
  • Biomarkers
  • CST3 protein, human
  • 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
  • Creatinine
  • gamma-Glutamyltransferase