A novel urinary biomarker profile to identify acute kidney injury (AKI) in critically ill neonates: a pilot study

Pediatr Nephrol. 2013 Nov;28(11):2179-88. doi: 10.1007/s00467-013-2524-6. Epub 2013 Jun 20.

Abstract

Background: The goal of this study was to assess the value of a urinary biomarker profile comprised of neutrophil gelatinase-associated lipocalin (NGAL), fibroblast growth factor-2 (FGF-2), and epidermal growth factor (EGF), to detect acute kidney injury (AKI) in critically ill neonates.

Methods: We conducted a prospective cohort pilot study of at-risk neonates treated in a level IIIC neonatal intensive care unit (NICU) with therapeutic hypothermia (HT) (n = 25) or extracorporeal membrane oxygenation (ECMO) (n = 10). Urine was collected at baseline, 48 h of illness, and > 24 h post-recovery of their corresponding treatments. Control samples were collected from 27 healthy newborns. The data were expressed as urinary concentrations and values normalized for urinary creatinine. AKI was defined as the presence of oliguria >24 h and/or elevated serum creatinine (SCr), or the failure to improve the estimated creatinine clearance (eCCL) by >50% post-recovery. Non-parametric statistical tests and ROC analyses were used to interpret the data.

Results: Fifteen at-risk newborns had AKI. In the first 48 h of illness, the urinary levels of NGAL and FGF-2 had high sensitivity but poor specificity to identify neonates with AKI. At recovery, low urinary EGF levels identified neonates with AKI with a sensitivity of 74% and specificity of 84%. Overall, in the early stages of a critical illness, the urinary levels of NGAL and FGF-2 were sensitive, but not specific, to identify neonates at risk of AKI. Low EGF levels post-recovery identified critically ill neonates with AKI.

Conclusions: These findings require validation in larger prospective studies.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Kidney Injury / therapy
  • Acute Kidney Injury / urine*
  • Acute-Phase Proteins / urine
  • Biomarkers / urine*
  • Blood Urea Nitrogen
  • Creatinine / blood
  • Critical Care
  • Critical Illness
  • Epidermal Growth Factor / urine
  • Extracorporeal Membrane Oxygenation
  • Female
  • Fibroblast Growth Factor 2 / urine
  • Humans
  • Hypothermia, Induced
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Lipocalin-2
  • Lipocalins / urine
  • Male
  • Pilot Projects
  • Prospective Studies
  • Proto-Oncogene Proteins / urine
  • ROC Curve
  • Water-Electrolyte Balance / physiology

Substances

  • Acute-Phase Proteins
  • Biomarkers
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Proto-Oncogene Proteins
  • Fibroblast Growth Factor 2
  • Epidermal Growth Factor
  • Creatinine