Towards a biomarker panel for the assessment of AKI in children receiving intensive care

Pediatr Nephrol. 2015 Oct;30(10):1861-71. doi: 10.1007/s00467-015-3089-3. Epub 2015 Apr 15.


Background: Critically ill children and neonates are at high risk of developing acute kidney injury (AKI). AKI is associated with short- and long-term renal impairment and increased mortality. Current methods of diagnosing AKI rely on measurements of serum creatinine, which is a late and insensitive marker. Few studies to date have assessed AKI biomarkers in a heterogeneous patient cohort.

Methods: We conducted a prospective feasibility study in a paediatric intensive care setting over a 6-month period to describe the relationship between AKI (defined according to pRIFLE criteria) and new AKI biomarkers.

Results: In total, 49 patients between the ages of 16 days and 15 years were recruited for measurement of plasma cystatin C (Cys-C) and neutrophil gelatinase-associated lipocalin (pNGAL) concentrations, as well as for urinary kidney injury molecule-1 (KIM-1) and urinary NGAL (uNGAL) concentrations. Almost one-half (49 %) of the patient cohort experienced an AKI episode, and Cys-C and pNGAL were the strongest candidates for the detection of AKI. Our data suggest that the widely used estimated baseline creatinine clearance value of 120 mL/min/1.73 m(2) underestimates actual baseline function in patients admitted to paediatric intensive care units.

Conclusions: This investigation demonstrates the feasibility of new AKI biomarker testing in a mixed patient cohort and provides novel biomarker profiling for further evaluation.

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / metabolism*
  • Acute-Phase Proteins
  • Adolescent
  • Biomarkers / blood
  • Biomarkers / urine
  • Child
  • Child, Preschool
  • Cystatin C / blood*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Hepatitis A Virus Cellular Receptor 1
  • Humans
  • Immunoassay
  • Incidence
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric*
  • Lipocalin-2
  • Lipocalins / blood*
  • Male
  • Membrane Glycoproteins / urine*
  • Prognosis
  • Prospective Studies
  • Proto-Oncogene Proteins / blood*
  • Receptors, Virus
  • Survival Rate / trends
  • United Kingdom / epidemiology


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