Biomarkers for Early Acute Kidney Injury Diagnosis and Severity Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the ICU

Palermo, Jennifer; Dart, Allison; Mello, Alanna De; Devarajan, Prasad; Gottesman, Ronald; Guerra, Gonzalo Garcia; Hansen, Gregory; Joffe, Ari R.; Mammen, Cherry; Majesic, Nick; Morgan, Catherine; Skippen, Peter; Pizzi, Michael; Palijan, Ana; Zappitelli, Michael

doi:10.1097/pcc.0000000000001183

Cited by 13 publications

(4 citation statements)

References 32 publications

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“…Biomarkers have been explored as a way to detect kidney injury earlier than rising serum creatinine and to predict hospital outcomes in both adult and pediatric settings (33)(34)(35)(36)(37). These biomarkers are also being explored as possible markers of CKD and its progression (38).…”

Section: Cardiac Surgery Populationmentioning

confidence: 99%

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

et al. 2021

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Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is an important risk factor for increased morbidity and mortality during hospitalization. Over the past decade, accumulated data on children and young people indicates that acute episodes of kidney dysfunction can have lasting consequences on multiple organ systems and health outcomes. To date, there are no guidelines for follow-up of surviving children that may be at risk of long-term sequelae following AKI in the PICU. This narrative review aims to describe literature from the last 5 years on the risk of medium and long-term kidney and non-kidney outcomes after AKI in the PICU. More specifically, we will focus on outcomes in children and young people following AKI in the general PICU population and children undergoing cardiac surgery. These outcomes include mortality, hypertension, proteinuria, chronic kidney disease, and healthcare utilization. We also aim to highlight current gaps in knowledge in medium and long-term outcomes in this pediatric population. We suggest a framework for future research to develop evidence-based guidelines for follow-up of children surviving an episode of critical illness and AKI.

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Section: Cardiac Surgery Populationmentioning

confidence: 99%

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

et al. 2021

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“…Many authors investigating AKI causes have noticed that in 50–80% of the cases, the cause of AKI is not a renal disease, but other disease (so-called secondary AKI), and such AKI develops as a consequence of the main disease [2,5,9]. Comparison of PICU-treated children who developed AKI with those who did not develop AKI revealed no significant difference in the distribution of patients by diagnosis between the groups [23]. Our study also showed that in all cases (100%), the cause of AKI was not a renal disease and there was no significant association between diagnosis and AKI development.…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, the study by McCaffrey et al reported that uNGAL level directly correlated with AKI [1]. However, there are studies reporting no significant difference in the NGAL comparing patients who developed AKI and did not develop AKI [23]. This confirms the necessity to continue more studies on uNGAL of children admitted in PICU.…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis and Prognostic Value of Acute Kidney Injury in Critically Ill Patients

et al. 2019

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Background and objectives: In hospitalized children, acute kidney injury (AKI) remains to be a frequent and serious condition, associated with increased patient mortality and morbidity. Identifying early biomarkers of AKI and patient groups at the risk of developing AKI is of crucial importance in current clinical practice. Specific human protein urinary neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin 18 (uIL-18) levels have been reported to peak specifically at the early stages of AKI before a rise in serum creatinine (sCr). Therefore, the aim of our study was to determine changes in uNGAL and uIL-18 levels among critically ill children and to identify the patient groups at the highest risk of developing AKI. Materials and methods: This single-center prospective observational study included 107 critically ill children aged from 1 month to 18 years, who were treated in the Pediatric Intensive Care Unit (PICU) of Lithuanian University of Health Sciences Hospital Kauno Klinikos from 1 December 2013, to 30 November 2016. The patients were divided into two groups: those who did not develop AKI (Group 1) and those who developed AKI (Group 2). Results: A total of 68 (63.6%) boys and 39 (36.4%) girls were enrolled in the study. The mean age of the patients was 101.30 ± 75.90 months. The mean length of stay in PICU and hospital was 7.91 ± 11.07 and 31.29 ± 39.09 days, respectively. A total of 32 (29.9%) children developed AKI. Of them, 29 (90.6%) cases of AKI were documented within the first three days from admission to hospital. In all cases, AKI was caused by diseases of non-renal origin. There was a significant association between the uNGAL level and AKI between Groups 1 and 2 both on day 1 (p = 0.04) and day 3 (p = 0.018). Differences in uNGAL normalized to creatinine in the urine (uCr) (uNGAL/uCr) between the groups on days 1 and 3 were also statistically significant (p = 0.007 and p = 0.015, respectively). uNGAL was found to be a good prognostic marker. No significant associations between uIL-18 or Uil-18/uCr and development of AKI were found. However, the uIL-18 level of >69.24 pg/mL during the first 24 h was associated with an eightfold greater risk of AKI progression (OR = 8.33, 95% CI = 1.39–49.87, p = 0.023). The AUC for uIL-18 was 73.4% with a sensitivity of 62.59% and a specificity of 83.3%. Age of <20 months, Pediatric Index of Mortality 2 (PIM2) score of >2.5% on admission to the PICU, multiple organ dysfunction syndrome with dysfunction of three and more organ systems, PICU length of stay more than three days, and length of mechanical ventilation of >five days were associated with a greater risk of developing AKI. Conclusions: Significant risk factors for AKI were age of <20 months, PIM2 score of >2.5% on admission to the PICU, multiple organ dysfunction syndrome with dysfunction of 3 and more organ systems, PICU length of stay of more than three days, and length of mechanical ventilation of > five days. uNGAL was identified as a good prognostic marker of AKI. On admission to PICU, uNGAL should be measured within the first three days in patients at the risk of developing AKI. The uIL-18 level on the first day was found to be as a biomarker predicting the progression of AKI.

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“…Patients were recruited from the respective cohorts of two older studies, from which the first compared cystatin C with serum creatinine in critically ill children [ 49 ]. The second trial was also performed in pediatric ICU patients; it aimed to compare certain biomarkers for early AKI diagnosis and grading [ 50 ]. The initial urine samples were collected within a maximum of three days after ICU admission; afterwards, samples were stored daily until days 5 or 14.…”

Section: Acute Kidney Injurymentioning

confidence: 99%

Metabolomics in Acute Kidney Injury: The Clinical Perspective

Patschan

Matyukhin

et al. 2023

JCM

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Background: Acute kidney injury (AKI) affects increasing numbers of hospitalized patients worldwide. The diagnosis of AKI is made too late in most individuals since it is still based on dynamic changes in serum creatinine. In recent years, new AKI biomarkers have been identified; however, none of these can reliably replace serum creatinine yet. Metabolomic profiling (metabolomics) allows the concomitant detection and quantification of large numbers of metabolites from biological specimens. The current article aims to summarize clinical studies on metabolomics in AKI diagnosis and risk prediction. Methods: The following databases were searched for references: PubMed, Web of Science, Cochrane Library, and Scopus, and the period lasted from 1940 until 2022. The following terms were utilized: ‘AKI’ OR ‘Acute Kidney Injury’ OR ‘Acute Renal Failure’ AND ‘metabolomics’ OR ‘metabolic profiling’ OR ‘omics’ AND ‘risk’ OR ‘death’ OR ‘survival’ OR ‘dialysis’ OR ‘KRT’ OR ‘kidney replacement therapy’ OR ‘RRT’ OR ‘renal replacement therapy’ OR ‘recovery of kidney function’ OR ‘renal recovery’ OR ‘kidney recovery’ OR ‘outcome’. Studies on AKI risk prediction were only selected if metabolomic profiling allowed differentiation between subjects that fulfilled a risk category (death or KRT or recovery of kidney function) and those who did not. Experimental (animal-based) studies were not included. Results: In total, eight studies were identified. Six studies were related to the diagnosis of AKI; two studies were performed on metabolic analysis in AKI risk (death) prediction. Metabolomics studies in AKI already helped to identify new biomarkers for AKI diagnosis. The data on metabolomics for AKI risk prediction (death, KRT, recovery of kidney function), however, are very limited. Conclusions: Both the heterogenous etiology and the high degree of pathogenetic complexity of AKI most likely require integrated approaches such as metabolomics and/or additional types of ‘-omics’ studies to improve clinical outcomes in AKI.

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Biomarkers for Early Acute Kidney Injury Diagnosis and Severity Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the ICU

Cited by 13 publications

References 32 publications

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Early Diagnosis and Prognostic Value of Acute Kidney Injury in Critically Ill Patients

Metabolomics in Acute Kidney Injury: The Clinical Perspective

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