Kidney injury molecule type-1, interleukin-18, and insulin-like growth factor binding protein 7 levels in urine to predict acute kidney injury in pediatric sepsis

Abstract

BackgroundThis study aimed to observe the role of urinary kidney injury molecule (KIM-1), interleukin (IL-18), and insulin-like growth factor-binding protein 7 (IGFBP-7) levels in predicting acute kidney injury (AKI) in children with sepsis.Material and MethodsThis prospective cohort observational study was conducted at Dr. RSUP. Wahidin Sudirohusodo, Makassar, South Sulawesi, from January to December 2021. Inclusion criteria were septic patients treated in the pediatric intensive care unit (PICU) aged 1 month to 18 years with normal serum creatinine or normal urine output (>5 ml/kg/body weight (BW)/h in 6–12 h). Patients with a history of kidney disease, prior urinary tract infection, or history of using nephrotoxic drugs were excluded.ResultsThere was a significant difference in urinary KIM-1, IL-18, and IGFBP-7 levels between septic patients with and without AKI. The cut-off point for urinary KIM-1 level in sepsis with and without AKI was 1.666 ng/ml, with sensitivity of 82.5%, specificity of 82.2%, and a relative risk (RR) [95% confidence interval (CI)] of 6.866 (95% CI, 3.329–14.165). The cut-off point for urinary IL-18 levels was 3.868 ng/ml, with sensitivity of 92.50%, specificity of 91.78%, and RR of 20.078 (95%CI, 6.593–61.142). The cut-off point for urinary IGFBP-7 levels was ≥0.906 ng/ml with a sensitivity of 75.00%, specificity of 75.34%, and RR of 4.063 (95% CI, 2.206–7.483).ConclusionUrinary KIM-1, IL-8, and IGFBP-7 levels could be used to predict AKI in septic patients. Urinary IL-8 has a higher sensitivity and specificity as a predictor of AKI in patients with sepsis.

Review of the limitations of current biomarkers in acute kidney injury clinical practices

“…Therefore, it is still challenging to introduce these AKI biomarkers into the medical practice. However, some biomarkers, such as NGAL can predict AKI in patients needed for renal replacement therapy, 60 IL-18 in patients with sepsis, 61 and L-FABP in patients with sepsis and open heart surgery. 62 These data suggest that the specificity of the biomarkers for predicting AKI differs with the different clinical situations.…”

Elevated Serum KIM-1 in Sepsis Correlates with Kidney Dysfunction and the Severity of Multi-Organ Critical Illness

“…While urinary KIM-1 has been characterised thoroughly in acute and chronic kidney injury [ 14 , 25 , 36 ], there are limited data on serum KIM-1 in these or other settings [ 35 , 37 , 42 , 43 , 44 ]. Given its implication as a non-myeloid scavenger receptor, facilitating semi-professional phagocytic reactions, investigating KIM-1 in sepsis and other critical illness may reduce the knowledge gap in SA-AKI and critical illness.…”

“…Another study in paediatric patients reported that urine levels of KIM-1 can predict AKI in septic children [ 43 ].…”