Postoperative Neutrophil Gelatinase–Associated Lipocalin Predicts Acute Kidney Injury After Pediatric Cardiac Surgery*

Romero, Andrés J. Alcaraz; Gil-Ruiz, Maite Augusta; Castillo, Ana Isabel Corchado; López, Jorge; Romero, Carlos Posadas; Fernández, Sarah N.; Carrillo, Ángel

doi:10.1097/pcc.0000000000000034

Cited by 29 publications

(24 citation statements)

References 41 publications

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“…It is important to distinguish these novel AKI biomarkers from functional biomarkers such as serum creatinine and cystatin C. Novel biomarkers classically include those that detect damage; some of these include urine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin 18 (IL-18), liver fatty acid binding protein, and others [26]. These have been extensively studied in children undergoing congenital heart surgery and cardiopulmonary bypass [27][28][29]. In these studies, the biomarkers rose between 2 and 12 h after cardiopulmonary bypass and successfully predicted AKI, as defined by rise in serum creatinine, at 48 h following surgery [27].…”

Section: Advances In Novel Biomarkers: Moving Beyond Serum Creatininementioning

confidence: 99%

Diagnosis and Treatment of Acute Kidney Injury in Pediatrics

Rhone

Harer

Charlton

et al. 2016

Curr Treat Options Peds

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Acute kidney injury I Pediatric I Continuous renal replacement therapy I Biomarker I Renal angina Opinion statement The term acute kidney injury (AKI) has replaced the outdated term acute renal failure throughout the literature and clinical practice. The term Binjury^highlights the spectrum of organ injury that may occur and reflects the fact that even small changes in serum creatinine (rise of 0.3 mg/dL) can be associated with adverse outcomes. A major advance in the field of AKI research has been the development of standardized staged definitions of AKI that allow for comparison of incidence, prevalence, and outcomes across studies. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition represents the most recent consensus definition which is currently recommended for use in pediatric populations. Utilization of standard AKI definitions has made it clear that AKI occurs often in hospitalized patients and is associated with adverse short-term and long-term outcomes (hospital length of stay, mortality, subsequent chronic kidney disease). Awareness of the impact of AKI has resulted in increased efforts to understand, diagnose, prevent, and manage AKI earlier in the course of illness. While attempts at finding a treatment for AKI have been unsuccessful, largely due to the lack of sensitivity of the primary biomarker, serum creatinine, there have been many major advances in this field over the last 15 years. The development of novel biomarkers to predict the development of AKI in a timely manner and improve diagnostic accuracy is being pioneered by pediatric AKI researchers. The development of risk stratification scores (renal angina) and functional bedside tests (furosemide stress test) is enhancing our use of these biomarkers and our ability to predict those patients most likely to develop severe AKI. The recognition of the impact of fluid overload on mortality and hospital length of stay in patients with severe AKI has prompted more timely and frequent use of renal replacement therapy in critically ill children. Finally, we are recognizing that children who suffer AKI are at long-term risk for the development of chronic kidney disease and warrant follow-up.

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Section: Advances In Novel Biomarkers: Moving Beyond Serum Creatininementioning

confidence: 99%

Diagnosis and Treatment of Acute Kidney Injury in Pediatrics

Rhone

Harer

Charlton

et al. 2016

Curr Treat Options Peds

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“…Most of the paediatric cardiac surgery-associated acute kidney injury reports note much longer cardiopulmonary bypass times and higher average neutrophil gelatinase-associated lipocalin values in patients developing acute kidney injury compared with ours. [27][28][29][30]33,34 Prolonged surgery with cardiopulmonary bypass times comparatively longer than those in our study may accentuate these processes leading to acute kidney injury. Our study was unique in that patients in the acute kidney injury and non-acute kidney injury group showed equal median cardiopulmonary bypass times.…”

Section: Cpbmentioning

confidence: 61%

“…24,29 Adding urinary neutrophil gelatinase-associated lipocalin to these models increased the area under the curve value by a small extent. 25,30 For example, in one study the area under the curve of 0.85 for prediction of acute kidney injury by the clinical model was increased to 0.91 by adding urinary neutrophil gelatinase-associated lipocalin. 30 Further, in our study, the kinetics of urinary and plasma neutrophil gelatinase-associated lipocalin values differed with plasma neutrophil gelatinaseassociated lipocalin values showing a later peak.…”

Section: Cpbmentioning

confidence: 99%

“…25,30 For example, in one study the area under the curve of 0.85 for prediction of acute kidney injury by the clinical model was increased to 0.91 by adding urinary neutrophil gelatinase-associated lipocalin. 30 Further, in our study, the kinetics of urinary and plasma neutrophil gelatinase-associated lipocalin values differed with plasma neutrophil gelatinaseassociated lipocalin values showing a later peak. Therefore, urinary and plasma neutrophil gelatinaseassociated lipocalin may reflect different pathological processes.…”

Section: Cpbmentioning

confidence: 99%

See 1 more Smart Citation

Neutrophil gelatinase-associated lipocalin reflects inflammation and is not a reliable renal biomarker in neonates and infants after cardiopulmonary bypass: a prospective case–control study

Reiter

Balling²,

Bonelli

et al. 2017

Cardiol Young

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Our results suggest that plasma and urinary neutrophil gelatinase-associated lipocalin values are not reliable indicators of impending acute kidney injury in neonates and infants after cardiac surgery with cardiopulmonary bypass. Inflammation may have a major impact on plasma neutrophil gelatinase-associated lipocalin values in infant cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin may add little prognostic value over cardiopulmonary bypass time.

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“…Many studies have supported the hypothesis that duration bears a negative impact on postoperative renal function. 2,[5][6][7]18,19,20,22,23 Sethi et al reported that duration of CPB >90 minutes could cause AKI in adults. 24 Similarly, Zheng et al reported that AKI was significantly more common in patients with duration of CPB >90 minutes.…”

Section: Discussionmentioning

confidence: 99%