Urinary markers of acute kidney injury in newborns with perinatal asphyxia^*

Abstract

Background: Acute kidney injury (AKI) affects up to 60% of severely asphyxiated neonates. The diagnosis of AKI can be and is further challenged by a lack of good biomarkers. We studied the role of novel markers for AKI, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-18), Netrin-1 (NTN-1), and sodium hydrogen exchanger isoform 3 (NHE3) on development and early diagnosis of AKI in newborns with perinatal asphyxia (PA). Methods: Forty-one newborns with a diagnosis of PA (15 with AKI and 26 without AKI) and 20 healthy matched controls were involved to the study. Urinary samples were obtained on postnatal days 1 and 4 for patients with PA and on postnatal day 1 for the control subjects. AKI was defined using a serum creatininebased modification of the acute kidney injury network criteria. Results: The levels of NGAL, NTN-1, NHE3, and IL-18 on the first postnatal day urine samples were higher in patients compared to controls (p < 0.001, p <0.001, p <0.02, p <0.001, respectively). In patients with AKI, the levels of NGAL and IL-18 were higher when compared to patients without AKI (p ¼ 0.002, p <0.001, respectively). The levels of NTN-1 and NHE3 were similar in both groups. For the samples obtained on postnatal day 4, only NGAL levels were significantly higher in patients with AKI (p ¼ 0.004) compared to those without AKI. Conclusion: To our knowledge, this is the largest study, which evaluated the utility of urinary biomarkers in the diagnosis of AKI in newborns with PA. First day, urine NGAL and IL-18 levels have an important diagnostic power in such patients.

Can urinary biomarkers predict acute kidney injury in newborns with critical congenital heart disease?

“…In our study, NGAL levels were lower in the urine in the preoperative period and it increased significantly in the postoperative period. Oncel et al [19] reported elevated urinary NGAL levels in the first day among patients with perinatal asphyxia. In the study by Tanigasalam et al [20], of the 120 neonates exposed to perinatal asphyxia, 55 (46%) patients developed AKI.…”

Urinary netrin-1 concentration in healthy full-term newborns

“…The reference ranges for urinary netrin-1 in healthy adults and children have not been published in the literature to date. The only data concerning the normal values of urine netrin-1 concentrations come from control groups from studies conducted in patients with renal dysfunctions [12,13].…”

“…What is even more noteworthy is the fact that the urinary netrin-1 concentrations seem to be a marker of perinatal asphyxia [12]. Significantly, higher urinary concentrations of netrin-1 within 48 h after birth were found in neonates with acute renal injury than in the non-AKI group [13].…”

Urinary NGAL and KIM-1 Are the Early Detecting Biomarkers of Preterm Infants with Acute Kidney Injury

“…This study was performed on preterm infants below 32 weeks of gestation age. Oncel NY et al [24] studied 41 cases of newborn with a diagnosis of perinatal asphyxia and classified the cases into AKI and non-AKI groups. The AKI group included 15 newborns and Non-AKI group included 26 newborns.…”