Urinary NGAL, IGFBP-7, and TIMP-2: novel biomarkers to predict contrast medium-induced acute kidney injury in children

The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.

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“…A more prudent method would be to test novel biomarkers such NGAL, IGFBP-7, and TIMP-2 to predict and detect CI-AKI earlier ( 70 ).…”

Section: Risk Stratification and Predictionmentioning

confidence: 99%

Contrast-induced acute kidney injury and its contemporary prevention

Sůva¹,

Kala²,

Poloczek³

et al. 2022

Front. Cardiovasc. Med.

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“…[ 33 ] Additionally, multicenter studies have indicated that TIMP-2 and IGFBP7 outperform other existing markers in predicting AKI. [ 34 , 35 ] However, the predictive effect of this marker was not as robust in the literature, highlighting the significant variation in etiology and pathophysiology of AKI among different populations and the need for further studies. [ 36 – 38 ]…”

Section: Discussionmentioning

confidence: 99%

Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis

Lan,

Liu,

Yang

et al. 2023

Medicine

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Background: The timely identification of patients at risk of acute kidney injury (AKI), along with early prevention, real-time monitoring, and prompt intervention, plays a crucial role in enhancing patient prognosis after major surgery. Methods: We conducted a comprehensive search across multiple databases, including Web of Science, EMBASE, MEDLINE, China National Knowledge Infrastructure, and Cochrane Library. Each study’s risk of bias was independently evaluated as low, moderate, or high, utilizing criteria adapted from Quality Assessment of Diagnostic Accuracy Studies 2. The analysis was performed using STATA V.17.0 and R software V.3.4.1. Diagnostic tests were ranked based on the dominance index. We performed meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. We then carried out a network meta-analysis to compare the performances of these biomarkers. Results: Fifteen studies were included in this analysis. The meta-analysis findings revealed that among all the biomarkers assessed, serum cystatin C (s-CysC) (hierarchical summary receiver operating characteristic curve [HSROC] 82%, 95% CI 0.78–0.85) exhibited the highest HSROC value. The network meta-analysis demonstrated that urinary kidney injury molecule-1 (u-KIM-1) and s-CysC displayed relatively higher sensitivity and specificity, respectively. In subgroup analyses, u-KIM-1 in the urine output (OU) group (OR 303.75, 95% CI 3.39–1844.88), s-CysC in the non-OU group (OR 10.31, 95% CI 3.09–26.2), interleukin-18 in the noncardiac surgery group (OR 46.20, 95% CI 0.48–307.68), s-CysC in the cardiac group (OR 12.42, 95% CI 2.9–35.86), u-KIM-1 in the retrospective group (OR 243.00, 95% CI 1.73–1582.11), and s-CysC in the prospective group (OR 8.35, 95% CI 2.34–21.15) had the best diagnostic accuracy. However, it is important to note that existing publication bias may reduce the reliability of the above-mentioned results. Conclusion: The biomarker of s-CysC has the highest HSROC value to predicting acute kidney injury after major surgery in meta-analysis and relatively higher specificity in network meta-analyses. u-KIM-1 exhibited relatively higher sensitivity, with best diagnostic accuracy in the OU and retrospective group in the subgroup analysis.

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“…In the CI-AKI group, urinary levels of NGAL, IGFBP-7, TIMP-2 and [IGFBP-7]*[TIMP-2] were significantly increased 2 h after angiography and remained at high levels at 6 h. This increase was faster than SCr. When both urinary IGFBP-7 and TIMP-2 were used together the specificity was better than either marker alone and this combination has a good clinical value for the early diagnosis of CI-AKI in children and it could be extrapolated to the adult population [ 110 ].…”

Section: Novel Biomarkers: the Necessity For A Precise Ci-aki Diagnosismentioning

confidence: 99%

Biomarkers in Contrast-Induced Acute Kidney Injury: Towards A New Perspective

González-Nicolás,

González-Guerrero,

Goicoechea

et al. 2024

IJMS

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Contrast-Induced Acute Kidney Injury (CI-AKI) remains a frequent iatrogenic condition since radiological procedures using intra-vascular iodinated contrast media (CM) are being widely administered for diagnostic and therapeutic purposes. Despite the improvement of the medical healthcare system worldwide, CI-AKI is still associated with direct short-term and indirect long-term outcomes including increased morbidity and mortality, especially in patients with underlying pre-existing renal function impairment, cardiovascular disease, or diabetes that could rapidly progress into Chronic Kidney Disease. Although the RIFLE (Risk, Injury, Failure, Loss, End-Stage Kidney Disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease Improving Global Outcomes) clinical criteria and recommendation guidelines are based on traditional “gold standard” biomarkers known as serum creatinine, glomerular filtration rate, and urinary output, new reliable serum and urinary biomarkers are still needed for an effective unified diagnostic strategy for AKI. Starting from previous and recent publications on the benefits and limitations of validated biomarkers responding to kidney injury, glomerular filtration, and inflammation among others, this review unravels the role of new emerging biomarkers used alone or in combination as reliable tools for early diagnosis and prognosis of CI-AKI, taking into account patients and procedures-risk factors towards a new clinical perspective.

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Urinary NGAL, IGFBP-7, and TIMP-2: novel biomarkers to predict contrast medium-induced acute kidney injury in children

Cited by 9 publications

References 20 publications

Contrast-induced acute kidney injury and its contemporary prevention

Contrast-induced acute kidney injury and its contemporary prevention

Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis

Biomarkers in Contrast-Induced Acute Kidney Injury: Towards A New Perspective

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