Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

Zeid, Ali Mohammed Abu; Mohammed, Doaa; AbdAlazeem, Amal Saeed; Seddeeq, Anas Saad Elsayed mohammed; Elnaany, Ashraf Mohamed

doi:10.29328/journal.jcn.1001032

Cited by 8 publications

(6 citation statements)

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“…Unlike us, other authors [ 4 , 9 , 16 ] have demonstrated that the association of increased uNGAL + RAI ≥ 8 significantly increases the prediction for subsequent AKI. Individual uNGAL demonstrated marginal discrimination for severe AKI (AUC = 0.877, little higher than the prediction by RAI (AUC = 0.847), but the incorporation of uNGAL to the RAI significantly increased the AKI prediction (AUC = 0.847, increased to 0.893) [ 4 ]. Other authors also did not find an increased AKI prediction of such combination [ 19 ].…”

Section: Discussioncontrasting

confidence: 54%

“…The RAI score was calculated on day 1 of PICU admission. We recorded the RAI index in both ways: as a continuous variable from 1 to 40 as well as a categorical variable (dichotomous); a RAI score of ≥8 was considered as a positive index [ 4 ] We were looking for associations of uNGAL values from day 1 with CrCl from day 1 and from day 3 as well as the RAI score with the day 1 CrCl, and multiple regression RAI + NGAL as the independent and CrCl as the dependent variable.…”

Section: Methodsmentioning

confidence: 99%

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uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children

et al. 2022

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Acute kidney injury (AKI) occurs frequently in critically ill children, having an incidence of up to 26.9% and is associated with high morbidity and mortality in pediatric intensive care units (PICU). Currently, the decrease in the glomerular filtration rate is calculated using the serum creatinine levels. Nevertheless, there may be a 48 h delay between the renal injury and measurable increase in creatinine. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been validated in relation to cardiopulmonary bypass in children, being able to detect AKI before the functional change proven by the rise in serum creatinine. Our aim was to study the utility of using uNGAL in the management of critical pediatric patients admitted to our hospital in a six month period, more specifically, its capacity to predict AKI development, alone and in the association with the renal angina index (RAI). Twenty-eight critically ill children aged from 1 day to 15 years have been included. We found that an increase in uNGAL in day 1 of admission in the PICU was significantly correlated with a decrease in creatinine clearance but not anymore in day 3. However, in our sample uNGAL did not show a significant predictability for AKI development nor the supplementary incorporation of RAI into the prediction model. Therefore, apart from cardiac surgery, the efficacy and utility or uNGAL in the management of critically ill children is still questionable. For the best prediction, we will need to incorporate not only the RAI or other PICU scores, but other biomarkers such as KIM-1, urinary cystatin, and IL 18 in larger samples.

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Section: Discussioncontrasting

confidence: 54%

Section: Methodsmentioning

confidence: 99%

uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children

et al. 2022

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“…We present an experimental approach that utilizes biomarkers to enable early and sensitive detection of AKI resulting from HIE. Urinary NGAL has been established as an early responding biomarker of AKI, not only in rats following early ischemic AKI and in mice from cisplatin toxicity (Mishra et al, 2003(Mishra et al, , 2004, but also in both adult and pediatric patients after cardiac surgery (Mishra et al, 2005;Wagener et al, 2006), and in critically ill children with heterogeneous illness (Zeid et al, 2019). In both preclinical experiments and in clinical studies of pediatric cohorts, NGAL elevation preceded rises in other early responding markers (Mishra et al, 2003), and this is in line with our observations showing significant increases in NGAL as early as 1 day following injury, the earliest time point assayed in this study.…”

Section: Discussionmentioning

confidence: 99%

Neonatal hypoxic ischemic encephalopathy increases acute kidney injury urinary biomarkers in a rat model

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Johnston

Beutner

et al. 2022

Physiological Reports

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“…It has been reported that the incorporation of other indicators of kidney injury can further increase the predictive power of RAI. Fluid overload [ 18 ], urinary neutrophil gelatinase-associated lipocalin [ 19 ] and urinary L-type fatty acid-binding protein [ 20 ] combined with RAI have been shown to optimize AKI prediction in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

et al. 2020

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Background: Acute kidney injury (AKI) is independently related to the adverse outcome of septic shock, but it lacks effective early predictors. Renal anginal index (RAI) was used to predict subsequent severe AKI (AKIs) in critically ill patients. The application of RAI in children with septic shock has not been reported. This study aims to evaluate the efficacy of early RAI in predicting subsequent AKIs within 3 days after PICU admission in children with septic shock by comparing with early fluid overload (FO) and early creatinine elevation. Methods: Sixty-six children admitted to PICU aged 1 month to 16 years old, with septic shock from January 2016 to December 2019 were analyzed retrospectively. According to the 2012 Kidney Disease Improving Global outcomes (KDIGO) criteria, AKIs was defined by the KDIGO stage ≥2 within 3 days after PICU admission. Early RAI positive (RAI+) was defined as RAI ≥ 8 within 12 h of PICU admission. Any elevation of serum creatinine (SCr) over baseline within 12 h after PICU admission was denoted as "Early SCr > base". Early FO positive (FO+) was defined as FO > 10% within 24 h of PICU admission. Results: Of 66 eligible cases, the ratio of early RAI+, early SCr > base, early FO+ was 57.57, 59.09 and 16.67% respectively. The incidence of AKIs in early RAI+ group (78.94%) was higher than that in early RAI-group (21.42%) (p = 0.04), and there was no significant difference compared with the early FO+ group (71.79%) and early SCr > base group (81.82%) (P > 0.05). After adjustment for confounders, early RAI+ was independently associated with the occurrence of AKIs within 3 days (OR 10.04, 95%CI 2.39-42.21, p < 0.01). The value of early RAI+ (AUC = 0.78) to identify patients at high risk of AKIs was superior to that of early SCr > base (AUC = 0.70) and early FO+ (AUC = 0.58). A combination of serum lactate with early RAI+ improved the predictive performance for assessing AKIs (AUC = 0.83). Conclusions: Early RAI could be used as a more convenient and effective index to predict the risk of AKIs in children with septic shock within 3 days. Early RAI+ combined with serum lactate improved the predictive performance for assessing AKIs.

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Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

Cited by 8 publications

References 10 publications

uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children

uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children

Neonatal hypoxic ischemic encephalopathy increases acute kidney injury urinary biomarkers in a rat model

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

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