Urine Biomarkers Predict Acute Kidney Injury in Newborns

Askenazi, David; Koralkar, Rajesh; Hundley, Hayden E.; Montesanti, Angela; Parwar, Pushkar; Sonjara, Srdjan; Ambalavanan, Namasivayam

doi:10.1016/j.jpeds.2012.02.007

Cited by 108 publications

(85 citation statements)

References 38 publications

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“…[132][133][134] Biomarkers including urine cystatin C, uromodulin, epithelial growth factor, neutrophil gelatinase-associated lipocalin, and osteopontin predict AKI in specific neonatal populations. 135,136 …”

Section: Acute Kidney Injurymentioning

confidence: 99%

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

2013

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Thanks to remarkable advances in neonatal intensive care, infants who once had little chance for survival can now enter adulthood. Yet the consequences of premature birth or low birth weight (LBW) on nephrogenesis, final nephron number, and long-term kidney function are unclear. This review focuses on the theory, experimental evidence, and observational data that suggest an increased risk of chronic kidney disease (CKD) for infants born prematurely. Many premature and LBW infants begin life with an incomplete complement of immature nephrons. They are then exposed to a variety of external stressors that can hinder ongoing kidney development or cause additional nephron loss such as hemodynamic alterations, nephrotoxic medications, infections, and suboptimal nutrition. Acute kidney injury, in particular, may be a significant risk factor for the development of CKD. According to Brenner' s hypothesis, patients with decreased nephron number develop hyperfiltration that results in sodium retention, hypertension, nephron loss, and CKD due to secondary focal segmental glomerulosclerosis. Because the risk of CKD in premature and LBW infants has not been accurately determined, there are no evidence-based recommendations for screening or management. Yet with the first generation of infants from the surfactant era only now reaching adulthood, it is possible that there is already an unrecognized epidemic of CKD. We suggest individualized, risk-based assessments of premature and LBW infants due to the increased risk of CKD and call for additional research into the long-term risk for CKD these infants face.

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Section: Acute Kidney Injurymentioning

confidence: 99%

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

2013

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“…Although we believe that the AKI definition used here is the best definition of AKI currently available for asphyxiated infants receiving therapeutic hypothermia, the AKI-staging criteria may yet be imprecise with substantial severity overlap (especially between stages 2 and 3) and may poorly stratify outcomes. Future studies using novel biomarkers of kidney function that have been shown to be more precise in the neonatal period may allow for more precise definitions of AKI (18). Limitations of the descriptions of the MRI categories may also be another reason for the lack of correlation between AKI and the MRI findings.…”

Section: Kidney Injury Brain Mri and Coolingmentioning

confidence: 99%

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

et al. 2013

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Background:We hypothesized that acute kidney injury (AKI) in asphyxiated neonates treated with therapeutic hypothermia would be associated with hypoxic-ischemic lesions on brain magnetic resonance imaging (MRI). Methods: Medical records of 88 cooled neonates who had had brain MRI were reviewed. All neonates had serum creatinine assessed before the start of cooling; at 24, 48, and 72 h through cooling; and then on day 5 or 7 of life. A neonatal modification of the Kidney Disease: Improving Global Outcomes guidelines was used to classify AKI. MRI images were evaluated by a neuroradiologist masked to outcomes. Outcome of interest was abnormal brain MRI at 7-10 d of life. results: AKI was found in 34 (39%) of 88 neonates, with 15, 7, and 12 fulfilling criteria for stages 1, 2, and 3, respectively. Brain MRI abnormalities related to hypoxia-ischemia were present in 50 (59%) newborns. Abnormal MRI was more frequent in infants from the AKI group (AKI: 25 of 34, 73% vs. no AKI: 25 of 54, 46%; P = 0.012; odds ratio (OR) = 3.2; 95% confidence interval (CI) = 1.3-8.2). Multivariate analysis identified AKI (OR = 2.9; 95% CI = 1.1-7.6) to be independently associated with the primary outcome. conclusion: AKI is independently associated with the presence of hypoxic-ischemic lesions on postcooling brain MRI.

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“…The value of NGAL in pediatric field of medicine was most assessed in kidney injury states. Askenazi in 2 nested case-control studies on very low birth weight and normal weight neonates found that urinary level of NGAL was higher in neonates with acute kidney injury compared with normal ones (17)(18).Recently, a few investigations were performed to evaluate such levels in obstructive hydronephrotic children. Mia Gebauer Madsen et al, in a study on children suffered from ureteropelvic junction obstruction, evaluated NGAL levels in preoperative, perioperative, and postoperative periods and found a significant increased of NGAL in the perioperative urine compared to healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Urinary neutrophil-gelatinase associated lipocalin is a more prognostic biomarker to distinguish antenatal hydronephrosis in neonates

et al. 2013

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Background: Routine diagnostic methods of Vesicoureteral reflux (VUR) are invasive and can cause exposure to radiation and may increase risk of urinary tract infections. Therefore, introducing reliable, non invasive methods might be more interested in pediatric nephrology. The objective of this perospective case control study was to evaluate the prognostic value of urinary neutrophilgelatinase associated lipocalin (uNGAL) on antenatal hydronephrosis (AH) with and without VUR. Materials and Methods: A total of 50 patients diagnosed with AH; 78% males with mean age 5.71± 2.1 years, including 27 AH with VUR and 23 AH without VUR, and 19 normal healthy children; 78.9% males with mean age 5.63 ± 1.89 years, were enrolled in this study. Urinary NGAL levels were measured by enzyme linked immunosorbent assay (ELISA). Results: There was a significant difference in uNGAL concentration between AH patients and controls (0.80 ± 0.26 and 0.29 ± 0.27 ng/ml, p<0.0001). However, the levels of uNGAL was not significantly deviated between AH patients with VUR compared to those without VUR (0.84 ± 0.34 vs. 0.75 ± 0.13, p=0.419). Standardization of NGAL based on urinary creatinine (uNGAL/uCr) showed a significantly difference between AH neonates with VUR compared to those without VUR (2.43±1.61 vs. 1.91±0.79, p<0.0001). Receiver operator characteristic (ROC) analysis revealed higher prognostic power of uNGAL for identifying AH with a sensitivity; 95.7%, and specificity; 84.2%. Meanwhile, the levels of uNGAL or NGAL/uCr ratio did not correlate with reflux grade or laterality. Conclusions:The urinary level of NGAL and NGAL/Cr ratio might be a surrogate non invasive, reliable tool to distinguish hydronephrosis.

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Urine Biomarkers Predict Acute Kidney Injury in Newborns

Cited by 108 publications

References 38 publications

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

Urinary neutrophil-gelatinase associated lipocalin is a more prognostic biomarker to distinguish antenatal hydronephrosis in neonates

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