Pediatric Nephrology

, 23:1317 | Cite as

Urinary aprotinin as a predictor of acute kidney injury after cardiac surgery in children receiving aprotinin therapy

  • Mai T. Nguyen
  • Catherine L. Dent
  • Gary F. Ross
  • Nathan Harris
  • Peter B. Manning
  • Mark M. Mitsnefes
  • Prasad Devarajan
Original Article


Proteomic analysis has revealed potential early biomarkers of acute kidney injury (AKI) in children undergoing cardiopulmonary bypass (CPB), the most prominent one with a mass-to-charge ratio of 6.4 kDa. The objective of this study was to identify this protein and test its utility as a biomarker of AKI. Trypsin-digested protein bands were analyzed by tandem mass spectrometry (MS/MS) to identify the protein in urine samples. Surface-enhanced laser desorption/ionization time-of-flight analysis and a functional activity assay were performed to quantify urinary levels in a pilot study of 106 pediatric patients undergoing CPB. The protein was identified as aprotinin. Urinary aprotinin levels 2 h after initiation of CPB were predictive of AKI (for functional assay: 92% sensitivity, 96% specificity, area under the curve of 0.98). By multivariate analysis, the urinary aprotinin level 2 h after CPB was an independent predictor of AKI (β = 0.001, P < 0.0001). The 2 h urinary aprotinin level correlated with serum creatinine, duration of AKI, and length of hospital stay. We concluded that urinary aprotinin levels 2 h after initiation of CPB predict the development of AKI and adverse clinical outcomes.


Acute renal failure Acute kidney injury Biomarker Cardiac surgery Aprotinin 


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Copyright information

© IPNA 2008

Authors and Affiliations

  • Mai T. Nguyen
    • 1
  • Catherine L. Dent
    • 2
  • Gary F. Ross
    • 3
  • Nathan Harris
    • 4
  • Peter B. Manning
    • 5
  • Mark M. Mitsnefes
    • 1
  • Prasad Devarajan
    • 1
    • 6
  1. 1.Department of Pediatrics, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Department of Pediatrics, Division of Cardiology, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Bio-Rad LaboratoriesHerculesUSA
  4. 4.Ciphergen BiosystemsFremontUSA
  5. 5.Department of Surgery, Division of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  6. 6.MLC 7022CincinnatiUSA

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