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Predictive ability of urinary biomarkers for outcome in children with acute kidney injury

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Abstract

Background

Urinary neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-beta-D-glucosaminidase (NAG), and interleukin 18 (IL-18) were found to be useful for early detection of acute kidney injury (AKI). The objective of this study was to determine the predictive ability of biomarkers for mortality and variation in levels in relation to different stages of AKI, need for dialysis, etiologies, and with duration of hospital stay.

Methods

Urinary NGAL, NAG, and IL-18 levels were measured in 50 children with AKI and 30 age- and gender-matched healthy controls. AKI was classified as per pediatric Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria.

Results

Median NGAL, NAG, and IL-18 values were significantly increased in AKI patients compared with controls (p < 0.001), with significant increase among risk, injury, and failure stages. Nonsurvivors had significantly higher median levels of NGAL (p = 0.008) and NAG (p = 0.018) than survivors. NGAL had highest area under the curve (AUC) at 0.750 [confidence interval (CI) 0.580–0.920], followed by NAG at 0.724 (CI 0.541–0.907), with sensitivity and specificity of 75 % each; and IL-18 (AUC 0.688, CI 0.511–0.864), with sensitivity 62.5 % and specificity 70.8 %, for predicting mortality. Values were significantly higher in patients who required peritoneal dialysis (PD) than in those in whom it was not indicated. Levels were comparable among different etiologies. Only NGAL level was found to be a significant risk factor associated with longer duration of hospital stay.

Conclusions

Urinary NGAL and NAG had modest predictive ability for mortality. Children requiring dialysis had significantly raised levels, and the NGAL level had significant association with duration of hospital stay.

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Abbreviations

AKI:

Acute kidney injury

IL-18:

Interleukin 18

NAG:

N-acetyl-beta-D-glucosaminidase

NAGL:

Neutrophil gelatinase-associated lipocalin

PD:

Peritoneal dialysis

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Author’s contributions

OPM, AKR, and AA were involved in the study design, conduction, data analysis, and manuscript drafting; RP and RNM helped in data analysis and manuscript drafting; PS and KP performed estimation of urinary biomarkers; FS helped conceptualize the study and provide critical revision of the manuscript.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Om P. Mishra, Avinash K. Rai, Abhishek Abhinay & Rajniti Prasad

  2. Division of Biostatistics, Department of Community Medicine, Institute of Medical Sciences,Banaras Hindu University, Varanasi, 221005, India

    Rabindra N Mishra

  3. Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221005, India

    Khushaboo Pandey

  4. School of Biochemical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, 221005, India

    Pradeep Srivastava

  5. Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, 69120, Heidelberg, Germany

    Franz Schaefer

Authors
  1. Om P. Mishra
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  2. Avinash K. Rai
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  3. Pradeep Srivastava
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  4. Khushaboo Pandey
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  5. Abhishek Abhinay
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  7. Rabindra N Mishra
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  8. Franz Schaefer
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Corresponding author

Correspondence to Om P. Mishra.

Ethics declarations

The study protocol was approved by the institute's Ethical Committee, and informed consent was taken from each parent.

Funding

The study was supported by the Institutional Grant of School of Biochemical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi and University Grants Commission (Dr. D. S. Kothari Post Doctoral Fellowship- F 4-2/2006 (BSR)/13-679/2012 (BSR), New Delhi, India.

Competing interest

None

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Mishra, O.P., Rai, A.K., Srivastava, P. et al. Predictive ability of urinary biomarkers for outcome in children with acute kidney injury. Pediatr Nephrol 32, 521–527 (2017). https://doi.org/10.1007/s00467-016-3445-y

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  • DOI: https://doi.org/10.1007/s00467-016-3445-y

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