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A pilot study of urinary fibroblast growth factor-2 and epithelial growth factor as potential biomarkers of acute kidney injury in critically ill children

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Abstract

Background

Acute kidney injury (AKI) increases the morbidity of critically ill children. Thus, it is necessary to identify better renal biomarkers to follow the outcome of these patients. This prospective case–control study explored the clinical value of a urinary biomarker profile comprised of neutrophil gelatinase lipocalin (uNGAL), fibroblast growth factor-2 (uFGF-2), and epidermal growth factor (uEGF) to follow these patients.

Methods

Urine samples were collected from 21 healthy children, and 39 critically ill children (mean age 7.5 years ± 6.97 SD) admitted to a pediatric intensive care unit with sepsis or requiring extra corporeal membrane oxygenation (ECMO). uNGAL, uFGF-2, and uEGF levels were measured using ELISA kits during the first 24 h of admission to PICU, at peak of illness, and upon resolution of the critical illness.

Results

On admission, the uNGAL and uFGF-2 levels were increased, and the uEGF levels were decreased, in critically ill children with AKI (n = 19) compared to those without AKI (n = 20), and healthy controls. A biomarker score using the combined cut-off values of uNGAL, uFGF-2, and uEGF (AUC = 0.90) showed the highest specificity to identify children with AKI, relative to each biomarker alone. uNGAL and uFGF-2 on admission showed high sensitivity and specificity to predict mortality (AUC = 0.82).

Conclusions

The biomarker profile comprised of uNGAL, uFGF-2, and uEGF increased the specificity to detect AKI in critically ill children, when compared to each biomarker used alone. uNGAL and uFGF-2 may also predict the risk of death. Further validation of these findings in a large sample size is warranted.

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Acknowledgments

This manuscript was supported by National Institutes of Health Grants R0-1 HL-102497, R0-1HL 55605, R0-1 DK 049419, and U54 HD071601.

Conflict of interest

The authors have no financial relationships or conflicts of interest relevant to this article to disclose.

Author information

Author notes

  1. Kitman Wai

    Present address: Division of Pediatric Critical Care, Pediatric Intensive Care, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA

  2. Ángel A. Soler-García

    Present address: Molecular Methods & Subtyping Branch, Division of Microbiology, Center for Safety & Applied Nutrition, US Food and Drug Administration, 5100 Paint Branch Parkway, College Park, MD, 20740, USA

  3. Parnell Mattison

    Present address: Tripler Army Medical Center, 1 Jarret White Road, Honolulu, HI, 96859, USA

Authors and Affiliations

  1. Division of Pediatric Critical Care, Children’s National Medical Center, Washington, DC, USA

    Kitman Wai

  2. Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, USA

    Ángel A. Soler-García, Sofia Perazzo & Patricio E. Ray

  3. Department of Pediatrics, Division of Nephrology, Children’s National Medical Center, Room 5543, 5th Floor, 111 Michigan Ave, NW, Washington, DC, 20010, USA

    Parnell Mattison & Patricio E. Ray

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  1. Kitman Wai
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  2. Ángel A. Soler-García
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Correspondence to Patricio E. Ray.

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Wai, K., Soler-García, Á.A., Perazzo, S. et al. A pilot study of urinary fibroblast growth factor-2 and epithelial growth factor as potential biomarkers of acute kidney injury in critically ill children. Pediatr Nephrol 28, 2189–2198 (2013). https://doi.org/10.1007/s00467-013-2543-3

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  • DOI: https://doi.org/10.1007/s00467-013-2543-3

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