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Pediatric Nephrology
Erschienen in: Pediatric Nephrology 11/2022

24.02.2022 | Original Article

Evaluation of acute kidney injury by urinary tissue inhibitor metalloproteinases-2 and insulin-like growth factor-binding protein 7 after pediatric cardiac surgery

verfasst von: Yue Tao, Fabienne Heskia, Mingjie Zhang, Rong Qin, Bin Kang, Luoquan Chen, Fei Wu, Jihong Huang, Karen Brengel-Pesce, Huiwen Chen, Xi Mo, Ji Liang, Wei Wang, Zhuoming Xu

Erschienen in: Pediatric Nephrology | Ausgabe 11/2022

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Abstract

Background

With adult patients, the measurement of [TIMP-2]*[IGFBP7] can predict the risk of moderate to severe AKI within 12 h of testing. In pediatrics, however, the performance of [TIMP-2]*[IGFBP7] as a predictor of AKI was less studied and yet to be widely utilized in clinical practice. This study was conducted to validate the utility of [TIMP-2]*[IGFBP7] as an earlier biomarker for AKI prediction in Chinese infants and small children.

Methods

We measured urinary [TIMP-2]*[IGFBP7] using NEPHROCHECK® at eight perioperative time points in 230 patients undergoing complex cardiac surgery and evaluated the performance of [TIMP-2]*[IGFBP7] for predicting severe AKI within 72 h of surgery.

Results

A total of 50 (22%) of 230 developed AKI stages 2–3 within 72 h after CPB initiation. In the AKI stage 2–3 patients, two patterns of serum creatinine (SCr) elevations were observed. The patients with only a transient increase in SCr within 24 h (< 24 h, early AKI 2–3) did not experience a worse outcome than patients in AKI stage 0–1. AKI stage 2–3 patients with SCr elevation after 24 h (24–72 h, late AKI 2–3), as well as AKI dialysis patients (together designated severe AKI), did experience worse outcomes. Compared to AKI stages 0–1, significant elevations of [TIMP-2]*[IGFBP7] values were observed in severe AKI patients at hours T2, T4, T12, and T24 following CPB initiation. The AUC for predicting severe AKI with [TIMP-2]*[IGFBP7] at T2 (AUC = 0.76) and maximum T2/T24 (AUC = 0.80) are higher than other time points. The addition of the NEPHROCHECK® test to the postoperative parameters improved the risk assessment of severe AKI.

Conclusions

Multiple AKI phenotypes (early versus late AKI) were identified after pediatric complex cardiac surgery according to SCr-based AKI definition. Urinary [TIMP-2]*[IGFBP7] predicts late severe AKI (but not early AKI) as early as 2 h following CPB initiation.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information
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Metadaten
Titel
Evaluation of acute kidney injury by urinary tissue inhibitor metalloproteinases-2 and insulin-like growth factor-binding protein 7 after pediatric cardiac surgery
verfasst von
Yue Tao
Fabienne Heskia
Mingjie Zhang
Rong Qin
Bin Kang
Luoquan Chen
Fei Wu
Jihong Huang
Karen Brengel-Pesce
Huiwen Chen
Xi Mo
Ji Liang
Wei Wang
Zhuoming Xu
Publikationsdatum
24.02.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 11/2022
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-022-05477-6

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