Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
Pediatric Nephrology
Erschienen in:

08.08.2023 | Original Article

Urinary biomarkers associated with acute kidney injury in pediatric mechanical circulatory support patients

verfasst von: Rachel E. Harris, Andrew R. Yates, Deipanjan Nandi, Catherine D. Krawczeski, Brett Klamer, Gabriela Vasquez Martinez, Gabriel Mayoral Andrade, Brian F. Beckman, Jianli Bi, Diana Zepeda-Orozco

Erschienen in: Pediatric Nephrology | Ausgabe 2/2024

Einloggen, um Zugang zu erhalten

Abstract

Background

In patients requiring mechanical circulatory support (MCS), the incidence of acute kidney injury (AKI) is between 37 and 63%. In this study, we performed an exploratory analysis evaluating the relationship of multiple urine biomarkers with AKI development in pediatric MCS patients.

Methods

This is a single center retrospective study in a pediatric cohort receiving MCS from August 2014 to November 2020. We measured 14 urine biomarkers of kidney injury on day 1 following MCS initiation and analyzed their association with development of AKI in the first 7 days of MCS initiation.

Results

Sixty patients met inclusion criteria. Patients with AKI were more likely to be supported by venoarterial extracorporeal membrane oxygenation (65% vs. 8.3%, p < 0.001), compared to the no AKI group and less likely to have ventricular assist devices (10% vs. 50%, p < 0.001). There was a significant increase in the median urine albumin and urine osteoactivin in the AKI group, compared to the no AKI group (p = 0.020 and p = 0.018, respectively). When normalized to urine creatinine (UCr), an increased log osteoactivin/UCr was associated with higher odds of AKI development (OR: 2.05; 95% CI: 1.07, 4.44; p = 0.028), and higher log epidermal growth factor (EGF)/UCr (OR: 0.41; 95% CI: 0.15, 0.96) was associated with decreased odds of AKI.

Conclusions

Early increase in urine osteoactivin is associated with AKI development within 7 days of MCS initiation in pediatric patients. Contrary, an increased urine EGF is associated with kidney protection.

Graphical Abstract

Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, Goldstein SL (2015) AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 10:554–561PubMedPubMedCentral
2.
Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20PubMed
3.
Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S (2013) Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr 162:725-729.e1PubMed
4.
Carmody JB, Swanson JR, Rhone ET, Charlton JR (2014) Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol 9:2036–2043PubMedPubMedCentral
5.
Zappitelli M, Moffett BS, Hyder A, Goldstein SL (2011) Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort study. Nephrol Dial Transplant 26:144–150PubMed
6.
Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, Chishti AS, Woroniecki R, Mammen C, Swanson JR, Sridhar S, Wong CS, Kupferman JC, Griffin RL, Askenazi DJ, NK Collaborative (NKC) (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194PubMedPubMedCentral
7.
Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, Phan V, Zappitelli M (2011) Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care 15:R146PubMedPubMedCentral
8.
Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D (2011) Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res 69:354–358PubMed
9.
Askenazi DJ, Griffin R, McGwin G, Carlo W, Ambalavanan N (2009) Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case-control analysis. Pediatr Nephrol 24:991–997PubMed
10.
Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N (2013) Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol 28:661–666PubMed
11.
Xu X, Nie S, Zhang A, Mao J, Liu HP, Xia H, Xu H, Liu Z, Feng S, Zhou W, Liu X, Yang Y, Tao Y, Feng Y, Chen C, Wang M, Zha Y, Feng JH, Li Q, Ge S, Chen J, He Y, Teng S, Hao C, Liu BC, Tang Y, He W, He P, Hou FF (2018) Acute kidney injury among hospitalized children in China. Clin J Am Soc Nephrol 13:1791–1800PubMedPubMedCentral
12.
Searns JB, Gist KM, Brinton JT, Pickett K, Todd J, Birkholz M, Soranno DE (2020) Impact of acute kidney injury and nephrotoxic exposure on hospital length of stay. Pediatr Nephrol 35:799–806PubMed
13.
Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, Bittleman D, Cruz D, Endre Z, Fitzgerald RL, Forni L, Kane-Gill SL, Hoste E, Koyner J, Liu KD, Macedo E, Mehta R, Murray P, Nadim M, Ostermann M, Palevsky PM, Pannu N, Rosner M, Wald R, Zarbock A, Ronco C, Kellum JA, Acute Disease Quality Initiative Workgroup 16 2 (2017) Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 13:241–257PubMed
14.
Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstadt H, Boanta A, Gerss J, Meersch M (2016) Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA 315:2190–2199PubMed
15.
Meersch M, Kullmar M, Schmidt C, Gerss J, Weinhage T, Margraf A, Ermert T, Kellum JA, Zarbock A (2018) Long-term clinical outcomes after early initiation of RRT in critically ill patients with AKI. J Am Soc Nephrol 29:1011–1019PubMed
16.
Goldstein SL, Dahale D, Kirkendall ES, Mottes T, Kaplan H, Muething S, Askenazi DJ, Henderson T, Dill L, Somers MJG, Kerr J, Gilarde J, Zaritsky J, Bica V, Brophy PD, Misurac J, Hackbarth R, Steinke J, Mooney J, Ogrin S, Chadha V, Warady B, Ogden R, Hoebing W, Symons J, Yonekawa K, Menon S, Abrams L, Sutherland S, Weng P, Zhang F, Walsh K (2020) A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children. Kidney Int 97:580–588PubMed
17.
Thongprayoon C, Cheungpasitporn W, Lertjitbanjong P, Aeddula NR, Bathini T, Watthanasuntorn K, Srivali N, Mao MA, Kashani K (2019) Incidence and impact of acute kidney injury in patients receiving extracorporeal membrane oxygenation: a meta-analysis. J Clin Med 8:981PubMedPubMedCentral
18.
Thongprayoon C, Lertjitbanjong P, Cheungpasitporn W, Hansrivijit P, Fulop T, Kovvuru K, Kanduri SR, Davis PW, Vallabhajosyula S, Bathini T, Watthanasuntorn K, Prasitlumkum N, Chokesuwattanaskul R, Ratanapo S, Mao MA, Kashani K (2020) Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a meta-analysis. Ren Fail 42:495–512PubMedPubMedCentral
19.
McCullough PA, Bouchard J, Waikar SS, Siew ED, Endre ZH, Goldstein SL, Koyner JL, Macedo E, Doi K, Di Somma S, Lewington A, Thadhani R, Chakravarthi R, Ice C, Okusa MD, Duranteau J, Doran P, Yang L, Jaber BL, Meehan S, Kellum JA, Haase M, Murray PT, Cruz D, Maisel A, Bagshaw SM, Chawla LS, Mehta RL, Shaw AD, Ronco C (2013) Implementation of novel biomarkers in the diagnosis, prognosis, and management of acute kidney injury: executive summary from the tenth consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:5–12PubMed
20.
Stanski N, Menon S, Goldstein SL, Basu RK (2019) Integration of urinary neutrophil gelatinase-associated lipocalin with serum creatinine delineates acute kidney injury phenotypes in critically ill children. J Crit Care 53:1–7PubMed
21.
Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P (2005) Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 365:1231–1238PubMed
22.
Devarajan P (2008) Neutrophil gelatinase-associated lipocalin–an emerging troponin for kidney injury. Nephrol Dial Transplant 23:3737–3743PubMedPubMedCentral
23.
Nickolas TL, O’Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, Buchen C, Khan F, Mori K, Giglio J, Devarajan P, Barasch J (2008) Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 148:810–819PubMedPubMedCentral
24.
Mostafa EA, Shahin KM, El Midany AAH, Hassaballa AS, El-Sokkary IN, Gamal MA, Elsaid ME, ElBarbary MG, Khorshid R, Elelwany SE (2022) Validation of cardiac surgery-associated neutrophil gelatinase-associated lipocalin score for prediction of cardiac surgery-associated acute kidney injury. Heart Lung Circ 31:272–277PubMed
25.
Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, Barasch J, Devarajan P (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 14:2534–2543PubMed
26.
Mori K, Lee HT, Rapoport D, Drexler IR, Foster K, Yang J, Schmidt-Ott KM, Chen X, Li JY, Weiss S, Mishra J, Cheema FH, Markowitz G, Suganami T, Sawai K, Mukoyama M, Kunis C, D’Agati V, Devarajan P, Barasch J (2005) Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest 115:610–621PubMedPubMedCentral
27.
Askenazi DJ, Koralkar R, Patil N, Halloran B, Ambalavanan N, Griffin R (2016) Acute kidney injury urine biomarkers in very low-birth-weight infants. Clin J Am Soc Nephrol 11:1527–1535PubMedPubMedCentral
28.
Wasung ME, Chawla LS, Madero M (2015) Biomarkers of renal function, which and when? Clin Chim Acta 438:350–357PubMed
29.
30.
Saeidi B, Koralkar R, Griffin RL, Halloran B, Ambalavanan N, Askenazi DJ (2015) Impact of gestational age, sex, and postnatal age on urine biomarkers in premature neonates. Pediatr Nephrol 30:2037–2044PubMedPubMedCentral
31.
Dobiliene D, Masalskiene J, Rudaitis S, Vitkauskiene A, Peciulyte J, Kevalas R (2019) Early diagnosis and prognostic value of acute kidney injury in critically ill patients. Medicina (Kaunas) 55:506PubMed
32.
Goldstein SL, Mottes T, Simpson K, Barclay C, Muething S, Haslam DB, Kirkendall ES (2016) A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury. Kidney Int 90:212–221PubMed
33.
Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, Kent AL (2015) Neonatal acute kidney injury. Pediatrics 136:e463–e473PubMed
34.
Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedPubMedCentral
35.
Hessey E, Ali R, Dorais M, Morissette G, Pizzi M, Rink N, Jouvet P, Lacroix J, Phan V, Zappitelli M (2017) Evaluation of height-dependent and height-independent methods of estimating baseline serum creatinine in critically ill children. Pediatr Nephrol 32:1953–1962PubMed
36.
Krawczeski CD, Goldstein SL, Woo JG, Wang Y, Piyaphanee N, Ma Q, Bennett M, Devarajan P (2011) Temporal relationship and predictive value of urinary acute kidney injury biomarkers after pediatric cardiopulmonary bypass. J Am Coll Cardiol 58:2301–2309PubMedPubMedCentral
37.
Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387PubMed
38.
Brisco MA, Testani JM, Cook JL (2016) Renal dysfunction and chronic mechanical circulatory support: from patient selection to long-term management and prognosis. Curr Opin Cardiol 31:277–286PubMedPubMedCentral
39.
Menez S, Ju W, Menon R, Moledina DG, Thiessen Philbrook H, McArthur E, Jia Y, Obeid W, Mansour SG, Koyner JL, Shlipak MG, Coca SG, Garg AX, Bomback AS, Kellum JA, Kretzler M, Parikh CR, Translational research investigating biomarker endpoints in AKI (TRIBE-AKI) Consortium and the Kidney Precision Medicine Project (2021) urinary EGF and MCP-1 and risk of CKD after cardiac surgery. JCI Insight 6:e147464PubMedPubMedCentral
40.
Worawichawong S, Worawichawong S, Radinahamed P, Muntham D, Sathirapongsasuti N, Nongnuch A, Assanatham M, Kitiyakara C (2016) Urine epidermal growth factor, monocyte chemoattractant protein-1 or their ratio as biomarkers for interstitial fibrosis and tubular atrophy in primary glomerulonephritis. Kidney Blood Press Res 41:997–1007PubMed
41.
Patel-Chamberlin M, Wang Y, Satirapoj B, Phillips LM, Nast CC, Dai T, Watkins RA, Wu X, Natarajan R, Leng A, Ulanday K, Hirschberg RR, Lapage J, Nam EJ, Haq T, Adler SG (2011) Hematopoietic growth factor inducible neurokinin-1 (Gpnmb/osteoactivin) is a biomarker of progressive renal injury across species. Kidney Int 79:1138–1148PubMed
42.
Zhou L, Zhuo H, Ouyang H, Liu Y, Yuan F, Sun L, Liu F, Liu H (2017) Glycoprotein non-metastatic melanoma protein b (Gpnmb) is highly expressed in macrophages of acute injured kidney and promotes M2 macrophages polarization. Cell Immunol 316:53–60PubMed
Metadaten
Titel
Urinary biomarkers associated with acute kidney injury in pediatric mechanical circulatory support patients
verfasst von
Rachel E. Harris
Andrew R. Yates
Deipanjan Nandi
Catherine D. Krawczeski
Brett Klamer
Gabriela Vasquez Martinez
Gabriel Mayoral Andrade
Brian F. Beckman
Jianli Bi
Diana Zepeda-Orozco
Publikationsdatum
08.08.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 2/2024
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-023-06089-4

Weitere Artikel der Ausgabe 2/2024

Ocular manifestations of congenital anomalies of the kidney and urinary tract (CAKUT)

  • Open Access
  • Review

Immune urinary biomarkers predict infant cardiac surgery-associated acute kidney injury

  • Original Article

Utility of kidney ultrasonography during initial evaluation of pediatric nephrotic syndrome

  • Brief Report

Fluid management in children with volume depletion

  • Educational Review

Hospital admissions associated with dehydration in childhood kidney transplantation

  • Open Access
  • Original Article

Ambulatory blood pressure monitoring in children and adolescents post-hematopoietic stem cell transplantation

  • Original Article

Neu im Fachgebiet Pädiatrie

Hohe Atrophierate nach Hodentorsion im Kindesalter

Auf längere Sicht ist die Atrophierate nach einer Hodentorsion pädiatrischer Patienten erschreckend hoch. Das hat eine Studie mit jahrelanger Nachbeobachtung ergeben. Entscheidend ist die Zeit, die bis zur Detorsion verstreicht.

Infektanfälligkeit in früher Kindheit: eine bleibende Last?

Wenn Kinder in den ersten Lebensjahren immer wieder Infekte durchmachen, lässt dies Schlüsse auf die Infektneigung in der weiteren Kindheit zu.

Adipositas als negativer Prognosefaktor bei Kindern mit Krebs

Eine kanadische Studie weist darauf hin, dass Übergewicht zum Zeitpunkt der Krebsdiagnose ein unabhängiger Risikofaktor für schlechtere Überlebenschancen bei erkrankten Kindern und Jugendlichen sein könnte. Allerdings sind nicht alle Patientinnen und Patienten gleichermaßen betroffen.


Vorsicht mit Glukokortikoiden bei Glomerulopathie

Auch niedrig dosierte Glukokortikoide zur Behandlung einer primären Glomerulopathie lassen offenbar die Infektionsgefahr steigen. In einer US-Studie hing das Risiko vor allem mit der kombinierten Anwendung von Immunsuppressiva zusammen.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise