ESPN 50th Annual Meeting

ESPN 2017


 
Urinary Biomarkers of Acute Kidney Injury in Very Low Birth Weight Infants on Indomethacin for Patent Ductus Arteriosus
FICHTNER ALEXANDER 1 WALDHERR SINA 2 BEEDGEN BERND 2 WESTHOFF TIMM H. 3 SCHAEFER FRANZ 1 TÖNSHOFF BURKHARD 1 Pöschl Johannes 2 Westhoff Jens H. 1

1- DEPARTMENT OF PEDIATRICS I, UNIVERSITY CHILDREN’S HOSPITAL, HEIDELBERG, GERMANY
2- DEPARTMENT OF NEONATOLOGY, UNIVERSITY CHILDREN’S HOSPITAL, HEIDELBERG, GERMANY
3- MEDICAL DEPARTMENT I, MARIEN HOSPITAL HERNE, UNIVERSITY HOSPITAL OF THE RUHR-UNIVERSITY OF BOCHUM, GERMANY
 
Introduction:

Indomethacin for closure of a patent ductus arteriosus (PDA) adversely affects renal function in preterm neonates. A serum creatinine (SCr)- or urine output-based diagnosis of acute kidney injury (AKI) as defined by neonatal Kidney Disease Improving Global Outcomes (KDIGO) criteria is methodologically uncertain. We therefore aimed to determine the diagnostic value of novel urinary biomarkers of AKI.

Material and methods:

We performed a prospective cohort study in 32 very low birth weight (VLBW) neonates including 14 neonates treated with indomethacin (five doses of 0.2 mg/kg body weight) for PDA on day 2-3 of life and 18 neonates without PDA as control. Urinary neutrophil-gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), calprotectin and the product of tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) were measured before, during (at 6, 12 and 36 hours) and after (at 84 and 120 hours and at day 7, 14 and 28) indomethacin administration.

Results:

Indomethacin therapy was associated with higher SCr concentrations at 36, 84 and 120 hours compared to controls and with AKI in three (21%) patients. [TIMP-2]•[IGFBP7] was elevated (P<0.05) in the AKI subgroup already at 12 h, in the indomethacin cohort at 36 and 84 h. NGAL and calprotectin were increased (P<0.05) at 6 and 12 h, irrespective of fulfillment of AKI criteria. Urinary KIM-1 was not significantly altered.

Conclusions:

While urinary [TIMP-2]•[IGFBP7] proves valuable for the early detection of neonatal KDIGO defined AKI, elevated urinary biomarkers in indomethacin-treated neonates not fulfilling AKI criteria may indicate subclinical kidney injury.