ESPN 50th Annual Meeting

ESPN 2017


 
Urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C measurements for early diagnosis of acute kidney injury in children
Jameela Kari 1 Mohamed Shalaby 1 Kholoud Sofyani 2 Sara Sharief 1 Khalid A alhassan 3 Osama Safder 1

1- PAEDIATRIC NEPHROLOGY CENTER OF EXCELLENCE , DEPARTMENT OF PEDIATRICS, KING ABDULAZIZ UNIVERSITY, JEDDAH, KINGDOM OF SAUDI ARABIA
2- PAEDIATRIC INTENSIVE CARE UNIT, DEPARTMENT OF PEDIATRICS, KING ABDULAZIZ UNIVERSITY, JEDDAH, KINGDOM OF SAUDI ARABIA,
3- Pediatrics Department, King Saud University, Riyadh, Kingdom of Saudi Arabia
 
Introduction:

Acute kidney injury (AKI) is common in critically ill children with significant mortality and morbidity. Serum creatinine is insensitive and late biomarker compared to newly proposed AKI biomarkers.

Material and methods:

Prospective study in pediatric intensive care unit (PICU) over three months to compare between serum cystatin-C(Cys-C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) as AKI biomarkers at multiple time points with pRIFLE classification in diagnosing AKI.

Results:

Forty children were recruited. Twenty two of them developed AKI according to pRIFLE criteria. There was difference between AKI and non-AKI in age; mean ± SD 38.1 ± 39.5 vs55.5 ±58.0 (p value 0.29). Post cardiac surgery renal insult was the main cause of AKI (27.3%). There was 2-fold increased risk of incident AKI in those patients with high baseline uNGAL at PICU admission and almost 4-fold increased risk in patients with high baseline cystatin-C at PICU admission. uNGAL levels were highly predictive of AKI during the follow-up period , Area Under the Curve(AUC 0.76, 95% CI: 0.61 – 0.92) The cutoff point with the highest correctly classified proportion was 223 ng/ml ( ≥ 12 centiles) which correctly predict 80.0% patients with AKI, with a corresponding sensitivity of 72.7% and a specificity of 89.9%. AUC for serum cystatin-C was 0.86 (95% CI: 0.75-0.97), and the highest correctly classified proportion was 1009 ugL (≥ 13 centiles); 75% of patients with AKI, with a corresponding sensitivity of 63.6% and a specificity of 88.9%

Conclusions:

uNGAL and serum cystatin-C predicts AKI early in critically ill children.