Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery
Journal Title: Paediatrica Indonesiana - Year 2016, Vol 56, Issue 4
Abstract
Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.
Authors and Affiliations
Meta Hanindita, Riskky Prasetyo, Ninik Soemyarso, I Ketut Utamayasa, Paul Tahalele
Keywords
Related Articles
- EP ID EP446140
- DOI 10.14238/pi56.4.2016.230-7
- Views 64
- Downloads 0
Left ventricular mass in male adolescent athletes and non-athletes
Background Systematic exercise leads to increased left ventricular mass, which may be misleading in a differential diagnosis of heart disease in athletes (physiologic hypertrophy versus pathologic hypertrophy). T he caus...
Impact of malnutrition on febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy
Background Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents. Febrile Neutropenia (FN) is a medical emergency on ALL that often leads to death. Nutrition status assessment on AL...
The accuracy of a clinical parameters-based scoring system to predict spontaneous intracranial hemorrhage in children under one year old
Background Previous studies show that most children aged less than 1 year had intracranial hemorrhage without any history of trauma. The sign and symptoms of spontaneous intracranial hemorrhage (SIH) in children varies....
Puberty onset in rural and urban children
Background Accelerated pubertal onset has been reported in recent years. Environmental factors are assumed to influence this condition.Objective To assess differences in pubertal onset between children in rural and urban...
Effect of intravenous gentamicin on urinary calcium excretion in newborns
Background Studies in newborns and animals have shown that gentamicin increases urinary calcium excretion. New recommendation for gentamicin in newborns is administered intravenously 36-48 hourly. Subsequent to this new...