HDCN Abstract:  ASN Annual Meeting -- San Diego  

Koyner JL, Devarajan P, Vaidya VS, et al.

Comparison of Novel Early Biomarkers of Acute Kidney Injury (AKI) To Predict the Course and Severity of AKI Developing after Cardiac Surgery.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:360A 2009

To evaluate the utility of multiple novel urinary biomarkers of AKI (Neutrophil Gelatinase Associated Lipocalin (NGAL), Cystatin C (CyC), Kidney Injury Molecule-1 (KIM1), Hepatocyte Growth Factor (HGF), -Glutathione S-Transferase (GST) and -GST in the diagnostic and prognostic evaluation of AKI, we prospectively studied 115 adults undergoing cardiac surgery. Perioperatively blood and urine were sampled for fractional excretions of sodium and urea (FENa and FEUrea) and urine for CyC, NGAL, KIM1, HGF, and -GST. AKI (AKIN definitions) developed in 46 subjects (40.0%); of these 37 (32.2%) only developed Stage 1 AKI within 72 hours of the surgery. All remaining 9 AKI subjects progressed to Stage 3 AKI.

We performed Receiver Operator Characteristic Curves at the time of AKI diagnosis (creatinine elevation - Stage 1 AKI) for the progression to Stage 3; AUCs in Table. At the time of serum creatinine increase FEUrea and KIM1 are unable to predict the progression to more severe AKI and HGF and FENa are potentially useful. There was a difference between those who remained at Stage 1 compared to those who progressed to Stage 3 AKI for NGAL (median, 25-75%) ((46(12-133) vs. 571(250- 6273); p=0.03), CyC ((0.09(0.04-0.32) vs. 0.62(0.26-1.05); p=0.03), and -GST ((0.033(0.02-0.12) vs 0.92(0.17-13); p=0.003). NGAL, CyC and -GST are useful in the diagnostic and prognostic evaluation of AKI following adult cardiac surgery and can predict progression to severe AKI.

AUC (95%CI)P value
FEUrea(%)0.54(0.18- 0.90)NS
FENa(%)0.72(0.51- 0.92)0.09
CyC (mg/g)0.75(0.53- 0.96)0.03
NGAL (ng/mg)0.75(0.53- 0.97)0.03
KIM-1 (ng/mg)0.58(0.35 - 0.82)NS
HGF (ng/mg)0.75(0.51- 0.99)0.07
-GST (g/mg)0.63(0.35 - 0.91)NS
-GST (g/mg)0.87(0.74 - 0.99)0.003


© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
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