›› 2014, Vol. 32 ›› Issue (6): 517-523.

• Original Article • Previous Articles     Next Articles

Combination of urine neutrophil gelatinase lipocalin associated lipocalin, kidney injury molecular-1 and interleukin-18 in the diagnosis of acute kidney injury in children after cardiopulmonary bypass

LIU Huajie1, WANG Ping1, SHEN Yunlin1, LI Xiaobing2, ZHANG Rufang2, SUN Lei1, KUANG Xinyu1, HUANG Wenyan1   

  1. (1. Department of Nephrology and Rheumatology, 2. Department of Cardiac Surgery, Children's Hospital of Shanghai Jiaotong University, Shanghai 200040, China)
  • Received:2014-04-04 Online:2014-06-15 Published:2014-06-15

Abstract:  Objective To investigate the values of urine neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecular-1 (KIM-1) and interleukin-18 (IL-18) in the diagnosis of acute kidney injury (AKI) in children after cardiopulmonary bypass (CPB). Methods Sixty-seven patients who had undergone CPB were recruited from March to June 2013 and assigned to acute kidney injury group (AKI group) or non-acute kidney injury group (non-AKI group) according to the pediatric RIFLE (pRIFLE) criteria. Serum and urine samples were collected from each patient at 30 min, 2 h, 4 h, 24 h, 48 h and 72 h after CPB for serum and urine creatinine, urine NGAL, KIM-1 and IL-18. All the data were evaluated by receiver operator characteristic curve (ROC) analysis and area under curve (AUC) analysis. Results Twenty-three cases (34.3%) had AKI in 67 children after CPB. Among them 15 cases were risk-stage AKI, 4 cases injury-stage AKI, 3 cases failure-stage AKI and 1 cases loss-stage AKI. The levels of urine NGAL/Ucr were higher in AKI group than those in non-AKI group at 4h, 48h and 72h after CPB (P<0.05). The cut-off value of NGAL/Ucr was 1.200 at 4 h after CPB, the sensitivity and specificity for prediction of AKI were 0.864 and 0.561, and the AUC was 0.671 (95%CI: 0.537-0.804). The levels of urine KIM-1/Ucr were higher in AKI group than those in non-AKI group at 48h and 72 h after CPB (P<0.05). The cut-off value of KIM-1/Ucr was 1.162 at 24h after CPB, the sensitivity and specificity for prediction of AKI were 0.773 and 0.512, and the AUC was 0.698 (95%CI: 0.563-0.834). The levels of IL-18/Ucr were higher in AKI group than those in non-AKI group at 4 h after CPB (P<0.05). The cut-off value of IL-18/Ucr was 0.04 at 4 h after CPB, the sensitivity and specificity for prediciton of AKI were 0.773 and 0.561, and the AUC was 0.655 (95%CI: 0.510-0.800). Conclusions It is indicated that urine NGAL, KIM-1 and IL-18 may have important clinical values for early prediction of AKI.