Urinary N-acetyl-beta-(D)-glucosaminidase activity and kidney injury molecule-1 level are associated with adverse outcomes in acute renal failure.
The role of urinary biomarkers of kidney injury in the prediction of adverse clinical outcomes in acute renal failure (ARF) has not been well described. The relationship between urinary N-acetyl-beta-(D)-glucosaminidase activity (NAG) and kidney injury molecule-1 (KIM-1) level and adverse clinical outcomes was evaluated prospectively in a cohort of 201 hospitalized patients with ARF. NAG was measured by spectrophotometry, and KIM-1 was measured by a microsphere-based Luminex technology. Mean Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score was 16, 43% had sepsis, 39% required dialysis, and hospital mortality was 24%. Urinary NAG and KIM-1 increased in tandem with APACHE II and Multiple Organ Failure scores. Compared with patients in the lowest quartile of NAG, the second, third, and fourth quartile groups had 3.0-fold (95% confidence interval [CI] 1.3 to 7.2), 3.7-fold (95% CI 1.6 to 8.8), and 9.1-fold (95% CI 3.7 to 22.7) higher odds, respectively, for dialysis requirement or hospital death (P < 0.001). This association persisted after adjustment for APACHE II, Multiple Organ Failure score, or the combined covariates cirrhosis, sepsis, oliguria, and mechanical ventilation. Compared with patients in the lowest quartile of KIM-1, the second, third, and fourth quartile groups had 1.4-fold (95% CI 0.6 to 3.0), 1.4-fold (95% CI 0.6 to 3.0), and 3.2-fold (95% CI 1.4 to 7.4) higher odds, respectively, for dialysis requirement or hospital death (P = 0.034). NAG or KIM-1 in combination with the covariates cirrhosis, sepsis, oliguria, and mechanical ventilation yielded an area under the receiver operator characteristic curve of 0.78 (95% CI 0.71 to 0.84) in predicting the composite outcome. Urinary markers of kidney injury such as NAG and KIM-1 can predict adverse clinical outcomes in patients with ARF.
Liangos
Orfeas
O
Division of Nephrology, Caritas St. Elizabeth's Medical Center, 736 Cambridge Street, Boston, MA 02135, USA.
Perianayagam
Mary C
MC
Vaidya
Vishal S
VS
Han
Won K
WK
Wald
Ron
R
Tighiouart
Hocine
H
MacKinnon
Robert W
RW
Li
Lijun
L
Balakrishnan
Vaidyanathapuram S
VS
Pereira
Brian J G
BJ
Bonventre
Joseph V
JV
Jaber
Bertrand L
BL
D018806:APACHE; D000118:Acetylglucosaminidase / Q000652:urine*; D058186:Acute Kidney Injury / Q000150:complications / Q000652:urine*; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D009846:Oliguria / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D011991:Receptors, Virus; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018805:Sepsis / Q000209:etiology*
D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D008562:Membrane Glycoproteins; D011991:Receptors, Virus; D000118:Acetylglucosaminidase