Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery.
OBJECTIVE
Serum creatinine (Scr) does not allow for early diagnosis of acute kidney injury (AKI). The diagnostic utility of urinary kidney injury molecule-1 (KIM-1), N-acetyl-beta-D-glucosaminidase (NAG), and neutrophil gelatinase associated lipocalin (NGAL) was evaluated for the early detection of postoperative AKI in a prospective study of 90 adults undergoing cardiac surgery. Designs, setting, participants, & measurements: Urinary KIM-1, NAG, and NGAL were measured at 5 time points for the first 24 h after operation and normalized to the urinary creatinine concentration after cardiac surgery. Receiver-operating characteristic curves were generated and the areas under the curve (AUCs) compared for performance of biomarkers in detection of postoperative AKI.


RESULTS
Thirty-six patients developed AKI, defined as an increase in Scr of > or =0.3 mg/dl within 72 h after surgery. The AUCs for KIM-1 to predict AKI immediately and 3 h after operation were 0.68 and 0.65; 0.61 and 0.63 for NAG; and 0.59 and 0.65 for NGAL, respectively. Combining the three biomarkers enhanced the sensitivity of early detection of postoperative AKI compared with individual biomarkers: the AUCs for the three biomarkers combined were 0.75 and 0.78. The performance of combining biomarkers was even better among 16 early postoperative AKI patients with AUCs of 0.80 and 0.84, respectively.


CONCLUSIONS
The results of this study support that a combination of urinary biomarkers may allow for early detection of postoperative AKI after cardiac surgery before a rise in Scr.
Han
Won K
WK
Thomas Jefferson University Hospital, Department of Medicine, Jefferson Medical School, Philadelphia, Pennsylvania 19107, USA. won.han@jefferson.edu
Wagener
Gebhard
G
Zhu
Yanqing
Y
Wang
Shuang
S
Lee
H Thomas
HT
D000118:Acetylglucosaminidase / Q000652:urine; D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D000581:Amidohydrolases / Q000097:blood; D015415:Biomarkers / Q000652:urine*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015925:Cryopreservation; D042241:Early Diagnosis; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000652:urine*; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve; D011991:Receptors, Virus
D000209:Acute-Phase Proteins; D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; D000118:Acetylglucosaminidase; D000581:Amidohydrolases; C019946:creatininase