title: Urinary liver-type fatty acid-binding protein level as a predictive biomarker of contrast-induced acute kidney injury.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) is a well-known complication of contrast medium exposure in patients with chronic kidney disease. However, there are no biological markers to accurately predict the onset of CI-AKI. Liver-type fatty acid-binding protein (L-FABP), an intracellular carrier protein for free fatty acids, is markedly upregulated and abundantly expressed in the proximal tubules after renal ischaemia. We prospectively investigated whether urinary L-FABP is a suitable marker for the prediction of CI-AKI.
  
  
  METHODS
  We performed a prospective study of 220 consecutive patients with chronic kidney disease who underwent elective catheterization [serum creatinine (Cr) ≥ 1.2 mg/dL (106 M)]. Serum Cr and L-FABP levels were measured immediately before and 1 and 2 days after the procedure. CI-AKI was defined as an increase in serum Cr level of ≥ 0.3 mg/dL within 48 h after the procedure.
  
  
  RESULTS
  We observed the development of CI-AKI in 19 patients (8.6%). Urinary L-FABP levels were significantly higher in patients with CI-AKI than those without CI-AKI before contrast medium exposure. Receiver operating characteristic analysis showed that baseline urinary L-FABP level exhibited 82% sensitivity and 69% specificity, at a cut-off value of 24.5 μg/g Cr. Using multivariate analysis, we found that independent predictors of CI-AKI development were L-FABP level of ≥ 24.5 μg/g Cr [odds ratio (OR): 9.10; 95% confidence interval (CI), 3.20-28.9], and left ventricular ejection fraction ≤ 40% (OR, 3.42; 95% CI, 1.07-10.8).
  
  
  CONCLUSIONS
  Urinary L-FABP level is useful for predicting the onset of CI-AKI before contrast medium exposure.
authors: Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata Hospital, Hirakata, Japan. manabek@hirakata.kmu.ac.jp
authors: Kenichi
authors: K
authors: Manabe
authors: Hiroshi
authors: H
authors: Kamihata
authors: Masayuki
authors: M
authors: Motohiro
authors: Takeshi
authors: T
authors: Senoo
authors: Susumu
authors: S
authors: Yoshida
authors: Toshiji
authors: T
authors: Iwasaka
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000652:urine*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000652:urine*; D007687:Kidney Tubules, Proximal; D008297:Male; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D050556:Fatty Acid-Binding Proteins