title: A novel urinary biomarker profile to identify acute kidney injury (AKI) in critically ill neonates: a pilot study.
abstract: BACKGROUND
  The goal of this study was to assess the value of a urinary biomarker profile comprised of neutrophil gelatinase-associated lipocalin (NGAL), fibroblast growth factor-2 (FGF-2), and epidermal growth factor (EGF), to detect acute kidney injury (AKI) in critically ill neonates.
  
  
  METHODS
  We conducted a prospective cohort pilot study of at-risk neonates treated in a level IIIC neonatal intensive care unit (NICU) with therapeutic hypothermia (HT) (n = 25) or extracorporeal membrane oxygenation (ECMO) (n = 10). Urine was collected at baseline, 48 h of illness, and > 24 h post-recovery of their corresponding treatments. Control samples were collected from 27 healthy newborns. The data were expressed as urinary concentrations and values normalized for urinary creatinine. AKI was defined as the presence of oliguria >24 h and/or elevated serum creatinine (SCr), or the failure to improve the estimated creatinine clearance (eCCL) by >50% post-recovery. Non-parametric statistical tests and ROC analyses were used to interpret the data.
  
  
  RESULTS
  Fifteen at-risk newborns had AKI. In the first 48 h of illness, the urinary levels of NGAL and FGF-2 had high sensitivity but poor specificity to identify neonates with AKI. At recovery, low urinary EGF levels identified neonates with AKI with a sensitivity of 74% and specificity of 84%. Overall, in the early stages of a critical illness, the urinary levels of NGAL and FGF-2 were sensitive, but not specific, to identify neonates at risk of AKI. Low EGF levels post-recovery identified critically ill neonates with AKI.
  
  
  CONCLUSIONS
  These findings require validation in larger prospective studies.
authors.affiliation: Neonatology, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
authors.forename: Suma Bhat
authors.initials: SB
authors.lastname: Hoffman
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
authors.forename: Angel A
authors.initials: AA
authors.lastname: Soler-García
authors.forename: Sofia
authors.initials: S
authors.lastname: Perazzo
authors.forename: Patricio E
authors.initials: PE
authors.lastname: Ray
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine; D015415:Biomarkers / Q000652:urine*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D016638:Critical Illness; D004815:Epidermal Growth Factor / Q000652:urine; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000652:urine; D006801:Humans; D007036:Hypothermia, Induced; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve; D014882:Water-Electrolyte Balance / Q000502:physiology
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D016222:Fibroblast Growth Factor 2; D004815:Epidermal Growth Factor; D003404:Creatinine