title: Biomarkers of acute kidney injury in pediatric cardiac surgery.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a significant problem in children undergoing cardiopulmonary bypass (CPB). The aims of this study were to assess the diagnostic validity of serum CysC (sCysC), serum neutrophil gelatinase lipocalin (sNGAL), urine neutrophil gelatinase lipocalin (uNGAL), urine kidney injury molecule (uKIM)-1, and urine liver fatty acid-binding protein (uL-FABP) to predict AKI presence and severity in children undergoing CPB.
  
  
  METHODS
  We performed a prospective single-center evaluation of sCysC, sNGAL, uNGAL, uKIM-1 and uL-FABP at 0, 2, 6, 24 and 48 h postoperatively in children undergoing CPB during cardiac surgery. AKI was defined as ≥25% decrease in the estimated creatinine clearance (eCCl) from pre-operative baseline at 48h after surgery.
  
  
  RESULTS
  Of the 112 patients, 18 patients (16.1%) developed AKI; four of them needed acute dialysis treatment and three AKI patients died. In the AKI compared to the non-AKI group, sCysC at 2h, and uNGAL and uL-FABP at 2-48 h were significantly increased, as well as CPB, aortic cross clamp time and length of hospital stay. Biomarkers increased with worsening AKI severity. At 2h after CPB the best accuracy for diagnosis of AKI had uL-FABP and sCysC with area under the receiver operator curve (AUC) of 0.89 and 0.73, respectively. At 6 and 24h after CPB the best AUC was found for uL-FABP (0.75 and 0.87 respectively) and for uNGAL (0.70 and 0.93, respectively).
  
  
  CONCLUSIONS
  sCysC, uNGAL and uL-FABP are reliable early predictors for AKI after CPB. By allowing earlier timing of injury and earlier intervention, they could improve AKI outcome.
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia. amirapecoantic@yahoo.com
authors.forename: Amira
authors.initials: A
authors.lastname: Peco-Antić
authors.forename: Ivana
authors.initials: I
authors.lastname: Ivanišević
authors.forename: Irena
authors.initials: I
authors.lastname: Vulićević
authors.forename: Jelena
authors.initials: J
authors.lastname: Kotur-Stevuljević
authors.forename: Slobodan
authors.initials: S
authors.lastname: Ilić
authors.forename: Jasmina
authors.initials: J
authors.lastname: Ivanišević
authors.forename: Milica
authors.initials: M
authors.lastname: Miljković
authors.forename: Nikola
authors.initials: N
authors.lastname: Kocev
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000235:genetics* / Q000473:pathology* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D055316:Cystatin C / Q000097:blood / Q000652:urine; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007223:Infant; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D011991:Receptors, Virus; D006435:Renal Dialysis / Q000379:methods
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; 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
keywords: Acute kidney injury; Cardiopulmonary bypass; Cystatin C; L-FABP; NGAL