title: A Potential Biomarker for Acute Kidney Injury in Preterm Infants from Metabolic Profiling.
abstract: BACKGROUND
  Currently used biomarkers for acute kidney injury (AKI), namely Ngal, SCr, and BUN, are inadequate for timely detection of AKI in preterm infants.
  
  
  METHODS
  Nuclear magnetic resonance (NMR) spectroscopy-based metabolic profiling was conducted on urines from 20 preterm infants to determine if novel metabolic biomarkers could be identified for early detection of AKI. Urines were collected from every patient each day for the first 14 days of life. NMR spectra were measured for all urines and metabolic profiling analysis conducted.
  
  
  RESULTS
  One metabolite, carnitine, increased significantly in urines of three extremely low birth weight (ELBW) infants starting on day five of life. The three affected infants either received prolonged antibiotic treatment, extended treatment with indomethacin, or both. One ELBW patient who received both treatments and reached the highest urinary carnitine level died on day 10 of life due to localized gut perforation complicated by suspected AKI.
  
  
  CONCLUSIONS
  It was concluded that carnitine increased in the three neonates in part due to antibiotic- and/or indomethacin-induced AKI. It is hypothesized that combined antibiotic and indomethacin treatment promoted AKI resulting in reduced proximal renal tubule reabsorption of carnitine and that β-lactam antibiotics blocked renal carnitine uptake by human organic cation transporter, hOCTN2.
authors.affiliation: Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, USA.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Romick-Rosendale
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Schibler
authors.affiliation: Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kennedy
keywords: Acute kidney injury; Blood Urea Nitrogen (BUN); Carnitine; Metabonomics; NMR; Necrotizing enterocolitis; Neutrophil gelatinase-associated lipocalin (Ngal); Preterm infant