title: Urinary netrin-1 and KIM-1 as early biomarkers for septic acute kidney injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) during sepsis is associated with poor outcome. However, diagnosis of AKI with serum creatinine (SCr) level change is neither highly sensitive nor specific. Therefore, identification of novel biomarkers for early diagnosis of AKI is desirable.
  
  
  OBJECTIVE
  To evaluate the capacity of combining urinary netrin-1 and human kidney injury molecule type 1 (KIM-1) in the early diagnosis of septic AKI.
  
  
  METHODS
  We prospectively recruited 150 septic patients from Jun 2011 to Jun 2013 at Zhejiang Provincial People's Hospital, China. SCr, urinary netrin-1, and KIM-1 levels were recorded at 0, 1, 3, 6, 24, and 48 h of ICU admission and compared between AKI and non-AKI patients. In addition, we investigated the prognostic value of netrin-1 and KIM-1 between non-survivors and survivors in septic AKI patients.
  
  
  RESULTS
  SCr levels started to show elevation after 24 h of ICU admission. However, netrin-1 levels increased significantly as early as 1 h, peaked at 3-6 h and remained elevated up to 48 h of ICU admission in septic AKI patients. KIM-1 increased significantly by 6 h, peaked at 24 h and remained significantly elevated until 48 h of ICU admission. Furthermore, we observed significant higher urinary KIM-1 levels at 24 h and 48 h in non-survivors compared to survivors in AKI patients.
  
  
  CONCLUSIONS
  Our results suggest that both netrin-1 and KIM-1 are clinically useful as early biomarkers in the diagnosis of septic AKI. In addition, persistent elevation of urinary KIM-1 level may be associated with poor prognosis.
authors.affiliation: Intensive Care Unit, Zhejiang Provincial People's Hospital , Hangzhou , China .
authors.forename: Yuexing
authors.initials: Y
authors.lastname: Tu
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Renhua
authors.initials: R
authors.lastname: Sun
authors.forename: Yin
authors.initials: Y
authors.lastname: Ni
authors.forename: Leilei
authors.initials: L
authors.lastname: Ma
authors.forename: Fei
authors.initials: F
authors.lastname: Xv
authors.forename: Xiuping
authors.initials: X
authors.lastname: Hu
authors.forename: Lingzhi
authors.initials: L
authors.lastname: Jiang
authors.forename: Aiping
authors.initials: A
authors.lastname: Wu
authors.forename: Xv
authors.initials: X
authors.lastname: Chen
authors.forename: Minhua
authors.initials: M
authors.lastname: Chen
authors.forename: Jingquan
authors.initials: J
authors.lastname: Liu
authors.forename: Fang
authors.initials: F
authors.lastname: Han
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000652:urine*; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000652:urine*; D000075388:Netrin-1; D011446:Prospective Studies; D011991:Receptors, Virus; D018805:Sepsis / Q000150:complications*; D025521:Tumor Suppressor Proteins / Q000652:urine*
chemical_list: D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D008562:Membrane Glycoproteins; C000617351:NTN1 protein, human; D009414:Nerve Growth Factors; D011991:Receptors, Virus; D025521:Tumor Suppressor Proteins; D000075388:Netrin-1; D003404:Creatinine
keywords: AKI; KIM-1; biomarkers; netrin-1; sepsis