title: Towards a biomarker panel for the assessment of AKI in children receiving intensive care.
abstract: BACKGROUND
  Critically ill children and neonates are at high risk of developing acute kidney injury (AKI). AKI is associated with short- and long-term renal impairment and increased mortality. Current methods of diagnosing AKI rely on measurements of serum creatinine, which is a late and insensitive marker. Few studies to date have assessed AKI biomarkers in a heterogeneous patient cohort.
  
  
  METHODS
  We conducted a prospective feasibility study in a paediatric intensive care setting over a 6-month period to describe the relationship between AKI (defined according to pRIFLE criteria) and new AKI biomarkers.
  
  
  RESULTS
  In total, 49 patients between the ages of 16 days and 15 years were recruited for measurement of plasma cystatin C (Cys-C) and neutrophil gelatinase-associated lipocalin (pNGAL) concentrations, as well as for urinary kidney injury molecule-1 (KIM-1) and urinary NGAL (uNGAL) concentrations. Almost one-half (49 %) of the patient cohort experienced an AKI episode, and Cys-C and pNGAL were the strongest candidates for the detection of AKI. Our data suggest that the widely used estimated baseline creatinine clearance value of 120 mL/min/1.73 m(2) underestimates actual baseline function in patients admitted to paediatric intensive care units.
  
  
  CONCLUSIONS
  This investigation demonstrates the feasibility of new AKI biomarker testing in a mixed patient cohort and provides novel biomarker profiling for further evaluation.
authors: Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre, Manchester, UK.
authors: James
authors: J
authors: McCaffrey
authors: Beatrice
authors: B
authors: Coupes
authors: Chris
authors: C
authors: Chaloner
authors: Nicholas J A
authors: NJ
authors: Webb
authors: Rachael
authors: R
authors: Barber
authors: Rachel
authors: R
authors: Lennon
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D000209:Acute-Phase Proteins; D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002648:Child; D002675:Child, Preschool; D055316:Cystatin C / Q000097:blood*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007118:Immunoassay; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D011991:Receptors, Virus; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; 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