title: Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Renal Injury Following Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  To evaluate the course of urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 levels in young children during extracorporeal membrane oxygenation and concomitant continuous hemofiltration. Furthermore, to evaluate whether these levels predict outcome.
  
  
  METHODS
  Prospective observational cohort study from July 2010 to July 2013.
  
  
  METHODS
  ICU of a level III university children's hospital.
  
  
  METHODS
  Thirty-one extracorporeal membrane oxygenation-treated children up to 1 year were included.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patients were weaned from extracorporeal membrane oxygenation after a median of 162 hours (interquartile range, 83-304). Throughout the study, 58% of the patients met the criteria for acute kidney injury (i.e., Risk Injury Failure Loss End-Stage Renal Disease-Risk or higher defined as an increase in serum creatinine corresponding to ≥ 150% when compared with age-specific reference values). Levels of both biomarker patterns changed significantly throughout extracorporeal membrane oxygenation (urinary neutrophil gelatinase-associated lipocalin, p < 0.001 and urinary kidney injury molecule-1, p = 0.005, linear mixed model analyses). Urinary neutrophil gelatinase-associated lipocalin levels were already high before extracorporeal membrane oxygenation, whereas urinary kidney injury molecule-1 levels increased throughout the first extracorporeal membrane oxygenation day and peaked at 12-24 hours. Also, urinary neutrophil gelatinase-associated lipocalin levels at 12-24 hours of extracorporeal membrane oxygenation therapy were higher among patients with acute kidney injury post extracorporeal membrane oxygenation (p = 0.002, Mann-Whitney U test). Biomarker levels did not differ between survivors and nonsurvivors.
  
  
  CONCLUSIONS
  The increased urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 levels confirm that renal tubular damage occurs in critically ill infants in need of extracorporeal membrane oxygenation. The fact that the maximal urinary neutrophil gelatinase-associated lipocalin levels were measured 24 hours earlier than urinary kidney injury molecule-1 supports the use of biomarker combinations rather than a single biomarker to identify patients at risk of acute kidney injury. Finally, since urinary neutrophil gelatinase-associated lipocalin levels at 12-24 hours of extracorporeal membrane oxygenation therapy were associated with acute kidney injury post extracorporeal membrane oxygenation, this marker may facilitate more timely adjustment of therapeutic interventions.
authors.affiliation: 1Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. 2Department of Pediatric Nephrology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands. 4Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Alexandra J M
authors.initials: AJ
authors.lastname: Zwiers
authors.forename: Karlien
authors.initials: K
authors.lastname: Cransberg
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: de Rijke
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Saskia N
authors.initials: SN
authors.lastname: de Wildt
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins