title: Urinary KIM-1 in children undergoing nephrotoxic antineoplastic treatment: a prospective cohort study.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a significant complication in patients with cancer, and nephrotoxic drugs are among the most common causes of AKI. To date, there is no study evaluating the potential role of renal biomarkers in children receiving nephrotoxic chemotherapy.
  
  
  METHODS
  A prospective study was conducted in children receiving methotrexate (MTX) or platinum-based treatment. Urinary kidney injury molecule-1 (KIM-1) was measured 24 h after the initiation of the chemotherapy infusion, and serum creatinine (sCr) was measured prior to drug infusion and at 24, 48, 72, and 96 h, 1 and 2 weeks, and 3 months post-initiation of treatment.
  
  
  RESULTS
  A total of 64 children were evaluated, of whom 21 (32.8%) developed AKI. The majority had AKI stage 1 (n = 12, 57.1%) and only one developed AKI stage 3. Median values of urinary KIM-1 were higher in patients with AKI than in those without AKI [10.7, interquartile range (IQR) 1.6-17.9 vs. 4.3 (IQR 1.3-6.1) ng/mg creatinine; p < 0.01]. Urinary KIM-1 showed good discrimination for AKI in patients receiving nephrotoxic chemotherapy, with an area under the receiver operator characteristic curve for AKI up to 1 week later of 0.82 (95% confidence interval 0.66-0.95). Even when measured only 24 h after drug infusion, urinary KIM-1 still showed good discrimination to predict persistent renal impairment three months later.
  
  
  CONCLUSIONS
  Urinary KIM-1 measured 24 h after the start of drug infusion has the potential to detect early AKI in pediatric patients treated with MTX or platinum-class drugs.
authors.affiliation: Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil.
authors.forename: Danielle
authors.initials: D
authors.lastname: Carvalho Pedrosa
authors.affiliation: Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Macedo de Oliveira Neves
authors.affiliation: Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil.
authors.forename: Gdayllon
authors.initials: G
authors.lastname: Cavalcante Meneses
authors.affiliation: Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Pinheiro Gomes Wirtzbiki
authors.affiliation: Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil.
authors.forename: Carlos Artur
authors.initials: CA
authors.lastname: da Costa Moraes
authors.affiliation: Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil.
authors.forename: Alice Maria
authors.initials: AM
authors.lastname: Costa Martins
authors.affiliation: Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil. alexandreliborio@yahoo.com.br.|Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil. alexandreliborio@yahoo.com.br.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Braga Libório
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000652:urine; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000652:urine; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008727:Methotrexate / Q000009:adverse effects*; D017671:Platinum Compounds / Q000009:adverse effects*; D011446:Prospective Studies; D012372:ROC Curve; D011991:Receptors, Virus
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D008562:Membrane Glycoproteins; D017671:Platinum Compounds; D011991:Receptors, Virus; D008727:Methotrexate
keywords: Acute kidney injury; Biomarkers; Diagnostic capacity; Methotrexate; Nephrotoxic chemotherapy; Platinum-class drugs; Urinary kidney injury molecule-1