Urinary biomarkers for the differentiation of prerenal and intrinsic pediatric acute kidney injury.
Urinary calprotectin and neutrophil gelatinase-associated lipocalin (NGAL) have recently been identified as promising biomarkers for the differentiation of prerenal and intrinsic acute kidney injury (AKI) in adults. In the study reported here we examined the diagnostic accuracy of calprotectin, NGAL, and kidney injury molecule 1 (KIM-1) in pediatric patients.



Urinary calprotectin, NGAL, and KIM-1 concentrations were assessed in a study population of 139 pediatric subjects including 39 patients with intrinsic AKI, 14 with prerenal AKI, and 86 non-AKI subjects.



Median urinary calprotectin and NGAL concentrations were higher in patients with intrinsic AKI than in those with prerenal AKI (calprotectin by 22-fold, NGAL by 9-fold). Receiver operating characteristic (ROC) curve analyses for the differentiation of intrinsic and prerenal AKI resulted in an area under the curve (AUC) of 0.90 [95 % confidence interval (CI) 0.81-0.98] for calprotectin and 0.73 (95 % CI 0.58-0.87) for NGAL. Median urinary KIM-1 concentrations were not significantly different between patients with prerenal AKI and those with intrinsic disease (P = 0.98; AUC 0.50, 95 % CI, 0.35-0.65). The AUC for the fractional excretion of sodium (FENa) and proteinuria was 0.78 (95 % CI 0.63-0.92) and 0.77 (CI 0.65-0.90), respectively.



Urinary calprotectin outperforms NGAL, KIM-1, FENa, and proteinuria as a biomarker for the differentiation of prerenal and intrinsic AKI in pediatric patients with a high diagnostic accuracy.
Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany. jens.westhoff@med.uni-heidelberg.de.
Jens H
JH
Westhoff
Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany.
Alexander
A
Fichtner
Department of Neonatology, University Children's Hospital, Heidelberg, Germany.
Sina
S
Waldherr
Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Bochum, Germany.
Nikolaos
N
Pagonas
Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Bochum, Germany.
Felix S
FS
Seibert
Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Bochum, Germany.
Nina
N
Babel
Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany.
Burkhard
B
Tönshoff
Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Bochum, Germany.
Frederic
F
Bauer
Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Bochum, Germany. timm.westhoff@marienhospital-herne.de.
Timm H
TH
Westhoff
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000652:urine*; D015415:Biomarkers / Q000652:urine*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1 / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D039841:Leukocyte L1 Antigen Complex / Q000652:urine; D000071068:Lipocalin-2 / Q000652:urine; D008297:Male; D011507:Proteinuria / Q000209:etiology / Q000652:urine; D015203:Reproducibility of Results; D012964:Sodium / Q000652:urine
D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C489506:LCN2 protein, human; D039841:Leukocyte L1 Antigen Complex; D000071068:Lipocalin-2; D012964:Sodium
Acute kidney injury; Calprotectin; KIM-1; NGAL; Pediatric; S100A8/S100A9