title: Predictive ability of urinary biomarkers for outcome in children with acute kidney injury.
abstract: Urinary neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-beta-D-glucosaminidase (NAG), and interleukin 18 (IL-18) were found to be useful for early detection of acute kidney injury (AKI). The objective of this study was to determine the predictive ability of biomarkers for mortality and variation in levels in relation to different stages of AKI, need for dialysis, etiologies, and with duration of hospital stay.
  
  
  
  Urinary NGAL, NAG, and IL-18 levels were measured in 50 children with AKI and 30 age- and gender-matched healthy controls. AKI was classified as per pediatric Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria.
  
  
  
  Median NGAL, NAG, and IL-18 values were significantly increased in AKI patients compared with controls (p < 0.001), with significant increase among risk, injury, and failure stages. Nonsurvivors had significantly higher median levels of NGAL (p = 0.008) and NAG (p = 0.018) than survivors. NGAL had highest area under the curve (AUC) at 0.750 [confidence interval (CI) 0.580-0.920], followed by NAG at 0.724 (CI 0.541-0.907), with sensitivity and specificity of 75 % each; and IL-18 (AUC 0.688, CI 0.511-0.864), with sensitivity 62.5 % and specificity 70.8 %, for predicting mortality. Values were significantly higher in patients who required peritoneal dialysis (PD) than in those in whom it was not indicated. Levels were comparable among different etiologies. Only NGAL level was found to be a significant risk factor associated with longer duration of hospital stay.
  
  
  
  Urinary NGAL and NAG had modest predictive ability for mortality. Children requiring dialysis had significantly raised levels, and the NGAL level had significant association with duration of hospital stay.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India. opmpedia@yahoo.co.uk.
authors.forename: Om P
authors.initials: OP
authors.lastname: Mishra
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Rai
authors.affiliation: School of Biochemical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, 221005, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Srivastava
authors.affiliation: Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221005, India.
authors.forename: Khushaboo
authors.initials: K
authors.lastname: Pandey
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Abhinay
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
authors.forename: Rajniti
authors.initials: R
authors.lastname: Prasad
authors.affiliation: Division of Biostatistics, Department of Community Medicine, Institute of Medical Sciences,Banaras Hindu University, Varanasi, 221005, India.
authors.forename: Rabindra N
authors.initials: RN
authors.lastname: Mishra
authors.affiliation: Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, 69120, Heidelberg, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000628:therapy / Q000652:urine*; D000293:Adolescent; D015415:Biomarkers / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D020382:Interleukin-18 / Q000652:urine; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000652:urine; D007902:Length of Stay; D000071068:Lipocalin-2 / Q000652:urine; D008297:Male; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016019:Survival Analysis; D020711:Threshold Limit Values
chemical_list: D015415:Biomarkers; C000589760:IL18 protein, human; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D000118:Acetylglucosaminidase
keywords: Acute kidney injury; Biomarkers; Children; Mortality; Predictive ability