title: KIM-1 Is a Potential Urinary Biomarker of Obstruction: Results from a Prospective Cohort Study.
abstract: Partial or complete obstruction of the urinary tract is a common and challenging urological condition that may occur in patients of any age. Serum creatinine is the most commonly used method to evaluate global renal function, although it has low sensitivity for early changes in the glomerular filtration rate or unilateral renal pathology. Hence, finding another measurable parameter that reflects the adaptation of the renal physiology to these circumstances is important. Several recent studies have assessed the use of new biomarkers of acute kidney injury (AKI), but the information among patients with stone disease and those with obstructive uropathy is limited.
  
  
  
  A prospective cohort study was conducted to determine the urinary levels of kidney injury molecule-1 (KIM-1), Total and Monomeric neutrophil gelatinase-associated lipocalin (NGAL) in patients with hydronephrosis secondary to renal stone disease, congenital ureteropelvic junction obstruction or ureteral stricture. Comparison between patients with hydronephrosis and no hydronephrosis was carried out along with correlation analysis to detect factors associated with biomarker expression.
  
  
  
  Urinary levels of KIM-1 significantly decreased after hydronephrosis treatment in patients with unilateral obstruction (1.19 ng/mL vs 0.76 ng/mL creatinine, p = 0.002), additionally KIM-1 was significantly higher in patients with hydronephrosis compared to stone disease patients without radiological evidence of obstruction (1.19 vs 0.64, p = 0.006). Total and Monomeric NGAL showed a moderate correlation with the presence of leukocyturia. We found that a KIM-1 value of 0.735 ng/mg creatinine had a sensitivity of 75% and specificity of 67% to predict the presence of hydronephrosis in preoperative studies (95% CI 0.58-0.87, p = 0.006).
  
  
  
  Our results show that KIM-1 is a promising biomarker of subclinical AKI associated with hydronephrosis in urological patients. NGAL values were influenced by the presence of leukocyturia, limiting its usefulness in this population.
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .|2 TEC Salud, Escuela Nacional de Medicina, Instituto de Cirugia, Monterrey, México.
authors.forename: Daniel
authors.initials: D
authors.lastname: Olvera-Posada
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: Thamara
authors.initials: T
authors.lastname: Dayarathna
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: Marie
authors.initials: M
authors.lastname: Dion
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: Husain
authors.initials: H
authors.lastname: Alenezi
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: Alp
authors.initials: A
authors.lastname: Sener
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler
authors.affiliation: 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .
authors.forename: Hassan
authors.initials: H
authors.lastname: Razvi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1 / Q000032:analysis*; D006801:Humans; D006869:Hydronephrosis / Q000652:urine*; D007669:Kidney Calculi / Q000150:complications / Q000652:urine*; D000071068:Lipocalin-2 / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014517:Ureteral Obstruction / Q000150:complications / Q000652:urine*
chemical_list: D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D000071068:Lipocalin-2
keywords: acute kidney injury; biomarkers; hydronephrosis