Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Variation in clinical usefulness of biomarkers of acute kidney injury in young children undergoing cardiac surgery

  • Baek, Hee Sun (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Lee, Youngok (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine) ;
  • Jang, Hea Min (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Cho, Joonyong (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine) ;
  • Hyun, Myung Chul (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Kim, Yeo Hyang (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Hwang, Su-Kyeong (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Cho, Min Hyun (Department of Pediatrics, Kyungpook National University, School of Medicine)
  • Received : 2019.08.09
  • Accepted : 2019.12.11
  • Published : 2020.04.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Acute kidney injury (AKI) is one of the most significant postoperative complications of pediatric cardiac surgery. Because serum creatinine has limitations as a diagnostic marker of AKI, new biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are being evaluated to overcome these limitations and detect AKI at an early stage after cardiac surgery. Purpose: This study aimed to investigate the clinical usefulness of these biomarkers in young children. Methods: Thirty patients with congenital heart diseases who underwent cardiac surgery using cardiopulmonary bypass (CPB) were selected, and their urine and blood samples were collected at baseline and 6, 24, and 48 hours after surgery. Serum creatinine and blood urea nitrogen levels as well as NGAL, KIM-1, and IL-18 levels in urine samples were measured, and clinical parameters were evaluated. Results: Of the 30 patients, 12 developed AKI within 48 hours after cardiac surgery. In the AKI group, 8 of 12 (66.6%) met AKI criteria after 24 hours, and urine KIM-1/creatinine (Cr) level (with adjustment of urine creatinine) peaked at 24 hours with significant difference from baseline level. Additionally, urine KIM-1/Cr level in the AKI group was significantly higher than in the non-AKI group at 6 hours. However, urine NGAL/Cr and IL-18/Cr levels showed no specific trend with time for 48 hours after cardiac surgery. Conclusion: It is suggested that urine KIM-1/Cr concentration could be considered a good biomarker for early AKI prediction after open cardiac surgery using CPB in young children with congenital heart diseases.

Keywords

References

  1. Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 2011;39:1493-9. https://doi.org/10.1097/CCM.0b013e31821201d3
  2. Hirano D, Ito A, Yamada A, Kakegawa D, Miwa S, Umeda C, et al. Independent risk factors and 2-year outcomes of acute kidney injury after surgery for congenital heart disease. Am J Nephrol 2017;46:204-9. https://doi.org/10.1159/000480358
  3. Lex DJ, Toth R, Cserep Z, Alexander SI, Breuer T, Sapi E, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg 2014;97:202-10. https://doi.org/10.1016/j.athoracsur.2013.09.014
  4. Park SK, Hur M, Kim E, Kim WH, Park JB, Kim Y, et al. Risk factors for acute kidney injury after congenital cardiac surgery in infants and children: a retrospective observational study. PLoS One 2016;11:e0166328. https://doi.org/10.1371/journal.pone.0166328
  5. Toth R, Breuer T, Cserep Z, Lex D, Fazekas L, Sapi E, et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012;93:1984-90. https://doi.org/10.1016/j.athoracsur.2011.10.046
  6. Gil-Ruiz Gil-Esparza MA, Alcaraz Romero AJ, Romero Otero A, Gil Villanueva N, Sanavia Moran E, Rodriguez Sanchez de la Blanca A, et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 2014;29:1265-72. https://doi.org/10.1007/s00467-014-2757-z
  7. Jefferies JL, Devarajan P. Early detection of acute kidney injury after pediatric cardiac surgery. Prog Pediatr Cardiol 2016;41:9-16. https://doi.org/10.1016/j.ppedcard.2016.01.011
  8. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231-8. https://doi.org/10.1016/S0140-6736(05)74811-X
  9. Greenberg JH, Parikh CR. Biomarkers for diagnosis and prognosis of AKI in children: one size does not fit all. Clin J Am Soc Nephrol 2017;12:1551-7. https://doi.org/10.2215/CJN.12851216
  10. Hwang YJ, Hyun MC, Choi BS, Chun SY, Cho MH. Acute kidney injury after using contrast during cardiac catheterization in children with heart disease. J Korean Med Sci 2014;29:1102-7. https://doi.org/10.3346/jkms.2014.29.8.1102
  11. Park JT. Postoperative acute kidney injury. Korean J Anesthesiol 2017;70:258-66. https://doi.org/10.4097/kjae.2017.70.3.258
  12. Toda Y, Sugimoto K. AKI after pediatric cardiac surgery for congenital heart diseases-recent developments in diagnostic criteria and early diagnosis by biomarkers. J Intensive Care 2017;5:49. https://doi.org/10.1186/s40560-017-0242-z
  13. Malhotra R, Siew ED. Biomarkers for the early detection and prognosis of acute kidney injury. Clin J Am Soc Nephrol 2017;12:149-73. https://doi.org/10.2215/cjn.01300216
  14. Dong L, Ma Q, Bennett M, Devarajan P. Urinary biomarkers of cell cycle arrest are delayed predictors of acute kidney injury after pediatric cardiopulmonary bypass. Pediatr Nephrol 2017;32:2351-60. https://doi.org/10.1007/s00467-017-3748-7
  15. Ross RD, Bollinger RO, Pinsky WW. Grading the severity of congestive heart failure in infants. Pediatr Cardiol 1992;13:72-5. https://doi.org/10.1007/BF00798207
  16. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002;123:110-8. https://doi.org/10.1067/mtc.2002.119064
  17. Section 2: AKI definition. Kidney Int Suppl 2012;2:19-36. https://doi.org/10.1038/kisup.2011.32
  18. Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol 2019;60:3-11. https://doi.org/10.1016/j.pedneo.2018.03.007
  19. Devarajan P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol 2006;17:1503-20. https://doi.org/10.1681/ASN.2006010017
  20. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012;94:1589-95. https://doi.org/10.1016/j.athoracsur.2012.06.050
  21. Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012;143:368-74. https://doi.org/10.1016/j.jtcvs.2011.06.021
  22. Gist KM, Kwiatkowski DM, Cooper DS. Acute kidney injury in congenital heart disease. Curr Opin Cardiol 2018;33:101-7. https://doi.org/10.1097/HCO.0000000000000473
  23. Liborio AB, Branco KM, Torres de Melo Bezerra C. Acute kidney injury in neonates: from urine output to new biomarkers. Biomed Res Int 2014;2014:601568. https://doi.org/10.1155/2014/601568
  24. Devarajan P. Neutrophil gelatinase-associated lipocalin--an emerging troponin for kidney injury. Nephrol Dial Transplant 2008;23:3737-43. https://doi.org/10.1093/ndt/gfn531
  25. Al-Ismaili Z, Palijan A, Zappitelli M. Biomarkers of acute kidney injury in children: discovery, evaluation, and clinical application. Pediatr Nephrol 2011;26:29-40. https://doi.org/10.1007/s00467-010-1576-0
  26. Han WK, Waikar SS, Johnson A, Betensky RA, Dent CL, Devarajan P, et al. Urinary biomarkers in the early diagnosis of acute kidney injury. Kidney Int 2008;73:863-9. https://doi.org/10.1038/sj.ki.5002715
  27. Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int 2006;70:199-203. https://doi.org/10.1038/sj.ki.5001527
  28. Parikh CR, Coca SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Wang Z, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol 2011;22:1748-57. https://doi.org/10.1681/ASN.2010121302