ACUTE KIDNEY INJURY IN NEONATES AND NEUTOPHILIC GELATINOUS ASSOCIATED LIPOCALIN AS EARLY BIOMARKER

  • Silvana Timovska Naunova 1Department of Intensive Care Unit-PHI University Clinic for Children Diseases - Skopje
  • Zoja Babinkostova University clinic of Psychiatry-Skopje
  • Olivera Jordanova University Children hospital-Skopje
  • Aspazija Sofijanova

Abstract

 


Objective: Acute kidney injury (AKI) is a serious problem in neonates in intensive care units. It is defined as a rapid decrease in glomerular filtration that leads to retention of creatinine and nitrogenous waste products and usually with a decrease in urine output. NGAL represents the most promising biomarker for early detection of kidney injury. It can detect the kidney injury in the first 2 to 3 hours of its occurrence, even before there is a decrease in urine output and an increase in sCr. The aim of the study was to determine the role of biomarker NGAL in early detection of kidney injury in neonates.


 Methods.  The study evaluated the neonates suffering kidney injury who at the period of three years were treated at the University Children's Hospital in Skopje. All cases of neonates with kidney injury were analyzed according to gender, gestational age, birth weight and risk factors such as asphyxia, sepsis, prematurity, meconium plug syndrome and congenital heart diseases. NGAL was analyzed in urine samples collected on two occasions (day of admission and 2 days later) and the concentration of NGAL was determined using NGAL ELISA KIT (Bioporto). Medical data records of admitted neonates with AKI were analyzed. The material was statistically processed using methods of descriptive statistics.


Results. The study was carried out at the neonatal intensive care unit at the University Children's Hospital  Skopje in which neonates  with documented acute kidney injury were evaluated. The whole study has been performed during the 3 year period. The estimated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study were born at term (68%) with predominance of male neonates (64%). The analyzed results showed a higher values of urinary NGAL on the day of admission (373.8 ± 194.9) and a slight upward trend, with  further increase in the third day after admission (439.4 ± 254, 7). There was a significant difference between the uNGAL values and sCr values on the day of admission of neonates in NICU, p<0,001. The mean urinary NGAL values in neonates with AKI with lethal outcome were 586.39 ± 182.3 while the mean values in neonates without lethal outcome was 254.22 ± 28.5. This difference was statistically significant (p<0,001). 


Conclusion: Early, biomarker based identification of neonates at risk of kidney injury is a fundamental step toward AKI prevention. NGAL has ability to predict AKI before clinical signs are evident and can facilitate implementation of appropriate preventive measures and improve resource utilization.  Its use allows us to make the right clinical decisions at the right time, before the illness is clinically manifest and take appropriate measures to prevent renal function decline.  

References

1. Andreoli SP. Acute kidney injury in children. Pediatr Nephrol.2009;24:253-63.
2. Askenazi D. Evaluation and management of critically ill children with acute kidney injury. Curr Opin Pediatr. 2011; 23:201-7.
3. Bezerra CT, Vaz Cunha LC, Libório AB. Defining reduced urine output in neonatal ICU: importance for mortality and acute kidney injury classification. Nephrol Dial Transplant. 2013;28:901-9
4. Weintraub AS, Carey A, Connors J. Relationship of maternal creatinine to first neonatal creatinine in infants less than 30 weeks gestation. J Perinatol. 2015; 35:401.
5. Bateman DA, Thomas W, Parravicini E. Serum creatinine concentration in very-low-birth-weight infants from birth to 34-36 wk postmenstrual age. Pediatr Res. 2015; 77:696.
6. Schrier W, Wang W, Poole B, et al. Acute renal failure: Definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 2004; 114: 5–14.
7. Mak RH. Acute kidney injury in children: the dawn of a new era. Pediatr Nephrol. 2008;23:2147-9.
8. Agras P, Tarcan A, Baskin E, et al. Acute renal failure in neonatal period. Ren Fail. 2004;26(3):305-9
9. Subramanian S, Agarwal R, Deorari AK et al. Acute renal failure in neonates. Indian J Pediatr. 2008:75(4):385-91.
10. Bailey D, Phan V, Litalien C, et al. Risk factors of acute renal failure in critically ill children: A prospective descriptive epidemiological study. Pediatr Crit Care Med. 2007;8:29–35.
11. Moghal NE, Brocklebank JT, Maedow SR et al. A review of acute reanal failure in children: incidence, etiology and outcome. Clin Nephrol. 1998; 49:91-5
12. Ottonello G, Dessi A, Neroni P, et al. Acute kidney injury in neonatal age. J of Pediatric and Neonatal I Medicine. 2014;3(2):e030246.
13. Cataldi L, Leone R, Moretti U, et al. Potential risk factors for the development of acute renal failure in preterm newborn infants: a case-control study. Arch Dis Child Fetal Neonatal Ed. 2005;90(6):514–9.
14. Doronjski A, Stojanovic V, Spasojevic S, et al. Acute Renal failure in premature neonates. Vojnosanit Pregl.2009;66(11):863–7.
15. Gupta BD, Sharma P, Bagla J, et al. Renal failure in asphyxiated neonates. Indian Pediatr. 2005;42(9):928–34.
16. Vishwanathan S, Manyam B, Azhibekou T, et al. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol. 2012;27(2):303–11.
17. Gopal Girish, Acute kidney injury in perinatal asphyxia , Indian J. Pharm. Biol. Res. 2014;2(2):60-5.
18. Kapoor K., Jajoo M., Dabas V et al.Predictors of mortality in neonates with acute renal failure. Iran J Pediatr. 2013;23(3):321–6.
19. Uchino S, Bellomo R, Goldsmith D, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34:1913-7.
20. Bresolin N., Bianchini A.P., and Haas C.A., Pediatric acute kidney injury assessed by pRIFLE as a prognostic factor in the intensive care unit. Pediatric Nephrology. 2013;28(3):485–92.
21. Mohkam M, Kompani F, Afjeii A, et al. RIFLE Criteria in Critically Ill Neonates with Acute Kidney Injury. J Ped. Nephrology. 2015;3(1):16-21.
22. Devarajan P. Emerging biomarkers of acute kidney injury. Contrib Nephrol. 2007;156:203-12.
23. Bennett M, Dent CL, Ma Q, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol. 2008;3:665-9.
24. Devarajan P. Neutrophil gelatinase-associated lipocalin (NGAL): a new marker of kidney disease. Scand J Clin Lab Invest Suppl. 2008;241:89-94.
25. Mortazavi F, Hosseinpour S, Nejati N. Acute kidney failure in neonatal period. Iran J Kidney Dis. 2009;3:136-40.
26. Youssef D, Abd-Elrahman H, Shehab N. Incidence of acute kidney injury in the neonatal intensiven care unit, Saudi J Kidney Dis Transpl.2015;26(1):67-72.
27. Nickolas TL, O’Rourke MJ, Yang J, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinaseassociated lipocalin for diagnosing acute kidney injury. Ann Intern Med. 2008;148:810-9.
28. Zappitelli M, Washburn KK, Arikan AA, et al., Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study, Crit Care, 2007;11:84.
29. Mishra J, Dent C, Tarabishi R, et al., Neutrophil gelatinaseassociated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery, Lancet, 2005;365:1231–8.
30. Mishra J, Ma Q, Prada A, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol. 2003;14:2534-43.
Published
2019-12-27
How to Cite
TIMOVSKA NAUNOVA, Silvana et al. ACUTE KIDNEY INJURY IN NEONATES AND NEUTOPHILIC GELATINOUS ASSOCIATED LIPOCALIN AS EARLY BIOMARKER. Journal of Morphological Sciences, [S.l.], v. 2, n. 2, p. 50-56, dec. 2019. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/79>. Date accessed: 02 july 2020.
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Articles