Urinary NMR Profiling in Pediatric Acute Kidney Injury—A Pilot Study

Acute kidney injury (AKI) in critically ill children and adults is associated with significant short- and long-term morbidity and mortality. As serum creatinine- and urine output-based definitions of AKI have relevant limitations, there is a persistent need for better diagnostics of AKI. Nuclear magnetic resonance (NMR) spectroscopy allows for analysis of metabolic profiles without extensive sample manipulations. In the study reported here, we examined the diagnostic accuracy of NMR urine metabolite patterns for the diagnosis of neonatal and pediatric AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. A cohort of 65 neonatal and pediatric patients (0–18 years) with established AKI of heterogeneous etiology was compared to both a group of apparently healthy children (n = 53) and a group of critically ill children without AKI (n = 31). Multivariate analysis identified a panel of four metabolites that allowed diagnosis of AKI with an area under the receiver operating characteristics curve (AUC-ROC) of 0.95 (95% confidence interval 0.86–1.00). Especially urinary citrate levels were significantly reduced whereas leucine and valine levels were elevated. Metabolomic differentiation of AKI causes appeared promising but these results need to be validated in larger studies. In conclusion, this study shows that NMR spectroscopy yields high diagnostic accuracy for AKI in pediatric patients.

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Proenkephalin as a new biomarker for pediatric acute kidney injury – reference values and performance in children under one year of age

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-0381 ◽

2020 ◽

Vol 58 (11) ◽

pp. 1911-1919

Author(s):

Stan J. F. Hartman ◽

Alexandra J. M. Zwiers ◽

Nadies E. C. van de Water ◽

Joost van Rosmalen ◽

Joachim Struck ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Reference Values ◽

Kidney Injury ◽

Additive Models ◽

Critically Ill Children ◽

Healthy Children ◽

Clinical Implementation ◽

Young Infants ◽

Healthy Infants

AbstractObjectivesAcute kidney injury (AKI) is common in critically ill children, but current biomarkers are suboptimal. Proenkephalin A 119–159 (PENK) is a promising new biomarker for AKI in adults, but pediatric data is lacking. We determined PENK reference intervals for healthy children, crucial for clinical implementation, and explored concentrations in critically ill infants aged under 1 year.MethodsObservational cohort study in healthy infants and critically ill children aged 0–1 years. Reference values were determined using generalized additive models. Plasma PENK concentrations between healthy children and critically ill children with and without AKI, were compared using linear mixed modelling. The performance of PENK as AKI biomarker was compared to cystatin C (CysC) and β-trace protein (BTP) using receiver-operating-characteristic (ROC) analysis.ResultsPENK concentrations in 100 healthy infants were stable during the first year of life (median 517.3 pmol/L). Median PENK concentrations in 91 critically ill children, were significantly higher in those with AKI (n=40) (KDIGO Stage 1 507.9 pmol/L, Stage 2 704.0 pmol/L, Stage 3 930.5 pmol/L) than non-AKI patients (n=51, 432.2 pmol/L) (p < 0.001). PENK appeared to relate better to AKI diagnosis than CysC and BTP (AUROC PENK 0.858, CysC 0.770 and BTP 0.711) in the first 24 h after recruitment.ConclusionsPENK reference values are much higher in young infants than adults, but clearly discriminate between children with and without AKI, with comparable or better performance than CysC and BTP. Our results illustrate the importance of establishing age-normalized reference values and indicate PENK as a promising pediatric AKI biomarker.

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Impact of Acute Kidney Injury on Critically Ill Children and Neonates

Frontiers in Pediatrics ◽

10.3389/fped.2021.635631 ◽

2021 ◽

Vol 9 ◽

Author(s):

Bassil Leghrouz ◽

Ahmad Kaddourah

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Pediatric Patients ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Clinical Syndrome ◽

Morbidity And Mortality ◽

Critically Ill Children ◽

Critically Ill Neonates

Acute kidney injury (AKI) is a clinical syndrome that manifests as an abrupt impairment of kidney function. AKI is common in critically ill pediatric patients admitted to the pediatric intensive care units. AKI is a deleterious complication in critically ill children as it is associated with increased morbidity and mortality. This review provides an overview of the incidence, morbidity, and mortality of AKI in critically ill children in general and specific cohorts such as post-cardiac surgeries, sepsis, critically ill neonates, and post stem cell transplantation.

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Long Term Renal Outcomes in Survivors of Acute Kidney Injury in Critically-Ill Children and Neonates

Journal of Clinical Pediatric Nephrology ◽

10.15401/jcpn/2014/v2i2/66350 ◽

2014 ◽

Vol 2 (2) ◽

pp. 51

Author(s):

Kathy Lee-Son ◽

Cherry Mammen

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children ◽

Renal Outcomes

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Epidemiology of acute kidney injury in critically ill children and young adults

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563217693559 ◽

2017 ◽

Vol 54 (3) ◽

pp. 416-416

Author(s):

Yachana Kataria

Keyword(s):

Acute Kidney Injury ◽

Young Adults ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children ◽

Children And Young Adults

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Acute Kidney Injury in Critically Ill Children — An Ominous Legacy

New England Journal of Medicine ◽

10.1056/nejme1613456 ◽

2017 ◽

Vol 376 (1) ◽

pp. 82-83

Author(s):

Julie R. Ingelfinger

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children

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OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

Clinical Nutrition ◽

10.1016/s0261-5614(15)30104-7 ◽

2015 ◽

Vol 34 ◽

pp. S2

Author(s):

J.C. Silva ◽

U.G. Kyle ◽

M. Treviño ◽

J.L. Lusk ◽

G. Dardon ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Nutrition Support ◽

Critically Ill Children ◽

Support Guidelines

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Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

10.21203/rs.3.rs-111865/v1 ◽

2020 ◽

Author(s):

Hui Huang ◽

Huiting Zhou ◽

Wenwen Wang ◽

Xiaomei Dai ◽

Wenjing Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Inflammatory Mediator ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Surviving Sepsis Campaign ◽

Predictive Values ◽

Specific Setting ◽

Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

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