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Kamianowska M, Rybi-Szumińska A, Kamianowska A, Maciejczyk M, Sołomianko K, Koput A, Wasilewska A. The Urinary Concentration of Trefoil Factor 3 (TFF3) in the Term and Preterm Neonates. J Clin Med 2023; 12:4936. [PMID: 37568337 PMCID: PMC10419516 DOI: 10.3390/jcm12154936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Distinguishing between a pathologic state and renal development is important in neonatology. Because the assessment of serum creatinine in neonates is not reliable, better biomarkers are needed. Trefoil factor 3 (TFF3) is proposed as a biomarker of kidney injury. The study aimed to assess its urinary concentration in healthy term and stable preterm neonates. MATERIAL AND METHODS The study included 80 term and 20 preterm neonates born in the Department of Perinatology of the University Clinical Hospital in Bialystok. Urine was obtained from the term neonates on the 1st day of life and from the preterm neonates on the 1st, 8th, 15th and 22nd day of life. The urinary concentration of TFF3 was determined using a commercially available immunoassay and was normalized for the urinary creatinine concentration (cr.). RESULTS The values of TFF3/cr. were higher in the preterm than in the term neonates (p < 0.05) (median (Q1-Q3): 1486.85 (614.92-3559.18) and 317.29 (68.07-671.40) ng/mg cr.). They did not differ in the subsequent days of the preterm neonates' lives. The ROC curve for TFF3/cr. in the preterm and term neonates showed AUC = 0.751 (cut-off value = 1684.25 ng/mg cr.). CONCLUSIONS Prematurity is associated with higher urinary excretion of TFF3. Male gender is associated with an increased urinary TFF3 excretion in term neonates.
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Affiliation(s)
- Monika Kamianowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, M. C. Sklodowskiej 24a Street, 15-276 Białystok, Poland;
| | - Agnieszka Rybi-Szumińska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-269 Bialystok, Poland (A.K.)
| | - Aleksandra Kamianowska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-269 Bialystok, Poland (A.K.)
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomic, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Katarzyna Sołomianko
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, M. C. Sklodowskiej 24a Street, 15-276 Białystok, Poland;
| | - Alicja Koput
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-269 Bialystok, Poland (A.K.)
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Martini S, Vitali F, Capelli I, Donadei C, Raschi E, Aiello V, Corvaglia L, De Ponti F, Poluzzi E, Galletti S. Impact of nephrotoxic drugs on urinary biomarkers of renal function in very preterm infants. Pediatr Res 2022; 91:1715-1722. [PMID: 34897282 DOI: 10.1038/s41390-021-01905-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/01/2021] [Accepted: 11/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Following preterm birth, the immature kidney is exposed to several harmful conditions, with an increased risk of renal impairment. We aimed to assess urinary biomarkers of renal function in very preterm infants during early nephrotoxic treatments. METHODS Infants ≤32 weeks' gestation and ≤1500 g were enrolled in this observational prospective study. Urine samples were collected on day 1(T1), 2-4(T2), 5-7(T3), 8-10(T4), 11-13(T5). The following urinary biomarkers were determined: osteopontin (uOPN), epidermal growth factor (uEGF), neutrophil gelatinase-associated lipocalin (uNGAL), cystatin C (uCysC). The infants were grouped according to their exposure to amikacin or ibuprofen during the study period and a between-group comparison of urinary biomarkers at each time point was performed. RESULTS Thirty-six infants were included. Urinary CysC, uOPN, and uNGAL rose significantly during ibuprofen or amikacin treatment, while no difference was observed for uEGF. After adjustment for possible influencing factors, amikacin administration was associated with higher uCysC at T1 (p = 0.007) and T2 (p = 0.016), whereas ibuprofen increased uOPN (p = 0.001) and uNGAL concentration (p = 0.009) at T3. CONCLUSION Nephrotoxic therapies induce molecule-specific change patterns of renal function biomarkers in treated preterm infants. Serial assessments of these biomarkers may aid to identify neonates at risk of renal impairment and to develop tailored therapeutic approaches. IMPACT Despite the wide use of nephrotoxic therapies in neonatal settings, little is known on their effect on renal function biomarkers in preterm infants. This study describes molecule-specific change patterns of urinary biomarkers during ibuprofen and amikacin administration, suggesting underlying pathophysiological effects on renal function. Given their low analytical costs and non-invasive collection, the urinary biomarkers investigated in this study represent a promising strategy for serial monitoring of renal function in at-risk neonates and may aid the early detection of renal function impairment at different kidney levels during nephrotoxic treatments.
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Affiliation(s)
- Silvia Martini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. .,Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Francesca Vitali
- Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Nephrology, Dialysis and Renal Transplant Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Chiara Donadei
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Nephrology, Dialysis and Renal Transplant Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Nephrology, Dialysis and Renal Transplant Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Corvaglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Galletti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Neonatal Intensive Care Unit, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
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Capelli I, Vitali F, Zappulo F, Martini S, Donadei C, Cappuccilli M, Leonardi L, Girardi A, Aiello V, Galletti S, Faldella G, Poluzzi E, DE Ponti F, Gaetano LAM. Biomarkers of Kidney Injury in Very-low-birth-weight Preterm Infants: Influence of Maternal and Neonatal Factors. In Vivo 2021; 34:1333-1339. [PMID: 32354927 DOI: 10.21873/invivo.11910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM Acute kidney injury is an important cause of mortality in very-low-birth-weight (VLBW) preterm infants. As in the general population, the detection of renal damage cannot rely on the measurement of serum creatinine, since it has been demonstrated to be a weak predictor and a delayed indicator of kidney function deterioration. However, several candidate biomarkers have failed to prove sufficient specificity and sensitivity for a routine clinical use because of the poor awareness of their biological role. This study was aimed to investigate the impact of different maternal and neonatal conditions on several renal biomarkers in VLBW preterm infants during the first week of life. PATIENTS AND METHODS Preterm infants<32 weeks' gestation and <1500g were enrolled. We measured urinary biomarkers kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, epidermal growth factor (EGF) and osteopontin (OPN) on the 1st, 3rd, and 7th day after birth. RESULTS Thirty-tree infants were included. The multivariate analysis showed a significant association between gestational age, the presence of patent ductus arteriosus, antenatal maternal hypertension and the levels of urinary biomarkers. CONCLUSION There is a possible relation between early biomarkers of renal injury and antenatal, perinatal and post-natal characteristics in VLBW preterm infants during the first week of life.
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Affiliation(s)
- Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesca Vitali
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Martini
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Chiara Donadei
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Luca Leonardi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Anna Girardi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Galletti
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Fabrizio DE Ponti
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - LA Manna Gaetano
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Cappuccilli M, Capelli I, Comai G, Cianciolo G, La Manna G. Neutrophil Gelatinase-Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights. Artif Organs 2017; 42:8-14. [PMID: 29266311 PMCID: PMC5814881 DOI: 10.1111/aor.13039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/22/2017] [Accepted: 08/21/2017] [Indexed: 12/12/2022]
Abstract
Neutrophil gelatinase‐associated lipocalin (NGAL), a protein belonging to the lipocalin superfamily initially found in activated neutrophils, is expressed by several cell types, including kidney tubule. The increase in NGAL production and release from tubular cells in response to various insults has been proven to predict acute kidney injury (AKI). For this reason, it has emerged as a valuable noninvasive biomarker of AKI in clinical nephrology. Also in the renal transplant setting, different studies have indicated NGAL as a valuable tool, especially in the early postoperative period, since the currently available clinical and laboratory parameters remain poorly sensitive to monitor immediate posttransplant graft function. This is an analysis of the recent literature to assess the utility of plasma and urinary NGAL, exosomal mRNA for NGAL, and NGAL levels in the perfusate of machine‐perfused kidneys for the prediction of graft function recovery in the early postsurgery phase after renal transplantation. We found that NGAL appears as a promising troponin‐like biomarker to detect short‐term impairment of graft function after renal transplant, but there are still some limitations in its clinical application, essentially related to its low specificity. Moreover, comparing NGAL assayed in serum, urine, machine‐perfusate, or as exosomal mRNA, each one has shown limitations and benefits in terms of predictive performance for DGF, according to various existing studies, feasibly due to different cut‐off levels, designs and patient sample sizes.
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Affiliation(s)
- Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Cianciolo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
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Shin SY, Ha JY, Lee SL, Lee WM, Park JH. Increased urinary neutrophil gelatinase-associated lipocalin in very-low-birth-weight infants with oliguria and normal serum creatinine. Pediatr Nephrol 2017; 32:1059-1065. [PMID: 28083702 DOI: 10.1007/s00467-016-3572-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND In infants, oliguria is defined as a urine output of <1.5 mL/kg/h. The aim of our study was to assess the impact of oliguria on urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C (CysC) levels in very-low-birth-weight infants (VLBWIs) with a normal serum creatinine (Cr) level. METHODS Fifty-seven VLBWIs were enrolled in the study. Urinary NGAL, serum CysC and Cr levels and urinary NGAL/Cr ratios were measured. Infants with Apgar scores of >5 at 5 min and/or a serum Cr level of >1.5 mg/dL or those treated for patent ductus arteriosus were excluded. In case of antibiotic treatment, blood and urine samples were collected at ≥48 h after discontinuation of antibiotic treatment. RESULTS There was a significant difference in gestational age between infants with oliguric episodes during hospitalization and those without, but not in birth weight, perinatal or postnatal factors. Gestational age was negatively correlated with urinary NGAL and serum CysC levels and urinary NGAL/Cr ratio (p < 0.05), whereas postnatal age was negatively correlated with serum Cr level and urinary NGAL/Cr ratio (p < 0.05). Of the 117 urine and blood samples collected, 25 (21.4%) were obtained from neonates with oliguric episodes. After adjusting for gestational age and postnatal age, comparison of samples collected in infants with and without oliguric episodes revealed significant differences in the mean level of urinary NGAL and in the urinary NGAL/Cr ratio, but not in mean serum CysC or serum Cr levels. The urinary NGAL level [area under the curve (AUC) 0.886, 95% confidence interval (CI) 0.814-0.937] and urinary NGAL/Cr ratio (AUC 0.853, 95% CI 0.775-0.911) showed significantly greater discrimination for oliguria than serum CysC (AUC 0.610, 95% CI: 0.515-0.699) or serum Cr (AUC 0.747, 95%CI 0.659-0.823) levels. CONCLUSIONS Urinary NGAL level and urinary NGAL/Cr ratio were more sensitive markers for the presence of oliguria in VLBWIs with normal serum Cr levels than serum CysC level.
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Affiliation(s)
- So Young Shin
- Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-Ro, Jung-gu, Daegu, 700-712, South Korea
| | - Ji Yong Ha
- Department of Urology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Sang Lak Lee
- Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-Ro, Jung-gu, Daegu, 700-712, South Korea
| | - Won Mok Lee
- Department of Laboratory Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Jae Hyun Park
- Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-Ro, Jung-gu, Daegu, 700-712, South Korea.
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Miklaszewska M, Korohoda P, Kwinta P, Zachwieja K, Tomasik T, Kiliś-Pstrusińska K, Drożdż D. Reference ranges and impact of selected confounders on classic serum and urinary renal markers in neonatal period. Adv Med Sci 2017; 62:143-150. [PMID: 28315591 DOI: 10.1016/j.advms.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/28/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Renal injury in term and pre-term neonates may be an antecedent to chronic kidney disease in the child's further life. The aim of the paper was to compile a reference range for selected serum and urinary renal markers in the neonatal period for full-term (FT) and pre-term (PT) newborns. MATERIAL AND METHODS The prospective study included 23 FT infants (birth weight - BW≥2500g and gestational age - GA≥37Hbd) and 32 PT children (BW<2500g and GA<37Hbd) in good general condition, without acute kidney injury (AKI) or sepsis. Between the 4th and 28th DOL, urinary concentrations of the studied renal markers (uCr, uNa, uOsm) were determined on a daily basis, while serum creatinine (SCr) was assessed minimum every 48-72h. RESULTS The mean GA and BW of the FT and PT infants were respectively as follows: 38.5±1.7Hbd; 3433±495.2g and 32.7±2.6Hbd; 1836.7±419.8g. For serum glomerular (SCr, eGFR) and tubular markers (FENa, RFI), the median values with normal ranges were compiled. For urinary renal markers (uCr, uNa, uOsm) and those values standardized for kg of body weight, percentile tables for 4-28DOL were elaborated. CONCLUSIONS The study has resulted in determining the normal ranges of serum glomerular and tubular renal markers, as well as percentile tables of selected urinary renal parameters during the neonatal period. The percentile tables may prove to be helpful for further standardization of other urinary parameters per urinary creatinine in neonatal population.
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Affiliation(s)
- Monika Miklaszewska
- Department of Pediatric Nephrology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
| | - Przemysław Korohoda
- AGH University of Science and Technology, Faculty of Computer Science, Electronics and Telecommunications, Department of Electronics, Cracow, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Zachwieja
- Department of Pediatric Nephrology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Tomasik
- Department of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Dorota Drożdż
- Department of Pediatric Nephrology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
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Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study. BMC Pediatr 2017; 17:7. [PMID: 28068947 PMCID: PMC5223413 DOI: 10.1186/s12887-016-0761-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background A patent ductus arteriosus (PDA) is frequently found in very preterm neonates and is associated with increased risk of morbidity and mortality. A shunt across a PDA can result in an unfavorable distribution of the cardiac output and may in turn result in poor renal perfusion. Urinary Neutrophil Gelatinase-associated Lipocalin (U-NGAL) is a marker of renal ischemia and may add to the evaluation of PDA. Our primary aim was to investigate if U-NGAL is associated with PDA in very preterm neonates. Secondary, to investigate whether U-NGAL and PDA are associated with AKI and renal dysfunction evaluated by fractional excretion of sodium (FENa) and urine albumin in a cohort of very preterm neonates. Methods A cohort of 146 neonates born at a gestational age less than 32 weeks were consecutively examined with echocardiography for PDA and serum sodium, and urine albumin and sodium were measured on postnatal day 3 and U-NGAL and serum creatinine day 3 and 6. AKI was defined according to modified neonatal Acute Kidney Injury Network (AKIN) criteria. The association between U-NGAL and PDA was investigated. And secondly we investigated if PDA and U-NGAL was associated with AKI and renal dysfunction. Results U-NGAL was not associated with a PDA day 3 when adjusted for gestational age and gender. A PDA day 3 was not associated with AKI when adjusted for gestational age and gender; however, it was associated with urine albumin. U-NGAL was not associated with AKI, but was found to be associated with urine albumin and FENa. Conclusions Based on our study U-NGAL is not considered useful as a diagnostic marker to identify very preterm neonates with a PDA causing hemodynamic changes resulting in early renal morbidity. The interpretation of NGAL in preterm neonates remains to be fully elucidated.
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Kuribayashi R, Suzumura H, Sairenchi T, Watabe Y, Tsuboi Y, Imataka G, Kurosawa H, Arisaka O. Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants. Exp Ther Med 2016; 12:3706-3710. [PMID: 28105101 PMCID: PMC5228453 DOI: 10.3892/etm.2016.3837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/20/2016] [Indexed: 12/22/2022] Open
Abstract
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is produced in response to tubular epithelial injury and is a biomarker of tubulointerstitial injury. The aim of the present study was to examine whether acute kidney injury (AKI) could be predicted by measuring uNGAL in very low-birth weight (VLBW) infants. Forty VLBW infants with birthweight below 1,500 g were enrolled in the present study. uNGAL and serum creatinine (sCre) were measured daily from postnatal days 0 to 8. Infants with sCre ≥1.2 mg/dl were diagnosed with AKI. The relationship of uNGAL with sCre was measured on the day after uNGAL measurement (next-day sCre) was examined. The results showed that 16 infants had sCre ≥1.2 mg/dl in this period. Logistic regression analysis revealed that uNGAL on postnatal days 2, 3, 4, 5 and 6 was correlated with next-day sCre (P<0.05). uNGAL corrected by urinary Cre (uCre) (uNGAL/uCre) was only correlated with an increase in next-day sCre on postnatal days 5 and 6 (P<0.05). For the logistic analysis, subjects with high and low uNGAL levels based on the median value for each day, uNGAL on postnatal days 2, 3 and 6 in the high uNGAL group was correlated with an increase in next-day sCre. Thus, AKI may be predicted by measuring uNGAL in VLBW infants. This measurement was non-invasive, and is potentially useful for the evaluation of renal function in VLBW infants.
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Affiliation(s)
- Ryota Kuribayashi
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Yoshiyuki Watabe
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Yayoi Tsuboi
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - George Imataka
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Hidemitsu Kurosawa
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
| | - Osamu Arisaka
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi 321-0293, Japan
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DeFreitas MJ, Seeherunvong W, Katsoufis CP, RamachandraRao S, Duara S, Yasin S, Zilleruelo G, Rodriguez MM, Abitbol CL. Longitudinal patterns of urine biomarkers in infants across gestational ages. Pediatr Nephrol 2016; 31:1179-88. [PMID: 26862052 DOI: 10.1007/s00467-016-3327-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Urinary biomarkers may be indicators of acute kidney injury (AKI), although little is known of their developmental characteristics in healthy neonates across a full range of gestational age (GA). The purpose of this study was to examine patterns of urinary biomarkers across GA groups from birth to 3 months of age. METHODS Fifty-two infants ranging from 24 to 41 weeks' GA had urine assayed from birth through 3 months of age for 7 biomarkers including albumin (ALB), beta-2-microglobulin (B2M), cystatin-C (CysC), epidermal growth factor (EGF), neutrophil-gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and uromodulin (UMOD). RESULTS Of the seven urinary biomarkers, EGF and UMOD increased while others decreased with advancing GA. By 3 months of age, EGF and UMOD had increased in preterm infants to levels similar to those of term infants. UMOD/ml and EGF/ml appeared to be predominantly developmental biomarkers distinguishing estimated glomerular filtration rate (GFR) <30 ml/min/1.73 m(2) with receiver operator characteristic area under the curve (ROC-AUC) of 0.82; p = 0.002. When factored by urine creatinine CysC/cr + ALB/cr were the most significant functional markers with AUC = 0.79; p = 0.004; sensitivity 96 %; specificity 58 %. CONCLUSIONS Among healthy neonates, urinary biomarkers vary with GA. These data support the use of urinary biomarkers in the assessment of normal kidney development in the absence of injury.
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Affiliation(s)
- Marissa J DeFreitas
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA.
| | - Wacharee Seeherunvong
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
| | - Chryso P Katsoufis
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
| | - Satish RamachandraRao
- O'Brien Center for AKI Research, UC San Diego School of Medicine, San Diego, CA, USA
| | - Shahnaz Duara
- Division of Neonatology, University of Miami/Holtz Children's Hospital, Miami, FL, USA
| | - Salih Yasin
- Division of Perinatology and Obstetrics, University of Miami/Holtz Children's Hospital, Miami, FL, USA
| | - Gaston Zilleruelo
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
| | - Maria M Rodriguez
- Division of Pediatric Pathology, University of Miami/Holtz Children's Hospital, Miami, FL, USA
| | - Carolyn L Abitbol
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
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Abstract
Only a small fraction of drugs widely used in neonatal intensive care units (NICU) are specifically authorized for this population. Even if unlicensed or off-label use is necessary, it is associated with increased adverse drug reactions, which must be carefully weighed against expected benefits. In particular, renal damage is frequent among preterm babies, and is considered a predisposing factor for the development of chronic kidney disease in adulthood. Apart from specific conditions affecting premature neonates (e.g. respiratory distress syndrome, perinatal asphyxia), drugs play an important role in impairing renal function because of well-known nephrotoxicity and/or interaction with renal developmental factors. From a review of the available studies on drug use in NICU patients, we identified and described the most commonly administered drugs that are correlated to renal damage. Early detection of kidney injury is becoming an essential aspects for clinicians because of the limited number of biomarkers applicable in the neonatal population. Postnatal changes of biochemical processes that influence pharmacokinetic and pharmacodynamic aspects need to be further investigated in order to better understand the mechanisms of drug toxicity in this population. The most promising strategies for dose adjustment and therapeutic schemes are discussed. The purpose of this review was to describe current knowledge on drug use among premature babies and their implication in kidney injury development, as well as to highlight available strategies for early detection of renal damage.
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Serum neutrophil gelatinase-associated lipocalin as a predictor of the development of bronchopulmonary dysplasia in preterm infants. Early Hum Dev 2013; 89:425-9. [PMID: 23332549 DOI: 10.1016/j.earlhumdev.2012.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/18/2012] [Accepted: 12/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic lung disease mostly occurring in preterm infants. The pathogenesis of BPD involves early inflammation and remodeling of the premature lung. AIM To search for the novel predictive marker of BPD development, we studied serum levels of neutrophil gelatinase-associated lipocalin (NGAL), an innate immune mediator, in preterm infants. METHODS Serum NGAL concentrations at birth were measured by enzyme-linked immunosorbent assay. The reference levels were determined in 52 infants having no anomalies or inherited diseases. The levels and clinical variables were assessed in association with BPD. RESULTS Geometric means (95%CI) of serum NGAL levels at birth of infants having no underlying diseases were 32.4 (22.1-47.5), 58.6 (47.9-71.8), and 126.2 (99.0-168.7) ng/mL for <31, 31-36 and >36 gestational weeks (GW), respectively (p<0.001). These levels positively correlated with neutrophil (p<0.0001) or monocyte counts (p<0.0001). The median NGAL levels (307.8 ng/mL) and neutrophil counts (4141/μL) at birth of 16 preterm infants (<31 GW) who developed BPD were higher than those (42.9 ng/mL and 1357/μL) of 20 infants (<31 GW) who did not (p<0.0001 and p=0.012), respectively. In multivariable analysis for 36 infants born less than 31 GW, higher NGAL levels (≥ 82 ng/mL) but not neutrophil counts at birth had a significant association with developing BPD (gestational-age adjusted odds ratio [OR]=37.45 [3.08-455.49], p<0.01). CONCLUSIONS High serum levels of NGAL at birth could be an early sensitive marker for BPD in preterm infants, because their levels were physiologically low.
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12
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Abstract
BACKGROUND Acute kidney injury (AKI) is a major complication for infants following an asphyxic insult at birth. We aimed to determine if kidney structure and function were affected in an animal model of birth asphyxia and if maternal dietary creatine supplementation could provide an energy reserve to the fetal kidney, maintaining cellular respiration during asphyxia and preventing AKI. METHODS Pregnant spiny mice were maintained on normal chow or chow supplemented with creatine from day 20 gestation. On day 38 (term ~39 d), pups were delivered by cesarean section (c-section) or subjected to intrauterine asphyxia. Twenty-four hours after insult, kidneys were collected for histological or molecular analysis. Urine and plasma were also collected for biochemical analysis. RESULTS AKI was evident at 24 h after birth asphyxia, with a higher incidence of shrunken glomeruli (P < 0.02), disturbance to tubular arrangement, tubular dilatation, a twofold increase (P < 0.02) in expression of Ngal (early marker of kidney injury), and decreased expression of the podocyte differentiation marker nephrin. Maternal creatine supplementation prevented the glomerular and tubular abnormalities observed in the kidney at 24 h and the increased expression of Ngal. CONCLUSION Maternal creatine supplementation may prove useful in ameliorating kidney injury associated with birth asphyxia.
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