June 2015 Vol. 3 No. 6

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Original Research Article

NGAL, IL-18, and KIM-1 in urine for early assessment of the risk of developing acute kidney injury in patients undergoing cardiopulmonary bypass

Julieta Hristova¹*, Antoaneta Dimitrova², Georgi Tsaryanski², Kamen Tzatchev³ and Gencho Nachev²

¹Department of Medical Genetics, Faculty of Medicine, Medical University, Sofia, Bulgaria/ M.D. Alexandrovska University Hospital, Central Clinical Laboratory, 1431 Sofia, Bulgaria, 1 George Sofiyski Str.
²St. Ekaterina University Hospital, Sofia, Bulgaria
³Department of Clinical Laboratory and Clinical Immunology, Faculty of Medicine, Medical University, Sofia, Bulgaria

*Corresponding Author’s E-mail: julieta_sd@yahoo.com
Tel: (359) 897 958 518

Accepted June 22, 2015

Abstract

Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM-1), and interleukin 18 (IL-18) in urine are sensitive quantitative markers for early diagnosis of acute kidney injury (AKI). The purpose of this study was to demonstrate the role of uNGAL, uKIM-1, and uIL-18 for early assessment of renal function. Measurement of structural markers during the first hour’s afterextracorporeal circulation (ECC) in patients undergoing cardiopulmonary bypass (CPB) allows detection of AKI much earlier than measurement of serum creatinine (48 hours following surgery). Early diagnosis and risk stratification of developing AKI are critical for adequate therapy. Results were presented as ratios to creatinine in urine allowing better comparability and reliability for variations of instant samples were compensated. Results of thereceiver-operator-characteristic curve (ROC) analysis of uNGAL/uCreat, uKIM-1/uCreat, anduIL-18/uCreat 2 – 6 hours post-ECC demonstrated highest area under the receiver operator characteristic curve for uKIM-1/uCreat- 0.85 (95% CI 0.75 – 0.95, p<0.01). uIL-18/uCreat achieved similar results- AUC 0.83 (95% CI 0.72 – 0.94, p<0.01). The diagnostic performance of uNGAL/uCreat showed AUC 0.78 (95% CI 0.71 – 0.85, p<0.01). Using a combination of structural and functional markers demonstrated the highest predictive value for the risk of developing AKI compensating the shortcomings of independent measurements of single markers.

Keywords: Acute kidney injury, early diagnosis, cardiopulmonary bypass, urinary biomarkers