BACKGROUND AND OBJECTIVES: The diagnostic and prognostic utility of novel and traditional AKI biomarkers was evaluated during a prospective study of 123 adults undergoing cardiac surgery.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Urinary neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CyC), kidney injury molecule-1 (KIM-1), hepatocyte growth factor (HGF), pi-glutathione-S-transferase (pi-GST), alpha-GST, and fractional excretions of sodium and urea were all measured at preoperative baseline, postoperatively, and at the time of the initial clinical diagnosis of AKI.
RESULTS: Forty-six (37.4%) subjects developed AKI Network stage 1 AKI; 9 (7.3%) of whom progressed to stage 3. Preoperative KIM-1 and alpha-GST were able to predict the future development of stage 1 and stage 3 AKI. Urine CyC at intensive care unit (ICU) arrival best detected early stage 1 AKI (AUC = 0.70, P < 0.001); the 6-hour ICU NGAL (AUC = 0.88; P < 0.001) best detected early stage 3 AKI. pi-GST best predicted the progression to stage 3 AKI at the time of creatinine increase (AUC = 0.86; P = 0.002).
CONCLUSION: Urinary biomarkers may improve the ability to detect early AKI and determine the clinical prognosis of AKI at the time of diagnosis.
- 109 subjects monitored for acute kidney injury following cardiac surgery using αGST and πGST
This publication was presented at the American Society of Nephrology in November 2008. The objective of the study was to evaluate the utility of urinary alpha (α) and pi (π) Gluthathione S-Transferase (GST) as early markers of Acute Kidney Injury (AKI) following adult cardiac surgery. Clinical characteristics of the 109 study subjects are detailed here.
The study concluded that Urinary α-GST may serve as an early diagnostic biomarker of AKI following adult cardiac surgery. Urinary π-GST is a promising early biomarker of distal tubular injury and may reliably predict the development of severe AKI as measured by AKIN network Stage 3. Additionally, it may serve a role as a severity marker of AKI at the time of clinical creatinine increase. Urinary α-GST and π-GST are promising biomarkers of the development and severity of AKI following Adult Cardiac surgery.
3) Comparison of Novel Early Biomarkers of Acute Kidney Injury (AKI) to predict the Course and Severity of AKI Developing after Cardiac Surgery
JL Koyner MD, P Devarajan MD, VS Vaidya PhD, and Murray, PT. (2009). Poster presented at the World American Society of Nephrology, San Diego, October 2009
- Evaluating the utility of urinary biomarkers Cystatin C (CyC), Neutrophil Gelatinase Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1), Hepatocyte Growth Factor (HGF), Pi-Glutathione-S-Transferase (π-GST) and α-GST as markers of Acute Kidney Injury severity, at the time ofclinical creatinine increase, following adult cardiac surgery.
