Faculty Collaboration Database

Urinary interleukin-18 and urinary neutrophil gelatinase-associated lipocalin predict acute kidney injury following pulmonary valve replacement prior to serum creatinine. Congenit Heart Dis 2012;7(5):441-7

Date

04/28/2012

Pubmed ID

22537138

DOI

10.1111/j.1747-0803.2012.00662.x

Scopus ID

2-s2.0-84866460526 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

BACKGROUND: It is becoming increasingly recognized that manifestations of congenital heart disease (CHD) extend beyond the cardiovascular system. The factors contributing to renal dysfunction in patients with CHD are multifactorial, with acute kidney injury (AKI) at time of cardiac surgery playing a major role. AKI is often diagnosed based on changes in serum creatinine and estimated glomerular filtration rate (eGFR). Such measurements are often late and imprecise. Recent data indicate that urinary biomarkers interleukin-18 (IL-18) and neutrophil gelatinase-associated lipocalin (NGAL) are earlier markers of AKI. We sought to determine the efficacy of urinary IL-18 and NGAL for detecting early AKI in patients undergoing surgical pulmonary valve replacement (PVR).

METHODS: Twenty patients presenting for surgical PVR with a history of previous repair of a conotruncal anomaly were enrolled. Preoperative clinical data were measured and urine samples and serum creatinine were collected at 6, 12, 24, and 72 hours post bypass. Urine was evaluated for NGAL and IL-18. AKI was determined using the Risk, Injury, Failure, Loss and End Stage Renal Disease (RIFLE) classification system.

RESULTS: Using the RIFLE classification system, seven patients (35%) were found to have AKI defined as a drop in the eGFR or an increase in serum creatinine. All seven patients with AKI had marked increase from preoperative baseline in urine IL-18 (sixfold) and NGAL (26-fold). Using NGAL and IL-18, AKI was detected at 6 hours postoperatively, resulting in AKI being identified 12-36 hours prior to detection by conventional methods. No preoperative predictors for AKI were identified.

CONCLUSION: Both NGAL and IL-18 are early predictive biomarkers of AKI, and both increase in tandem after surgical PVR. Importantly, both rise before an increase in creatinine or a decrease in eGFR is present. Monitoring both biomarkers may allow for earlier detection and subsequent interventions to prevent AKI at time of surgery for CHD.

Author List

Buelow MW, Dall A, Regner K, Weinberg C, Bartz PJ, Sowinski J, Rudd N, Katzmark L, Tweddell JS, Earing MG

Authors

Peter J. Bartz MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Matthew W. Buelow MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Aaron Dall MD Associate Professor in the Medicine department at Medical College of Wisconsin
Lindsey M. Katzmark RN APP Hybrid in the Pediatrics department at Medical College of Wisconsin
Kevin R. Regner MD Interim Chair, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Acute-Phase Proteins
Adolescent
Adult
Biomarkers
Child
Child, Preschool
Creatinine
Early Diagnosis
Female
Glomerular Filtration Rate
Heart Valve Prosthesis Implantation
Humans
Interleukin-18
Lipocalin-2
Lipocalins
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Proto-Oncogene Proteins
Pulmonary Valve
Time Factors
Treatment Outcome
Up-Regulation
Young Adult