Abstract: SA-PO040

NephroCheck AKIScore for AKI Prediction in Pregnancy

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Joslin, Jennifer R., King's College London, London, United Kingdom
  • Hassan-reshat, Sittiga, Guy's & St Thomas' Hospital , London, United Kingdom
  • Ostermann, Maria, Guy's & St Thomas' Hospital , London, United Kingdom
  • Conti-Ramsden, Frances I, King's College London, London, United Kingdom
  • Gill, Carolyn, King's College London, London, United Kingdom
  • Chappell, Lucy C., King's College London, London, United Kingdom
  • Bramham, Kate, King's College London, London, United Kingdom
Background

NephroCheck AKIScore is a urinary assay of G1 cell cycle arrest markers: Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) and Insulin-like Growth Factor Binding Protein-7 (IGFBP-7). Numerous studies have demonstrated incremental risk Acute Kidney Injury (AKI) with AKIScores >0.3 and 2.0 (ng/ml)2/103 but its predictive role in pregnancy is unknown

Aims: To determine AKIScore predictive value for AKI in pregnancy; to explore relationships between AKIScore and gestation, protein-creatinine ratio (uPCR) and pre-eclampsia diagnosis (PE).

Methods

Women recruited to the Pre-EclampsiA, Chronic Hypertension, rEnal and SLE (PEACHES) study with suspected or confirmed PE without pre-existing maternal disease with ≥1 creatinine concentration after baseline urine sampling were included. Urinary AKIScore (TIMP-2*IGFBP-7) was assessed. AKI was defined according to KDIGO criteria.

Results

116 women were included with Median creatinine 58μmol/L (IQR 52-66) at baseline. Proportion of women according to AKIScore thresholds are shown in Table 1. AKIScore >2.0 had high specificity (94.7%; 95% CI: 85.4-98.9) and NPV (92.9%; 84.8-96.8) but low sensitivity (33.3%; 0.8-90.7) and PPV (25.0%; 4.6-70.0) for prediction of AKI within 48 hours; AKIScore >0.3 had low sensitivity and specificity (<50%). 31 (54%) of women without AKI had AKIScore >0.3 (25-31% risk of AKI in non-pregnant populations).

86 women had a repeat creatinine within 7 days. There was no relationship between AKIScore and baseline or peak creatinine within 7 days. There was no difference in AKIScore between women with (Median 0.4; Range 0-8.4) and without PE (0.3; 0.1-1.5) and no correlations between AKIScore and uPCR or gestation.

Conclusion

The majority of women with suspected or confirmed PE had high AKIScores without developing AKI which were independent of gestation or PE diagnosis. Further study to determine if different AKIScore thresholds are required for prediction of pregnancy AKI is needed, and if pregnancy and/or PE are associated with subclinical renal tubular stress.

Table 1: AKIScore and development of AKI within 48 hours
AKIScore (ng/ml)2/103AKINo AKI
≤0.32
(66.6%)
26
(45.6%)
0.3-2.0028
(49.1%)
>2.01
(33.3%)
3
(5.3%)
Median AKIScore (range)0.23
(0.22-3.64)
0.32
(0-8.44)