ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO083

Usefulness of L-FABP as a Predictive Biomarker of AKI in Children with Cancer

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Yamanouchi, Sohsaku, Kansai Medical University, Hirakata-shi, Japan
  • Kimata, Takahisa, Kansai Medical University, Hirakata-shi, Japan
  • Tsuji, Shoji, Kansai Medical University, Hirakata-shi, Japan
  • Kaneko, Kazunari, Kansai Medical University, Hirakata-shi, Japan
Background

Acute kidney injury (AKI) is one of severe complications during the course of administration of anti-cancer chemotherapy. Lahoti et al. have reported that 36% of adults with acute myelogenous leukemia or high-risk myelodysplastic syndrome developed AKI associated with chemotherapy, and 8-week mortality rates were approximately 15% in patients with AKI compared to 3% in non-AKI patients (Lahoti A, Cancer, 2010). Therefore, early and accurate diagnosis of AKI is essential even in children though the available information is scarce.
Purpose: To identify predictive biomarkers of AKI in children with pediatric cancers.

Methods

We enrolled 16 children with cancer (acute leukemia in 11, and brain tumor in 5). Pediatric-modified RIFLE criteria modified by AKI Network were used to evaluate AKI. Urine samples were evaluated for: TP, Alb, NAG, BMG, and L-FABP. We obtained laboratory data thrice a week in 16 children with cancers who received 58 courses of chemotherapy consisting of Vincristine, Cisplatin, Cyclophosphamide, Carboplatin, Etoposide, Daunorubicin, L-asparaginase and Methotrexate. A course was between 4 and 8 weeks. AKI was noted in 14 out of 16 patients (87.5%) and 31 (53.4%) of 58 courses. Values of urinary biomarkers such as TP, Alb, NAG, BMG, and L-FABP were corrected using creatinine and compared between the courses with regard to patients showing AKI (n=31) and those without AKI (n=27). To assess the usefulness of these biomarkers in predicting AKI during chemotherapy, the receiver operating characteristic (ROC) curve was analyzed using the maximum value before developing AKI.

Results

Among urinary biomarkers, L-FABP and BMG (median value 15.5 μg/gCr and 320 μg/mgCr), demonstrated significantly higher levels in children who developed AKI than values in children without AKI (median value 6.8 μg/gCr and 201 μg/mgCr, P = 0.0007 and 0.003). Among the area under the curve in receiver operating characteristic curve calculated for each urinary biomarker, urinary L-FABP yielded the highest value: L-FABP (0.75) > BMG (0.72) > TP (0.64) > Alb (0.61) > NAG (0.53). Using the point on the curve closest to the (0, 1) point, cut-off for urinary L-FABP was 8.53 μg/gCr. Test sensitivity was 77.4 %, and specificity was 63.3 %.

Conclusion

We conclude that L-FABP is a possible predictive biomarker of AKI in children with cancer undergoing chemotherapy.