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.