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Kidney Week

Abstract: TH-PO052

Urinary Neutrophil Gelatinase Associated Lipocalin Is Elevated in Neonates Who Develop AKI After General Surgical Procedures

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Slagle, Cara L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Poindexter, Brenda, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Schmerge, Alexandra, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Gerhardt, Bradley S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Tepe, Melinda, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Kotagal, Meera, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Bondoc, Alexander, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Acute Kidney Injury (AKI) occurs commonly in critically ill neonates after surgery. AKI diagnosis by serum creatinine and urine output has significant limitations in this population. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been shown to predict AKI in many pediatric cohorts, but no study has assessed uNGAL performance to predict AKI in neonates after general surgical intervention.

Methods

Infants undergoing a surgical procedure were prospectively enrolled in this observational study. Urine was obtained pre-operatively and at 12, 24, 36, 48, 72 and 96 hours post-operatively. uNGAL was measured by The uNGAL Test™ (BioPorto, Denmark). AKI was defined by 2014 modified Kidney Disease Improving Outcomes (KDIGO) criteria. Mann-Whitney U tests were performed compare uNGAL levels of AKI and non-AKI groups.

Results

A total of 61 neonates had 70 surgical procedures at an average corrected gestational age of 41 weeks (SD ±8 weeks). AKI occurred in 18 (25%) patients. uNGAL levels above the published normative values occurred after 41 (58%) procedures - in 13 (72%) patients with AKI and in 28 (54%) patients without AKI. Post-op uNGAL values were elevated in infants with AKI with peak uNGAL values most commonly occurred approximately 48 hours after surgical intervention. (Table 1). The AUC-ROC for uNGAL to predict AKI at 48 hours was 0.74 (0.61-0.88).

Conclusion

Elevation of uNGAL occurs at 36-72 hours post-operatively in neonates who develop AKI after general surgical procedures. A substantial proportion of non-AKI patients had elevated uNGAL levels suggesting potential sub-clinical renal insult and this relationship should further be explored. Few patients were premature, however given that normative uNGAL values vary with gestational age, we intend to examine this relationship in the future.

Table 1 – Median [IQR] uNGAL levels in patients with vs. without AKI after surgery
 12 hour uNGAL24 hour uNGAL36 hour uNGAL48 hour uNGAL72 hour uNGAL96 hour uNGALMean uNGAL for all timepointsPeak uNGAL
All(n=59)(n=64)(n=64)(n=65)(n=64)(n=57)(n=71)(n=70)
No AKI (n=52)30 [15-122]20 [15-121]41 [16-117]32 [14-73]30 [11-87]31 [12-77]45 [22-136]73 [33-326]
AKI (n=18)37 [19-718]150 [28-275]114 [35-267]214 [42-463]211 [31-434]66 [14-195]20 [40-549]39 [111-1040]
p value0.230.070.040.0030.020.090.0040.005

Funding

  • Private Foundation Support