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Abstract: PO2281

Elevated Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Postoperative AKI

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Slagle, Cara L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Gavigan, Hailey Woollen, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Rowe, James A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Poindexter, Brenda, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Schmerge, Alexandra, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Liu, Chunyan, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Ehrlich, Shelley, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Kotagal, Meera, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Post-operative acute kidney injury (AKI) in neonates remains understudied despite occurring frequently. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) offers promise as a novel predictive biomarker for AKI, yet clinical utilization lags behind in neonatology.

Methods

Infants undergoing a general surgical procedure, excluding gastric tube placement alone, were prospectively enrolled. uNGAL samples were obtained prior to surgery and over post-operative days (POD) 0-3 at six time points. AKI was defined by the 2014 neonatal modified Kidney Diseases: Improving Global Outcomes (KDIGO) definition. Samples were processed using The NGAL Test® (BioPorto, Denmark). Generalized additive mixed effect model (GAMM) was utilized to study the longitudinal trajectory of log transformed uNGAL values. The ability to predict AKI was assessed using receiver operating characteristic curves (AUC-ROC).

Results

A total of 141 neonates underwent 192 surgical procedures. AKI occurred in 18% (35/192). Infants with AKI were more likely to have undergone an emergent procedure (63% vs. 31%, p=<0.001) and had higher uNGAL levels (Table 1). Pre-op uNGAL did not differ between AKI and no AKI patients (26ng/mL vs 59ng/mL, p=0.12). uNGAL levels were higher at all post-op time points even when controlled for pre-operative AKI (p values <0.001 to 0.0356). The AUC-ROC for predictability of post-operative AKI using uNGAL at 24 hours was 0.8 (95% CI: 0.71,0.88).

Conclusion

Post-op uNGAL predicts AKI. In patients undergoing emergent procedures, careful monitoring of renal function should be performed and uNGAL offers clinical utility. In all post-operative patients uNGAL trends could allow clinicians to better understand renal injury in real time and adjust treatment plans and/or avoid or restart nephrotoxic medications.

Table 1: Comparison of predicted uNGAL values (95% CI) following Emergent and Routine Procedures
 Preoperative uNGAL (ng/mL)12 hour uNGAL (ng/mL)24 hour uNGAL (ng/mL)36 hour uNGAL (ng/mL)48 hour uNGAL (ng/mL)72 hour uNGAL (ng/mL)96 hour uNGAL (ng/mL)
Emergent Procedures (95% CI)270 (164-403)270 (181-403)244 (164-365)244 (164-330)221 (148-330)164 (110-244)121 (81-181)
Routine Procedures (95% CI)30 (22-40)33 (25-45)37 (27-49)40 (30-55)40 (30-55)40 (30-55)37 (27-49)

Funding

  • NIDDK Support