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Abstract: SA-PO596

Urine Complement Factor Ba Is an AKI Biomarker in Critically Ill Children

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Stenson, Erin K., University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • You, Zhiying, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Edelstein, Charles L., University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Miyazaki-anzai, Shinobu, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Thurman, Joshua M., University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Dixon, Bradley P., University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Zappitelli, Michael, Sick Kids Foundation, Toronto, Ontario, Canada
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Kendrick, Jessica B., University of Colorado Denver School of Medicine, Aurora, Colorado, United States
Background

Critically ill children with acute kidney injury (AKI) suffer from high morbidity and mortality and lack treatment options. Complement activation is implicated in AKI pathogenesis, which could potentially be treated with complement-targeted therapeutics. We assessed the association between urine Ba, an activated fragment of the alternative complement pathway, and AKI in a heterogeneous cohort of critically ill children.

Methods

A biorepository of critically ill children was leveraged and identified children with pRIFLE criteria AKI (stage 1 eGFR 25% decreased; stage 2 eGFR 50% decreased; stage 3 eGFR 75% decreased). ELISAs quantified urine Ba values. The log value of Ba was used in ANOVA with pairwise comparison by the Tukey method. Logistic regression tested the association between urine Ba and AKI.

Results

73 patients from the original study had urine specimens available. 17 with no AKI, 26 with stage 1, 16 with stage 2, and 14 with stage 3 AKI. Ba was higher in patients with stage 3 AKI compared to all other stages, and higher in patients with stage 2 AKI versus no AKI (Figure 1; p<0.05). Multivariate analysis showed the association between urine Ba and AKI (OR 1.40, 95% CI 1.08-1.82, p = 0.002) after adjusting for PRISM (an estimate of illness severity).

Conclusion

Urine factor Ba levels are increased in patients with AKI compared to patients without AKI. In patients with similar illness severity on admission, a doubling of urine Ba level was associated with a 40% increase in AKI diagnosis. Further studies are needed to investigate the role of complement activation in critically ill children at risk of AKI, to help stratify patients to study complement therapeutics in.

Multivariate logistic regression
VariableOR (95% CI)p-value
Urine Ba1.40 (1.08-1.82)0.0015
Urine IL-181.21 (0.60-2.42)0.60
PRISM0.99 (0.91-1.07)0.78

Funding

  • NIDDK Support