Background/Aims: We hypothesized that sepsis could have an impact on the sensitivity of serum and urinary neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) for acute kidney injury (AKI) diagnosis in critically ill children. Methods: Serum NGAL (sNGAL) and urinary NGAL (uNGAL) and CysC were measured daily in the first 48 h from pediatric intensive care unit admission in 11 consecutive critically ill children with severe sepsis; a single measurement was made in a population of 10 healthy controls undergoing minor ambulatory surgery to exclude possible biases in the laboratory methods. Results: uNGAL, serum CysC (sCysC), and urinary CysC (uCysC) levels were significantly increased in patients with septic AKI compared with septic patients without AKI, while sNGAL levels were not significantly different between septic patients with and without AKI. Median serum creatinine levels did not show significant differences between AKI and non-AKI patients. Conclusions: uNGAL, sCysC and uCysC were not altered by sepsis and were good predictors of AKI. In a septic state, sNGAL alone did not discriminate patients with AKI from those without AKI.

1.
Bagshaw S, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H, D’amico G, Goldsmith D, Devarajan P, Bellomo R: Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med 2010;36:452–461.
2.
Wheeler DS, Devarajan P, Ma Q, Harmon K, Monaco M, Cvijanovich N, Wong HR: Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med 2008;36:1297–1303.
3.
Bailey D, Phan V, Litalien C, Ducruet T, Mérouani A, Lacroix J, Gauvin F: Risk factors of acute renal failure in critically ill children: a prospective descriptive epidemiological study. Pediatr Crit Care Med 2007;8:29–35.
4.
Abraham BP, Frazier EA, Morrow WR, Blaszak RT, Devarajan P, Mitsnefes M, Bryant JC, Sachdeva R: Cystatin C and neutrophil gelatinase-associated lipocalin as markers of renal function in pediatric heart transplant recipients. Pediatr Transplant 2011;15:564–569.
5.
Tomino Y: Serum cystatin C. Contrib Nephrol. Basel, Karger, 2001, vol 134, pp 82–84.
6.
Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, et al: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009;37:666–688.
7.
Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL: Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028–1035.
8.
Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Katz RW, Steinhart CM: Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 1987;111:324–328.
9.
Hariharan S, Krishnamurthy K, Grannum D: Validation of Pediatric Index of Mortality-2 scoring system in a pediatric intensive care unit, Barbados. J Trop Pediatr 2011;57:9–13.
10.
Martensson J, Bell M, Oldner A, Xu S, Venge P, Martling CR: Neutrophil gelatinase-associated lipocalin in adult septic with and without acute kidney injury. Intensive Care Med 2010;36:1333–1340.
11.
Soni SS, Ronco C, Katz N, Cruz DN: Early diagnosis of acute kidney injury: the promise of novel biomarkers. Blood Purif 2009;28:165–174.
12.
Lisowska-Myjak B: Serum and urinary biomarkers of acute kidney injury. Blood Purif 2010;29:357–365.
13.
Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, Parikh CR, Goldstein SL: Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care 2007;11:R84.
14.
Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P: Neutrophil gelatinase-associated lipocalin as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231–1238.
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