Introduction: The value of biomarkers at the time of nephrology consultation in predicting the prognosis of acute kidney injury (AKI) in hospitalized patients has not been well described. This study aimed to evaluate the possibility of biomarkers at the time of nephrology consultation in predicting the prognosis of AKI. Methods: We prospectively enrolled 103 hospitalized patients who developed AKI. Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL), IL-6, IL-18, N-Acetyl-F-D-Glucosaminidase (NAG), and serum Cystatin C (CysC) were measured at the time of nephrology consultation. Baseline values of serum creatinine (bScr), serum creatinine on consultation (cScr) and the peak level of serum creatinine (pScr) were recorded. All the patients were followed-up till 28 days since consultation. Serum and urinary levels of the biomarkers were compared according to the patient or kidney prognosis. Each marker was assessed for its predictive value using receiver operator characteristic (ROC) curves to predict AKI prognosis. Results: Patients were aged 54.28 w 19.05. Male patients constituted 65% of the study group and baseline Scr was 93.54 w 35.98 Vmol/l. The mortality rate of the patients was 25.2% and kidney loss rate was 18.8% at 28 days after consultation. The level of urinary NGAL was significantly higher in death patients than that in survival patients [147.00 (31.59, 221.87) Vg/ml vs. 22.43 (6.48, 89.77) Vg/ml, p = 0.001], while the level of bScr, cScr, pScr, urinary IL-6 and NAG were similar in both these groups. The AUC of urinary NGAL for predicting patients' death was 0.723 (p = 0.001). Serum CysC and urinary IL-18 concentration was higher in the death patients with a marginal p value (p = 0.065 and 0.059 respectively). All the urinary markers, including NAG, NGAL, IL-6 and IL-18 were significantly higher in patients with kidney loss than in those with kidney survival, while no difference was found in Scr and serum CysC levels. The AUCs of these urinary biomarkers for predicting kidney survival were 0.663, 0.655, 0.705 and 0.663 respectively (p < 0.05). The concentrations of cScr, pScr, serum CysC, urinary IL-6 and NGAL were significantly higher in RRT patients (p < 0.05). The AUCs for predicting RRT were 0.628, 0.781, 0.768, 0.672 and 0.775 respectively. Conclusions: The level of biomarkers at the time of nephrology consultation might predict the prognosis of AKI in hospitalized patients. Further studies should be done to understand the role of the serum and urinary markers in the prognosis of AKI. i 2014 S. Karger AG, Basel

1.
Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL: Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol 2006;1:43-51.
2.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365-3370.
3.
Bellomo R: The epidemiology of acute renal failure: 1975 versus 2005. Curr Opin Crit Care 2006;12:557-560.
4.
Lu R, Yucheng Yan Y, et al: The incidence prognosis and risk factors of acute kidney injury in hospitalized patients. Chin J Nephrol 2012;28,3:194-200.
5.
Cruz DN, Ronco C: Acute kidney injury in the intensive care unit: current trends in incidence and outcome. Crit Care 2007;11:149.
6.
Costa E, Silva VT, Liano F, Muriel A, Diez R, de Castro I, Yu L: Nephrology referral and outcomes in critically ill acute kidney injury patients. PLoS One 2013;8:e70482.
7.
Perianayagam MC, Seabra VF, Tighiouart H, Liangos O, Jaber BL: Serum cystatin C for prediction of dialysis requirement or death in acute kidney injury: a comparative study. Am J Kidney Dis 2009;54:1025-1033.
8.
Kumpers P, Hafer C, Lukasz A, Lichtinghagen R, Brand K, Fliser D, Kielstein JT: Serum neutrophil gelatinase-associated lipocalin at inception of renal replacement therapy predicts survival in critically ill patients with acute kidney injury. Crit Care 2010;14:R9.
9.
Siew ED, Ikizler TA, Gebretsadik T, Shintani A, Wickersham N, Bossert F, Ware LB: Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol 2010;5:1497-1505.
10.
Chawla LS, Seneff MG, Nelson DR, Williams M, Levy H, Kimmel PL, Macias WL: Elevated plasma concentrations of IL-6 and elevated APACHE II score predict acute kidney injury in patients with severe sepsis. Clin J Am Soc Nephrol 2007;2:22-30.
11.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG; Acute Kidney Injury Network: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
12.
Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A; NGAL Meta-analysis Investigator Group: Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009;54:1012-1024.
13.
Dent CL, Ma Q, Dastrala S, Bennett M, Mitsnefes MM, Barasch J, Devarajan P: Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care 2007;11:R127.
14.
Nickolas TL, O'Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, Barasch J: Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 2008;148:810-819.
15.
Liangos O, Perianayagam MC, Vaidya VS, Han WK, Wald R, Tighiouart H, Jaber BL: Urinary N-acetyl-beta-(D)-glucosaminidase activity and kidney injury molecule-1 level are associated with adverse outcomes in acute renal failure. J Am Soc Nephrol 2007;18:904-912.
16.
Urbschat A, Obermuller N, Haferkamp A: Biomarkers of kidney injury. Biomarkers 2011;16(suppl 1):S22-S30.
17.
Liu KD, Altmann C, Smits G, Krawczeski CD, Edelstein CL, Devarajan P, Faubel S: Serum interleukin-6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study. Crit Care 2009;13:R104.
18.
Simmons EM, Himmelfarb J, Sezer MT, Chertow GM, Mehta RL, Paganini EP; PICARD Study Group: Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int 2004;65:1357-1365.
19.
Kwon SH, Hyun J, Jeon JS, Noh H, Han DC: Subtle change of cystatin C, with or without acute kidney injury, associated with increased mortality in the intensive care unit. J Crit Care 2011;26:566-571.
20.
Ahlstrom A, Tallgren M, Peltonen S, Pettila V: Evolution and predictive power of serum cystatin C in acute renal failure. Clin Nephrol 2004;62:344-350.
21.
Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Dragun D, Haase M: Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery - a prospective cohort study. Crit Care Med 2009;37:553-560.
22.
Nejat M, Pickering JW, Walker RJ, Endre ZH: Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit. Nephrol Dial Transplant 2010;25:3283-3289.
23.
Kataqiri D, Doi K, Matsubara T, Neqishi K, Hamasaki Yishii T, Yahaqi N, Noiri E: New biomarker panel of plasma neutrophil gelatinase-associated lipocalin and endotoxin activity assay for detecting sepsis in acute kidney injury. J Crit Care 2013;28:564-570.
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