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Longitudinal kidney injury biomarker trajectories in children with obstructive uropathy

Daryl J McLeod1,2, Yuri V Sebastião3, Christina B Ching4,5

  • 1Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA. Daryl.mcleod@nationwidechildrens.org.

Pediatric Nephrology (Berlin, Germany)
|May 24, 2020
PubMed

Insights

In children with obstructive uropathy (OU), plasma neutrophil gelatinase-associated lipocalin (pNGAL) and urine liver-type fatty acid-binding protein (uL-FABP) levels increased over time, indicating potential for risk stratification in pediatric kidney disease.

Area of Science:

  • Pediatric Nephrology
  • Biomarker Discovery
  • Urology

Background:

  • Congenital obstructive uropathy (OU) is a primary cause of kidney failure in children.
  • Renal tubular injury from stretch and ischemia is a key mechanism in OU.
  • Tubular injury biomarkers may enhance risk assessment for OU patients.

Purpose of the Study:

  • To investigate the utility of urinary and plasma biomarkers in stratifying risk for pediatric obstructive uropathy.
  • To compare levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and liver-type fatty acid-binding protein (L-FABP) in children with and without kidney replacement therapy (KRT).

Main Methods:

  • Patients from the CKiD study with OU were categorized into cases (receiving KRT) and controls (KRT-free).
  • Urine and plasma NGAL, IL-18, and L-FABP levels were measured at baseline and annually.
  • Urine biomarker values were normalized to urine creatinine.

Main Results:

  • No significant differences in biomarkers were observed at enrollment between cases and controls.
  • Plasma NGAL and urine L-FABP/creatinine levels significantly increased annually in cases but remained stable in controls.
  • These findings persisted even after adjusting for baseline glomerular filtration rate (GFR).

Conclusions:

  • Plasma NGAL and urine L-FABP levels rise in the 5 years preceding KRT in children with OU, independent of baseline GFR.
  • These biomarkers show promise for predicting outcomes in pediatric obstructive uropathy.
  • Further research is needed to establish optimal cutoff values and compare their efficacy against existing clinical predictors.
Abstract

Keywords:
BiomarkersCKiDChildrenKidneyL-FABPNGALObstructive uropathy

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