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Early diagnosis of kidney injury in a paediatric population: a prospective cohort study (E-DRIP STUDY)

Tanvi Singh1, Vidushi Mahajan2, Jasbinder Kaur3

  • 1Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.

Pediatric Nephrology (Berlin, Germany)
|March 9, 2022
PubMed

Insights

The Renal Angina Index (RAI) and urinary NGAL show promise in predicting severe acute kidney injury (AKI) in children, though with limitations. Early identification of AKI risk is crucial for timely intervention.

Area of Science:

  • Pediatric Nephrology
  • Biomarkers in Critical Care
  • Acute Kidney Injury Research

Background:

  • Acute kidney injury (AKI) poses a significant threat to children, necessitating effective risk stratification tools.
  • The Renal Angina Index (RAI) is a clinical bedside tool for predicting AKI.
  • Kidney injury biomarkers offer real-time insights into kidney damage and potential AKI development.

Purpose of the Study:

  • To evaluate the predictive performance of the Renal Angina Index (RAI) and urinary (u) and plasma (p) neutrophil gelatinase-associated lipocalin (NGAL) for severe AKI in children.
  • To assess the utility of these markers in a tertiary hospital setting in India.

Main Methods:

  • A prospective study enrolled 253 children aged 2 months to 14 years.
  • RAI was calculated on Day 0 (D0).
  • Urinary and plasma NGAL levels were measured within 6 hours of admission, with follow-up for severe AKI development by Day 3 (D3) using KDIGO criteria.

Main Results:

  • 17.4% of children developed D3-AKI; 44% of those with stage 2/3 AKI had RAI ≥ 8 on D0.
  • The area under the ROC curve (AUROC) for D0-RAI predicting D3-severe-AKI was 0.66.
  • AUROC for uNGAL was 0.62, while pNGAL was 0.48; severe AKI cases required more ventilation and inotropic support, with higher mortality.

Conclusions:

  • RAI ≥ 8 and uNGAL demonstrated high negative predictive value but low sensitivity for predicting D3-severe-AKI.
  • Plasma NGAL showed poor predictive value for D3-severe-AKI.
  • These findings highlight the potential of RAI and uNGAL in identifying children at low risk for severe AKI, but further research is needed for improved prediction.
Abstract

Keywords:
Acute kidney failureAcute kidney injuryKDIGOKidney biomarkersNGALRenal angina

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