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Urinary biomarkers indicate pediatric renal injury among rural farming communities in Sri Lanka

T D K S C Gunasekara1, P Mangala C S De Silva2, E M D V Ekanayake3

  • 1Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka.

Scientific Reports
|May 16, 2022
PubMed

Insights

Elevated urinary kidney injury molecule (KIM-1) levels in Sri Lankan children from chronic kidney disease of uncertain etiology (CKDu) regions suggest early renal damage. KIM-1 shows promise as a biomarker for detecting pediatric kidney injury in affected communities.

Area of Science:

  • Nephrology
  • Environmental Health
  • Pediatric Medicine

Background:

  • Pediatric renal injury is a growing concern in areas with chronic kidney disease of uncertain etiology (CKDu).
  • Early detection of kidney damage through sensitive biomarkers is crucial for timely interventions.
  • Urinary biomarkers like Kidney Injury Molecule (KIM-1) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) are investigated for their diagnostic utility.

Purpose of the Study:

  • To evaluate the effectiveness of urinary KIM-1 and NGAL as early detection biomarkers for renal abnormalities in Sri Lankan children.
  • To compare biomarker levels in pediatric populations residing in CKDu endemic, emerging, and non-endemic regions.

Main Methods:

  • A cross-sectional study involving 804 school students (10-18 years) from Sri Lanka, stratified by CKDu prevalence.
  • Measurement of urinary KIM-1, NGAL, and albumin-creatinine ratio (UACR) levels.
  • Statistical analysis to compare biomarker levels across different regions and in relation to albuminuria status.

Main Results:

  • Significantly elevated median urinary KIM-1 levels were observed in children from CKDu endemic regions compared to emerging and non-endemic areas (p < 0.0001).
  • No significant differences in urinary NGAL levels were found across the study regions.
  • Albuminuric participants exhibited higher urinary KIM-1 levels than normoalbuminuric participants (p < 0.05).

Conclusions:

  • Elevated urinary KIM-1 in pediatric populations from CKDu-affected regions, particularly with albuminuria, indicates potential low-grade early renal damage.
  • Urinary KIM-1 demonstrates utility as a quantifiable biomarker for early detection of renal abnormalities in children exposed to CKDu risk factors.
  • NGAL was not found to be a significant differentiator for early renal injury in this pediatric cohort.

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