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Immune urinary biomarkers predict infant cardiac surgery-associated acute kidney injury

Daniella Levy Erez1,2,3, Shah Lokesh4, Kathryn D Howarth5

  • 1Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA. levy.erez.daniella@gmail.com.

Pediatric Nephrology (Berlin, Germany)
|August 19, 2023
PubMed

Insights

Acute kidney injury (AKI) in infants after heart surgery is linked to immune responses. Urinary CXCL10 and VCAM show promise as early biomarkers for detecting AKI and potential therapeutic targets.

Area of Science:

  • Pediatric Cardiology
  • Nephrology
  • Immunology

Background:

  • Acute kidney injury (AKI) is a common complication following infant cardiac surgery, associated with increased mortality and prolonged hospital stays.
  • The underlying mechanisms of AKI post-cardiac surgery are not fully understood, hindering the development of effective treatments.
  • Emerging evidence suggests that dysregulated immune activation plays a significant role in the development of AKI after cardiopulmonary bypass (CPB).

Purpose of the Study:

  • To identify immune-mediated biomarkers in urine for the early detection of AKI in infants undergoing CPB-assisted cardiac surgery.
  • To investigate the relationship between specific urinary immune biomarkers and the incidence of AKI.
  • To explore potential therapeutic targets for AKI by understanding its immune-mediated pathways.

Main Methods:

  • A prospective study involving 126 infants under one year old undergoing CPB-assisted cardiac surgery.
  • Urine samples were collected pre-operatively and at multiple time points (6, 24, 48, 72 hours) post-surgery.
  • Commercial ELISA and Luminex™ multiplex kits were used to measure immune biomarkers, with AKI defined by neonatal KDIGO criteria.

Main Results:

  • 27% of infants (35 out of 126) developed AKI, with younger infants, more complex surgeries, and longer CPB times being associated factors.
  • Elevated urinary levels of chemokine (C-X-C motif) ligand 10 (CXCL10) were observed at 24, 48, and 72 hours post-CPB in infants with AKI compared to those without.
  • Significantly higher median urinary vascular cell adhesion molecule 1 (VCAM) levels were detected at 6 hours post-CPB in the AKI group.

Conclusions:

  • Urinary CXCL10 and VCAM are identified as promising pro-inflammatory biomarkers for the early detection of AKI in infants following cardiac surgery.
  • These biomarkers may offer insights into the immune-mediated mechanisms of AKI, suggesting potential targets for future therapeutic interventions.
  • Further research into these biomarkers could lead to improved management strategies for post-cardiac surgery AKI in infants.
Abstract

Keywords:
Acute kidney injury (AKI)Cardiac bypass surgery urinary biomarkersInfant

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