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Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill

Mervat Ismail1, Nehal Abdelhamid1, Hasanin M Hasanin1

  • 1Department of Pediatrics, Institute of Medical Research and Clinical studies, National Research Center, Cairo, Egypt.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|October 16, 2024
PubMed

Insights

Urinary [TIMP-2][IGFBP7] shows promise in detecting acute kidney injury (AKI) in pediatric intensive care units (PICU). Higher levels indicate AKI and may predict severe outcomes in critically ill children.

Area of Science:

  • Pediatric critical care medicine
  • Nephrology
  • Biomarker research

Background:

  • Acute kidney injury (AKI) is a significant, often undetected, complication in pediatric intensive care units (PICUs).
  • Early identification of AKI is crucial for improving patient outcomes and managing critical illness in children.

Purpose of the Study:

  • To assess the early diagnostic and predictive capabilities of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) for AKI in PICU patients.
  • To correlate urinary [TIMP-2][IGFBP7] levels with AKI severity and patient outcomes.

Main Methods:

  • A case-control study involving 112 children (72 PICU patients, 40 healthy controls).
  • Urinary [TIMP-2][IGFBP7] levels were measured within 24 hours of PICU admission.
  • AKI was assessed using clinical criteria and the pRIFLE score.

Main Results:

  • 52 of 72 critically ill children developed AKI, with significantly higher serum creatinine, CRP, and pSOFA scores, and lower eCCl in the AKI group.
  • Urinary [TIMP-2][IGFBP7] levels were significantly elevated in patients with AKI compared to non-AKI patients (p=0.007).
  • Higher [TIMP-2][IGFBP7] levels correlated with AKI severity (Risk, Injury, Failure stages) and conditions like hypovolemia, sepsis, mechanical ventilation, and inotropic support.

Conclusions:

  • Urinary [TIMP-2][IGFBP7] is a valuable early biomarker for detecting AKI in critically ill children.
  • Elevated urinary [TIMP-2][IGFBP7] may predict severe morbidity and mortality, particularly in patients with hypovolemia, sepsis, or requiring mechanical ventilation and inotropic support.
Abstract

Keywords:
Acute kidney injuryCritically ill childrenPediatric intensive care unit

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