Acute kidney injury markers in pediatric pancreatitis: Differentiating disease states and assessing severity

Acute kidney injury (AKI) is a complication commonly observed in adults with acute pancreatitis (AP) but remains poorly studied in pediatric patients. We investigated the utility of AKI biomarkers-kidney injury molecule-1 (KIM-1), lipocalin 2 (NGAL), cystatin-C (CYS-C), and renalase (RNLS) in acute and chronic pancreatitis (CP), and to assess AP severity, and evaluate kidney function.

Plasma and urine samples were collected from children with AP (n = 49), CP (n = 50), and healthy controls (HC; n = 20). AKI biomarkers levels were measured using enzyme-linked immunosorbent assays (ELISA). AP patients were categorized into two groups: mild AP (MAP) and moderate/severe AP (SAP). Kidney function was evaluated using plasma creatinine (pCre) and CYS-C-based enhanced glomerular filtration rate (eGFR) formulas.

Plasma KIM-1 and pCYS-C were elevated in AP versus CP and HCs (p < 0.0001). Urinary NGAL (uNGAL) was elevated in AP subjects, with 14% of patients exceeding the value of 125 ng/mL. Plasma A-RNLS remained same between AP and HCs (p = 0.78) but was elevated in CP cohort (p < 0.0001). However, pF-RNLS levels declined in AP compared to HCs and CP (p < 0.0001). SAP subjects (20% of AP cohort) had elevated pKIM-1 and pCYS-C compared to MAP (p = 0.002, p = 0.003). eGFR declined in AP subjects with 84% of AP patients showing CYS-C eGFR <90 mL/min/1.73 m². Plasma CYS-C, pA-RNLS, and pF-RNLS predicted AP from CP with area under the receiving operating curve of 0.86 (95% CL).

Elevated pKIM-1, pCYS-C, and uNGAL, along with declining pF-RNLS, are helpful in distinguishing pediatric AP from CP. Quantifying the Levels of pKIM-1 and pCYS-C within the first 48 h can help predict development of SAP.