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Kidney Injury Urine Biomarker Normal Ranges in Children.

Hannah Weber¹, Katharina Schermuly¹, Anna Tschirner¹

¹Department of Pediatric Kidney, Liver, Metabolic and Neurological Diseases, Hannover Medical School, Hannover, Germany.

Kidney International Reports

|March 11, 2026

Summary

This summary is machine-generated.

New pediatric reference values for urinary kidney injury biomarkers like KIM-1 and NGAL have been established. These age- and sex-dependent values improve the interpretation of kidney health in children.

Keywords:

CHI3L1 DKK3 EGF KIM-1 MCP-1 PIIINP

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Area of Science:

Pediatric Nephrology
Biomarker Discovery
Clinical Chemistry

Background:

Traditional kidney disease biomarkers (e.g., eGFR, albuminuria) have limitations in sensitivity and specificity.
Novel urinary biomarkers (KIM-1, NGAL, DKK3, CHI3L1, MCP-1, PIIINP, EGF) show promise for detecting kidney injury in adults.
Lack of established pediatric reference values hinders the clinical use of these sensitive urinary biomarkers in children.

Purpose of the Study:

To develop lambda-mu-sigma (LMS)-based continuous pediatric reference values for sensitive urinary kidney injury biomarkers.
To establish age- and sex-specific reference ranges for urinary KIM-1, NGAL, DKK3, CHI3L1, MCP-1, PIIINP, and EGF in children.
To facilitate standardized interpretation of kidney biomarker test results in pediatric populations.

Main Methods:

The Hannover reference values for pediatrics (HARP) study enrolled 304 children aged 0.1 to 18 years.
Urinary biomarkers were quantified using enzyme-linked immunosorbent assay (ELISA) and normalized to urinary creatinine.
LMS-based continuous reference percentiles were generated using RefCurv software.

Main Results:

LMS-based percentiles were established for urinary KIM-1, NGAL, DKK3, CHI3L1, MCP1, PIIINP, and EGF to creatinine ratios, all demonstrating age dependency.
Urinary NGAL, DKK3, and MCP-1 to creatinine ratios were also associated with sex.
Most urinary biomarker to creatinine ratios peaked in infancy and declined by age 18, with NGAL showing a secondary peak at age 18, particularly in girls.

Conclusions:

All measured urinary biomarkers of kidney health exhibited age-dependency and, in part, sex-dependency.
The developed LMS-based continuous pediatric reference percentiles enable standardized patient z-score calculation.
These reference values are crucial for accurate and reliable interpretation of kidney biomarker test results in children.