Abstract:Objective: To investigate the expression characteristics of urine neutrophil gelatinase associated apolipoprotein (NGAL) and Kidney Injury Molecule-1 (KIM-1) in children with acute kidney injury (AKI) after congenital heart surgery. Methods:160 cases children with congenital heart disease undergoing surgical treatment included in the study from April 2014 to March 2017 were divided into AKI group and N-AKI group according to whether the postoperative acute kidney injury, (61 cases and 99 cases respectively).And 60 healthy children were selected as healthy group during the same period.The levels of urinary NGAL and KIM-1 in 3 groups were detected at different time points. Results: ①The baseline urinary NGAL levels in AKI group, AKI-free group and healthy group were (9.52+1.26), (9.45+1.33), (9.48+1.30) ng/mL, respectively, with no significant difference (P > 0.05). At 6h, 12h, 24h and 48h after operation, the levels of NGAL in AKI group were (25.17 [8.72], (40.14 [16.52], (31.17 [10.64], (30.54 [11.50] ng / mL, respectively, while those in AKI group were (10.29 [3.13, (13.05 [3.25, (11.39 [2.77, (10.65 [3.05] ng / mL, respectively. There was significant difference in urinary NGAL levels between AKI group and non-AKI group at 6 hours after operation (Fgroup= 31.315, P<0.05). The urinary NGAL levels of the two groups increased first and then decreased with the prolongation of time (Ftime= 21.073, P<0.05). The increase in AKI group was greater than that of the control group (Finteraction= 17.746, P<0.05). ② The baseline levels of urinary KIM-1 in AKI group, N-AKI group and healthy group were(281.63±24.77), (279.07±25.01),(280.48±23.80)ng/L, respectively, with no statistical difference (P>0.05); The levels of urinary KIM-1 in AKI group were (313.17±35.46),(496.16±35.21),(613.17±43.19), (582.33±37.13) at postoperative 6h, 12h, 24h and 48H, respectively, and those of N-AKI group were (290.69±26.14),(294.75±27.50),(286.32±23.34),(283.29±21.81)ng/L. There was significantly difference of urinary KIM-1 in these two groups (Fgroup=34.827,P<0.05), and were showed a inclined trend over time (Ftime=25.031,P<0.05), the changed amplitude in AKI group was higher than N-AKI group (Finteraction=23.847,P<0.05). Conclusion: Urinary NGAL and KIM-1 levels in children with congenital heart disease were similar to those in normal children; both indicators were increased after surgery, but the incidence of AKI was more significant, which could be used for early diagnosis of AKI in children with congenital heart disease.
王静. 先天性心脏病术后急性肾损伤患儿尿NGAL KIM-1表达分析[J]. 河北医学, 2018, 24(10): 1623-1626.
WANG Jing. Analysis of Urinary NGAL and KIM-1 Expression in Children with Acute Kidney Injury after Congenital Heart Surgery. HeBei Med, 2018, 24(10): 1623-1626.
[1] Han WK, Wagener G,Johnson A,et al.Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery[J]. Clin Am Son Nephrol,2009,4(7):873~882 [2] Taylor ML, Carmona F, Thiagarajan R R, et al. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease[J].Thorac Cardiovasc Surg, 2013, 146(1): 146~152. [3] Webb TN, Goldstein SL. Congenital heart surgery and acute kidney injury[J]. Curr Opin Anaesthesiol, 2017, 30(1): 105~112. [4] Mehta RL, Kellum JA, Shah SV, et al.Acute kidney injury network: report of an initiative to improve outcomesto improve acute kidney injury[J]. Critical Care, 2007,11(2):31. [5] Greenberg JH, Whitlock R, Zhang W R, et al. Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery[J]. Pediatr Nephrol, 2015, 30(9): 1519~1527. [6] Cooper DS, Claes D, Goldstein SL, et al. Follow-up renal assessment of injury long-term after acute kidney injury (FRAIL-AKI)[J]. Clin Am Soc Nephrol, 2016, 11(1): 21~29. [7] Zappitelli M, Greenberg JH, Coca SG, et al. Association of definition of acute kidney injury by cystatin C rise with biomarkers and clinical outcomes in children undergoing cardiac surgery[J]. JAMA Pediatr, 2015, 169(6): 583~591. [8] Hwang YJ, Hyun MC, Choi B S, et al. Acute kidney injury after using contrast during cardiac catheterization in children with heart disease[J].Korean Med Sci, 2014, 29(8): 1102~1107. [9] Ruf B, Bonelli V, Balling G, et al. Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study[J]. Critical care, 2015, 19(1): 27. [10] 郭露露,赵卫红.NGAL与肾脏疾病研究进展[J].中华肾脏病杂志,2015,31(2):156~160. [11] 刘会琼,范太兵,袁心刚.胱抑素C和NGAL与先天性心脏病患儿术后急性肾损伤的相关性研究[J].中国实用医药,2016,11(10):42~43. [12] 王静,崔红蕊,胡秀红,等.尿NGAL、KIM-1对先天性心脏病患儿术后急性肾损伤的预测价值[J].山东医药,2016,56(48):92~94. [13] Fortenberry JD, Paden ML, Goldstein SL. Acute kidney injury in children: an update on diagnosis and treatment[J]. Pediatr Clin North Am, 2013, 60(3): 669~688. [14] 王琳,崔应麟,王长安,等.肾移植术后并发急性肾损伤患者尿液中NGAL水平及临床意义[J].中国医药科学,2016,6(15):9~12.