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Neonatology. 2019;116(1):58-66. doi: 10.1159/000499083. Epub 2019 Apr 12.

Urinary Nephrin as a Biomarker of Glomerular Maturation and Injury Is Associated with Acute Kidney Injury and Mortality in Critically Ill Neonates.

Author information

1
Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China.
2
Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China.
3
Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China.
4
Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China, lyh072006@hotmail.com.
5
Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China, lyh072006@hotmail.com.

Abstract

BACKGROUND:

Nephrin is a key component of the slit diaphragm of the glomerular podocyte, and increased urinary nephrin level may reflect glomerular injury.

OBJECTIVES:

To determine whether urinary nephrin is a useful biomarker of glomerular maturation and injury and whether it is associated with acute kidney injury (AKI) and neonatal intensive care unit (NICU) mortality in critically ill neonates.

METHODS:

Urinary samples were serially collected in 234 neonates during NICU stay for measurements of nephrin, cystatin C (CysC), and albumin. AKI diagnosis was based on neonatal Kidney Disease: Improving Global Outcome (KDIGO) criteria.

RESULTS:

Of the neonates, 26 developed AKI and 24 died during NICU stay. The independent contributors to the initial urinary nephrin level obtained on the first 24 h admitted to NICU were gestational age (p = 0.004) and initial urinary CysC level (p < 0.001). Both initial (p = 0.037) and peak (p = 0.039) urinary nephrin were significantly associated with AKI, even after controlling for significant covariates, and had an area under the receiver-operating characteristic curve (AUC) of 0.71 and 0.70, respectively, for predicting AKI. At the optimal cutoff value of 0.375 μg/mg urinary creatinine, the initial urinary nephrin displayed sensitivity of 61.5% and specificity of 76.9% for predicting AKI. The AUCs for initial and peak urinary nephrin to predict NICU mortality were 0.81 and 0.83, respectively.

CONCLUSIONS:

Urinary nephrin, which may decrease with increasing glomerular maturity, is significantly associated with increased risk for AKI and NICU mortality even after adjustment for potential confounders. A higher level of urinary nephrin may be independently predictive of AKI and NICU mortality in critically ill neonates.

KEYWORDS:

Acute kidney injury; Critically ill neonates; Glomerular injury; Mortality; Urinary nephrin

PMID:
30982033
DOI:
10.1159/000499083

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