Review Article

Acute Kidney Injury in Neonates: From Urine Output to New Biomarkers

Table 2

Biomarkers in neonatal acute kidney injury.

AuthorStudy designAKI definitionPopulationBiomarkersMain findings

Askenazi
et al. [43]
Nested case-controlAKINVery low birth weight infants
(n = 30, AKI = 9)
Urine NGAL and OPNUrine biomarkers were higher in those with AKI. No information about early AKI diagnosis.

Krawczeski
et al. [44]
Prospective cohortAKIN374 infants (35 neonates, AKI = 8) undergoing cardiac surgery with CPBSerum and urine NGALSerum and urine NGAL 2 h after CPB are early predictive biomarkers for AKI.

Askenazi
et al. [37]
Nested case-controlSCr ≥1.7 mg/dL >72 h after birth or rising values >0.3 mg/dL within 48 h (AKIN)Neonates birth weight > 2000 g, GA >34 weeks, 5-minute score Apgar ≤7
(n = 58, 9 neonates developed AKI)
Urine NGAL, OPN, uCysc, albumin, β2 microglobulin, epithelial growth factor, UMOD, and KIM-1Urine CysC, UMOD, and epithelial growth factor were higher in those with AKI. No information about early AKI diagnosis.

Li et al. [45]Prospective cohort SCr >1.5 mg/dL or pRIFLENonseptic critically ill neonates
(n = 62, AKI = 11)
uCysC and uIL-18Urine CysC and IL-18 are predictive of AKI in nonseptic critically ill neonates.

Sarafidis et al. [46]Prospective cohortSCr ≥1.5 mg/dL >24 h or rising values >0.3 mg/dL from DOL 113 asphyxiated neonates and 22 nonasphyxiated
(n = 35, AKI = 8)
Serum CysC and NGAL
Urine CysC, NGAL, and KIM -1
Serum NGAL and uNGAL and uCysC are higher in asphyxiated neonates, even in those not developing AKI. They had also provided an early AKI diagnosis.

Elmas et al. [47]Case-controlpRIFLE or SCr ≥1.5 mg/dL on the first 3 daysPreterm neonates with RDS (n = 28, AKI = 8). Additional control group with 34 neonates without RDS nor AKISerum CysCSerum CysC is an independent predictor of AKI in RDS neonates.

CPB: cardiopulmonary bypass; RDS: respiratory discomfort syndrome; CysC: serum cystatin C; sNGAL: serum neutrophil gelatinase-associated lipocalin; uCysC: urine CysC; uNGal: urine NGAL; KIM-1: kidney injury molecule-1; OPN: osteopontin; B2mG: beta-2 microglobulin; IL-18: interleukin-18; DOL 1: day of life; GA: gestational age; UMOD: uromodulin; PA: postmenstrual age; CPB: cardiopulmonary bypass; RDS: respiratory distress syndrome.