CAN ACUTE KIDNEY INJURY BE DIAGNOSED USING BIOMARKERS IN INTENSIVE CARE PATIENTS?

Abstract

Introduction: and Objective: Recent clinical trials have examined several biomarkers, which are suggested to allow an early diagnosis of AKI. Considering that the ,following molecules will allow an early diagnosis of AKI, we examined neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL-18), cystatin C (Cys-C), and kidney injury molecule-1 (KIM-1) in the urine samples and compared the levels of these molecules with the serum creatinine levels.

Material and method: 27 patients who developed AKI and 27 patients who did not develop AKI, were included in the study. AKI and non-AKI groups namely , according to the RIFLE criteria. The urine samples from the patients were collected on the 1st, 3rd, and 7th days to study the levels of NGAL, IL-18, cystatin C, and KIM-1 as the biomarkers.

Results: A significant difference was observed between the AKI and the non-AKI groups in terms of the APACHE II scores (p<0.001). A moderately negative and significant correlation at the level of p<0.05 was determined between the APACHE II scores and the day of ARE development (p=0.041, r=-0.403). As regards to the biomarker levels, we studied, statistically significant differences were identified in the AKI and non-AKI groups in the IL-18 levels on all of the three days which the tests were performed (p=0.042, p=0.008, p<0.0001 respectively). However, Cys-C levels measured on the 1st, 3rd, and 7th days were not statistically significantly different in the AKI or non-AKI groups (p=0.625, p= 0.074, p=0.061 respectively).

Conclusion: NGAL can be a valuable biomarker to detect the development of AKI in the early phase in ICU admissions. NGAL and KIM-1 can be consecutively used for the early diagnosis of AKI. IL-18 can be used for the early diagnosis of AKI and it is a valuable biomarker.