Journal
KIDNEY INTERNATIONAL
Volume 74, Issue 8, Pages 1059-1069Publisher
ELSEVIER SCIENCE INC
DOI: 10.1038/ki.2008.341
Keywords
cystatin C; acute kidney injury; biomarker; cardiac surgery; Neutrophil Gelatinase Associated Lipocalin
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Funding
- NCRR NIH HHS [UL1 RR024999-01, MO1RR000055, M01 RR000055, UL1 RR024999] Funding Source: Medline
- NIDDK NIH HHS [T32 DK007510, 2 T32 DK007510, K23 DK081616, K23 DK081616-01A1] Funding Source: Medline
- NIGMS NIH HHS [1K23GM00713-01A1, K23 GM000713-01A1, K23 GM000713] Funding Source: Medline
- PHS HHS [P01 56788] Funding Source: Medline
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There is a need to develop early biomarkers of acute kidney injury following cardiac surgery, where morbidity and mortality are increased by its presence. Plasma cystatin C (CyC) and plasma and urine Neutrophil Gelatinase Associated Lipocalin (NGAL) have been shown to detect kidney injury earlier than changes in plasma creatinine in critically ill patients. In order to determine the utility of urinary CyC levels as a measure of kidney injury, we prospectively collected plasma and urine from 72 adults undergoing elective cardiac surgery for analysis. Acute kidney injury was defined as a 25% or greater increase in plasma creatinine or renal replacement therapy within the first 72 hours following surgery. Plasma CyC and NGAL were not useful predictors of acute kidney injury within the first 6 hours following surgery. In contrast, both urinary CyC and NGAL were elevated in the 34 patients who later developed acute kidney injury, compared to those with no injury. The urinary NGAL at the time of ICU arrival and the urinary CyC level 6 hours after ICU admission were most useful for predicting acute kidney injury. A composite time point consisting of the maximum urinary CyC achieved in the first 6 hours following surgery outperformed all individual time points. Our study suggests that urinary CyC and NGAL are superior to conventional and novel plasma markers in the early diagnosis of acute kidney injury following adult cardiac surgery.
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