Serial urinary neutrophil gelatinase associated lipocalin in pediatric diabetic ketoacidosis with acute kidney injury.

Clinical Diabetes and Endocrinology Pub Date : 2021-11-01 DOI:10.1186/s40842-021-00133-8

Vijai Williams, Muralidharan Jayashree, Karthi Nallasamy, Devi Dayal, Amit Rawat, Savita Verma Attri

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Abstract

Background: Acute kidney injury (AKI) due to Diabetic Ketoacidosis (DKA) is rather common. Novel biomarkers to diagnose AKI are being increasingly used in different settings. The use of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) in predicting persistent AKI in pediatric DKA cases is still not thoroughly investigated.

Methods: This was a secondary analysis of Saline versus Plasma-Lyte in Ketoacidosis (SPinK) trial data; 66 children (> 1 month-12 years) with DKA, defined by the International Society for Pediatric and Adolescent Diabetes (ISPAD), were analyzed. Children with cerebral edema, chronic kidney disease and those who received pre-referral fluids and/or insulin were excluded. uNGAL and urine NGAL-creatinine ratio (uNCR) at 0 and 24 h were measured in all. Persistent AKI was defined as a composite outcome of continuance of AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3 beyond 48 h from AKI onset, progression of AKI from either KDIGO stage 0 or 1 to a worse stage, need of renal replacement therapy or death.

Main outcomes: Thirty-five (53%) children had AKI at admission; 32 (91.4%) resolved within 48 h. uNGAL was significantly higher in the AKI group at admission [79.8 ± 27.2 vs 54.6 ± 22.0, p = 0.0002] and at 24 h [61.4 ± 28.3 vs 20.2 ± 14.5, p = 0.0003]. Similar trend was observed with uNCR at admission [6.7 ± 3.7 vs 4.1 ± 2.6, p = 0.002] and at 24 h [6.3 ± 2.5 vs 1.2 ± 1.0, p = 0.01]. Furthermore, uNGAL at admission showed a moderate positive linear correlation with serum creatinine. Additionally, elevated uNGAL at 0 and 24 h correlated with corresponding KDIGO stages. Admission uNGAL >88 ng/ml and uNCR of >11.3 ng/mg had a sensitivity of 66% and 67%, specificity of 76% and 95%, and Area under the receiver operating characteristic curve (AUC) of 0.78 and 0.89 respectively for predicting persistent AKI at 48 h.

Conclusions: Majority of AKI resolved with fluid therapy. While uNGAL and uNCR both correlated with serum creatinine and AKI stages, serial uNCR was a better predictor of persistent AKI than uNGAL alone. However, feasibility of routine uNGAL measurement to predict persistent AKI in DKA needs further elucidation.

Trial registration: This was a secondary analysis of the data of SPinK trial [CTRI/2018/05/014042 ( ctri.nic.in )].

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小儿糖尿病酮症酸中毒合并急性肾损伤患者的尿液中性粒细胞明胶酶相关脂质体。

背景：糖尿病酮症酸中毒（DKA）导致的急性肾损伤（AKI）相当常见。诊断 AKI 的新型生物标志物正越来越多地应用于不同场合。尿中性粒细胞明胶酶相关脂质体（uNGAL）在预测小儿 DKA 病例持续性 AKI 中的应用仍未得到深入研究：这是一项对酮症酸中毒（SPinK）试验数据进行的盐水与血浆-赖氨酸对比的二次分析；分析了66名患有国际儿童和青少年糖尿病学会（ISPAD）定义的DKA的儿童（大于1个月-12岁）。对所有患儿在 0 小时和 24 小时的尿 NGAL 和尿 NGAL-肌酐比值 (uNCR) 进行了测量。持续性 AKI 的定义是：自 AKI 发生 48 小时后，肾病改善全球结果（KDIGO）2 期或 3 期定义的 AKI 持续存在、AKI 从 KDIGO 0 期或 1 期进展到更严重的阶段、需要肾脏替代治疗或死亡：35名（53%）患儿入院时出现了AKI；32名（91.4%）患儿在48小时内缓解了AKI。入院时uNGAL明显高于AKI组[79.8 ± 27.2 vs 54.6 ± 22.0，p = 0.0002]，24小时时uNGAL也明显高于AKI组[61.4 ± 28.3 vs 20.2 ± 14.5，p = 0.0003]。入院时uNCR[6.7 ± 3.7 vs 4.1 ± 2.6，p = 0.002]和24 h时uNCR[6.3 ± 2.5 vs 1.2 ± 1.0，p = 0.01]也有类似趋势。此外，入院时的尿蛋白胆固醇与血清肌酐呈中度正线性相关。此外，0 和 24 h 的 uNGAL 升高与相应的 KDIGO 分期相关。入院时 uNGAL >88 ng/ml 和 uNCR >11.3 ng/mg 预测 48 小时后持续性 AKI 的敏感性分别为 66% 和 67%，特异性分别为 76% 和 95%，接收器操作特征曲线下面积（AUC）分别为 0.78 和 0.89：结论：大多数 AKI 可通过液体疗法缓解。虽然 uNGAL 和 uNCR 都与血清肌酐和 AKI 分期相关，但连续 uNCR 比单独 uNGAL 更能预测持续性 AKI。然而，常规测量uNGAL以预测DKA中持续性AKI的可行性还需进一步阐明：这是对SPinK试验[CTRI/2018/05/014042 ( ctri.nic.in )]数据的二次分析。

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Clinical Diabetes and Endocrinology

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8 weeks

期刊介绍： Clinical Diabetes and Endocrinology is an open access journal publishing within the field of diabetes and endocrine disease. The journal aims to provide a widely available resource for people working within the field of diabetes and endocrinology, in order to improve the care of people affected by these conditions. The audience includes, but is not limited to, physicians, researchers, nurses, nutritionists, pharmacists, podiatrists, psychologists, epidemiologists, exercise physiologists and health care researchers. Research articles include patient-based research (clinical trials, clinical studies, and others), translational research (translation of basic science to clinical practice, translation of clinical practice to policy and others), as well as epidemiology and health care research. Clinical articles include case reports, case seminars, consensus statements, clinical practice guidelines and evidence-based medicine. Only articles considered to contribute new knowledge to the field will be considered for publication.