TitleSerial Quantification of Urinary Protein Biomarkers to Predate Drug-Induced Acute Kidney Injury |
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Type Oral Presentation |
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Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
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Topic Acute Kidney Injury |
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Main Author YI DA1 2 |
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Presenting Author YI DA1 2 |
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Co-Author K AKALYA1 2 Tanusya Murali MURALI1 2 A VATHSALA1 2 Chuen-Seng TAN3 Sanmay LOW1 2 Horng-Ruey CHUA1 2 |
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Department / Institution / Country Division of Nephrology, University Medicine Cluster / National University Hospital / Singapore1 Department of Medicine, Yong Loo Lin School of Medicine, / National University of Singapore / Singapore2 Saw Swee Hock School of Public Health / National University of Singapore / Singapore3 |
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Abstract Content: Introduction, Method, Result, Conclusion
[Introduction] Drug-induced acute kidney injury (DI-AKI) develops in 10–15% of at-risk patients. We aim to determine urinary protein biomarkers that predate DI-AKI with lead-time for preventive strategies. [Methods] Serial urine samples were collected in 21 patients while receiving aminoglycosides, vancomycin, amphotericin, or calcineurin inhibitors; including 7 patients who subsequently developed DI-AKI (KDIGO criterion), and 14 non-AKI controls matched for age, baseline kidney function, and culprit nephrotoxin. Their urine were batch-analysed for biomarkers including clusterin, beta-2-microglobulin, KIM1, MCP1, cystatin-C, trefoil-factor-3, NGAL, interleukin-18, GST-Pi, calbindin, and osteopontin, all normalized to urine creatinine; at time-intervals before AKI onset, and corresponding time-intervals before cessation of nephrotoxins in controls. [Results] Mean ages were 55(±17) and 52(±16) years; baseline eGFR were 99(±21) and 101(±24) mL/min/1.73m2, for AKI versus non-AKI patients, respectively (all p=NS). Five biomarkers had median levels higher in AKI cases than controls that predated AKI by 1–3 days (all µg/mmol, p<0.05): clusterin [58(8-411) versus 7(3-17)], beta-2-microglobulin [1632(913-3823) versus 253(61-791)], KIM1 [0.16(0.13-0.76) versus 0.07(0.05-0.15)], MCP1 [0.40(0.16-1.90) versus 0.07(0.04-0.17)], and cystatin-C [33(27-2990) versus 11(7-19)]; their corresponding AUROC for AKI prediction were >0.80 (confidence intervals >0.50), with average accuracy highest for clusterin (86%), followed by beta-2-microglobulin, cystatin-C, MCP1, and KIM1 (57%) after cross-validation. [Conclusion] Rise in selected urinary protein biomarkers in patients receiving nephrotoxins predates DI-AKI by days. |