RESUMO
Acute kidney injury (AKI) following surgery with cardiopulmonary bypass (CPB-AKI) is common in pediatrics. Urinary liver-type fatty acid binding protein (uL-FABP) increases in some kidney diseases and may indicate CPB-AKI earlier than current methods. The aim of this systematic review with meta-analysis was to evaluate the potential role of uL-FABP in the early diagnosis and prediction of CPB-AKI. Databases Pubmed/MEDLINE, Scopus, and Web of Science were searched on 12 November 2023, using the MeSH terms "Children", "CPB", "L-FABP", and "Acute Kidney Injury". Included papers were revised. AUC values from similar studies were pooled by meta-analysis, performed using random- and fixed-effect models, with p < 0.05. Of 508 studies assessed, nine were included, comprising 1658 children, of whom 561 (33.8%) developed CPB-AKI. Significantly higher uL-FABP levels in AKI versus non-AKI patients first manifested at baseline to 6 h post-CPB. At 6 h, uL-FABP correlated with CPB duration (r = 0.498, p = 0.036), postoperative serum creatinine (r = 0.567, p < 0.010), and length of hospital stay (r = 0.722, p < 0.0001). Importantly, uL-FABP at baseline (AUC = 0.77, 95% CI: 0.64-0.89, n = 365), 2 h (AUC = 0.71, 95% CI: 0.52-0.90, n = 509), and 6 h (AUC = 0.76, 95% CI: 0.72-0.80, n = 509) diagnosed CPB-AKI earlier. Hence, higher uL-FABP levels associate with worse clinical parameters and may diagnose and predict CPB-AKI earlier.
Assuntos
Injúria Renal Aguda , Biomarcadores , Ponte Cardiopulmonar , Proteínas de Ligação a Ácido Graxo , Humanos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/urina , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/sangue , Ponte Cardiopulmonar/efeitos adversos , Proteínas de Ligação a Ácido Graxo/urina , Proteínas de Ligação a Ácido Graxo/sangue , Biomarcadores/urina , Criança , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/urina , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Pré-EscolarRESUMO
BACKGROUND: Acute Gastrointestinal Injury (AGI) is associated with adverse clinical outcomes, including increased mortality. We aimed to investigate the potential of citrulline and intestinal fatty acid binding protein (I-FABP) as biomarkers for early AGI diagnosis and predicting outcomes in surgical patients. METHODS: Prospective cohort study involving patients who underwent non-cardiac surgeries and were admitted to Intensive Care Units. AGI diagnosis was based on specific criteria, and severity was categorised following established guidelines. Statistical analyses were performed to assess the diagnostic accuracy of the biomarkers and their association with outcomes, P significant when <0.05. RESULTS: AGI was identified in 40.3% of patients with varying severity. Mortality rates were significantly higher in the AGI group in the ICU (19.4% vs. 0%, p = 0.001) and hospital (22.6% vs. 2.17%, p = 0.003). Urinary I-FABP levels on days 3 and 7 showed reasonable and good accuracy for AGI diagnosis (AUC 0.732 and 0.813, respectively). Urinary I-FABP levels on days 2 and 3 accurately predict sepsis. Urinary citrulline levels on day one predicted mortality (AUC 0.87) furthermore urinary I-FABP levels on day 2 showed reasonable accuracy (sensitivity 83.3%, specificity 92.4%). CONCLUSION: Urinary I-FABP and citrulline levels are promising diagnostic and prognostic markers in ICU patients following non-cardiac surgeries.
Assuntos
Citrulina , Proteínas de Ligação a Ácido Graxo , Complicações Pós-Operatórias , Humanos , Biomarcadores/urina , Citrulina/urina , Proteínas de Ligação a Ácido Graxo/urina , Período Pós-Operatório , Estudos Prospectivos , Complicações Pós-Operatórias/urinaRESUMO
Acute kidney injury (AKI) consists of a rapid renal function decline which usually increases serum urea and creatinine levels. Since kidney injury begins by inducing biological and molecular changes which evolve to cellular damage, biomarkers could be used as tools for monitoring early AKI appearance, and predicting its recovery. Among the main AKI biomarkers the neutrophil gelatinase-associated lipocalin, cystatin C, kidney injury molecule-1, monocyte chemotactic peptide-1, N-acetyl-ß-D-glucosaminidase, interleukin-18, liver-type fatty acid-binding protein, netrin-1, cycle arrest markers, endogenous ouabain, selenium-binding protein 1, and BPIFA2 marker, have been described. Even though novel biomarkers seem to be more helpful to early detect AKI and/or predict the need for renal replacement, and mortality compared to serum creatinine, more comprehensive studies are still required to determine their clinical utility.
Assuntos
Injúria Renal Aguda/sangue , Injúria Renal Aguda/urina , Cistatina C , Proteínas de Ligação a Ácido Graxo , Receptor Celular 1 do Vírus da Hepatite A , Lipocalina-2 , Acetilglucosaminidase/urina , Injúria Renal Aguda/diagnóstico , Biomarcadores/sangue , Biomarcadores/urina , Quimiocina CCL2/sangue , Quimiocina CCL2/urina , Cistatina C/sangue , Cistatina C/urina , Proteínas de Ligação a Ácido Graxo/urina , Receptor Celular 1 do Vírus da Hepatite A/análise , Humanos , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/urina , Interleucina-18/urina , Lipocalina-2/sangue , Lipocalina-2/urina , Inibidor Tecidual de Metaloproteinase-2/urinaRESUMO
ABSTRACT Aim: URS is a very commonly used procedure for treatment of ureter stones. Increased hydrostatic pressure in the collecting system linked to fluids used during the procedure may cause harmful effects on the kidney. The aim of this study is to determine whether the URS procedure has a negative effect on the kidney by investigating NGAL, KIM-1, FABP and Cys C levels in urine. Material and Methods: This study included 30 patients undergoing ureterorenoscopy (URS) for ureter stones. Urine samples were collected 5 times; before the URS procedure (control) and at 1, 3, 5 and 12 hours following the procedure. NGAL, KIM-1, FBAP and Cys C levels were measured in urine and compared with the control values. Results: The NGAL levels in urine before the procedure and at 1, 3, 5 and 12 hours after the procedure were 34.59±35.34; 62.72±142.32; 47.15±104.48; 45.23±163.16 and 44.99±60.79ng/mL, respectively (p=0.001). Similarly, the urinary KIM-1, FABP and Cys C levels were found to increase compared to control values; however this increase did not reach statistical significance (p >0.05). Conclusions: After the URS procedure, there were important changes in NGAL, FABP, KIM-1 and Cys C levels. These changes reached statistical significance for NGAL, but did not reach significance for the other parameters. In conclusion, the URS procedure significantly affects the kidney; however, this effect disappears over time.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Biomarcadores/urina , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Pessoa de Meia-Idade , Cálculos Ureterais/urina , Cistatinas/urina , Ureteroscopia/efeitos adversos , Proteínas de Ligação a Ácido Graxo/urina , Lipocalina-2/urina , Receptor Celular 1 do Vírus da Hepatite A/análiseRESUMO
AIM: URS is a very commonly used procedure for treatment of ureter stones. Increased hydrostatic pressure in the collecting system linked to fluids used during the procedure may cause harmful effects on the kidney. The aim of this study is to determine whether the URS procedure has a negative effect on the kidney by investigating NGAL, KIM-1, FABP and Cys C levels in urine. MATERIAL AND METHODS: This study included 30 patients undergoing ureterorenoscopy (URS) for ureter stones. Urine samples were collected 5 times; before the URS procedure (control) and at 1, 3, 5 and 12 hours following the procedure. NGAL, KIM-1, FBAP and Cys C levels were measured in urine and compared with the control values. RESULTS: The NGAL levels in urine before the procedure and at 1, 3, 5 and 12 hours after the procedure were 34.59±35.34; 62.72±142.32; 47.15±104.48; 45.23±163.16 and 44.99±60.79ng/mL, respectively (p=0.001). Similarly, the urinary KIM-1, FABP and Cys C levels were found to increase compared to control values; however this increase did not reach statistical significance (p >0.05). CONCLUSIONS: After the URS procedure, there were important changes in NGAL, FABP, KIM-1 and Cys C levels. These changes reached statistical significance for NGAL, but did not reach significance for the other parameters. In conclusion, the URS procedure significantly affects the kidney; however, this effect disappears over time.
Assuntos
Biomarcadores/urina , Cálculos Ureterais/cirurgia , Cálculos Ureterais/urina , Ureteroscopia/métodos , Adulto , Idoso , Cistatinas/urina , Proteínas de Ligação a Ácido Graxo/urina , Feminino , Receptor Celular 1 do Vírus da Hepatite A/análise , Humanos , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Ureteroscopia/efeitos adversosRESUMO
Necrotizing enterocolitis, characterized by sudden onset and rapid progression, remains the most significant gastrointestinal disorder among premature infants. In seeking a predictive biomarker, we found intestinal fatty acid binding protein, an indicator of enterocyte damage, was substantially increased within three and seven days before the diagnosis of necrotizing enterocolitis.
Assuntos
Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/urina , Proteínas de Ligação a Ácido Graxo/urina , Recém-Nascido Prematuro , Biomarcadores/urina , Peso ao Nascer , Estudos de Coortes , Progressão da Doença , Feminino , Idade Gestacional , Hospitais Pediátricos , Humanos , Recém-Nascido , Masculino , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
Over the past few years and with the use of innovative genomic and proteomic tools, several molecules that their urinary concentration is modified during acute kidney injury have been identified and proposed as biomarkers. Among the most studied biomarkers are neutrophil gelatinase-associated lipocalin-2, kidney injury molecule-1, interleukin-18, cystatin C, N-acetyl-ß-D-glucosaminidase, liver fatty-acid binding protein, and heat shock protein 72. Here, we reviewed and compared the sensitivity and specificity of each biomarker for the appropriate diagnosis of acute kidney injury, as well as its ability to stratify renal injury and to monitor a renoprotective pharmacologic strategy.