Use of the uNGAL biomarker in the early diagnostics of cardiac-surgery-associated acute kidney injury in neonates

Authors

  • A.Zh. Sadykova Asfendiyarov Kazakh National Medical University
  • R.Z. Boranbayeva
  • G.S. Berdiyarova
  • K.B. Zhubanysheva
  • D.R. Kachurina
  • N.R. Khairullina
  • T.Sh. Mustafazade
  • A.D. Sepbayeva

DOI:

https://doi.org/10.37800/RM.2.2023.82-88%20

Keywords:

congenital heart defects, newborns, acute kidney injury (AKI), biomarker, uNGAL

Abstract

Relevance: Acute kidney injury (AKI) in children after cardiac surgery on the open heart is called Cardiac surgery-associated (CSA)-AKI. The frequency of CSA-AKI in newborns is high, about 45-64%. In this connection, the issue of early diagnosis of AKI and the search and justification of new AKI biomarkers remains acute. One of the promising biomarkers among them is uNGAL (urinary NGAL).

The study aimed to establish the frequency of CSA-AKI and study the diagnostic value of the new biomarker uNGAL in newborns with CHD in the perioperative period.

Materials and Methods: A two-center prospective study of 35 newborns with a congenital heart defect after open surgery using a pulmonary bypass was conducted from 2019 to 2021. The CSA-AKI frequency was established using the modified KDIGO Neonatal AKI (mKDIGO) international neonatal сlassification criteria, according to which the patients were divided into two groups: “AKI(+)” and “AKI(-).”

Results: The incidence of CSA AKI was 45.7% (n=16). The AKI frequency by the mKDIGO classification stage was as follows: Stage 1 – 8 (50%) children, Stage 2 – 4 (25%), and Stage 3 – 4 (25%). Before surgery, the mean uNGAL value was 173.5 ng/mL (p<0.001) in the AKI(+) group compared to 30.1 ng/mL in the AKI(-) group. In the first 24 hours after surgery, the urine uNGAL in neonates with AKI increased to an average of 320.7 ng/mL (p<0.001), compared with patients without AKI who had 31.8 ng/mL. In the AKI(+) group, the uNGAL level slightly decreased to 263.6 ng/mL on Day 3 after surgery and increased again on Day 7 to 418.6 ng/mL, which was almost 1.5 times higher than the Day 3 level. The difference was statistically significant (p<0.001). ROC analysis in the AKI(+) group showed that the most significant sensitivity was registered before surgery (93.3%) and on Day 1 after surgery (92.9%).

The highest specificity of uNGAL in the AKI(+) group was registered before surgery (90%) and on Day 3 (89.5%) after surgery.

Conclusion: For the first time in Kazakhstan, new data on the incidence of CSA-AKI in newborns were obtained, and the diagnostic value of a new AKI biomarker in the early diagnosis of CCA-AKI with high sensitivity and specificity was studied.

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Published

2023-05-29

How to Cite

[1]
Sadykova А., Boranbayeva Р., Berdiyarova Г., Zhubanysheva К., Kachurina Д. , Khairullina Н., Mustafazade Т. and Sepbayeva А. 2023. Use of the uNGAL biomarker in the early diagnostics of cardiac-surgery-associated acute kidney injury in neonates. Reproductive Medicine (Central Asia). 2 (55) (May 2023), 82–88. DOI:https://doi.org/10.37800/RM.2.2023.82-88 .

Issue

No. 2 (55) (2023): Reproductive medicine

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Статьи

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