Objective: To evaluate the course of urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 levels in young children during extracorporeal membrane oxygenation and concomitant continuous hemofiltration. Furthermore, to evaluate whether these levels predict outcome. Design: Prospective observational cohort study from July 2010 to July 2013. Setting: ICU of a level III university children's hospital. Patients: Thirty-one extracorporeal membrane oxygenation-treated children up to 1 year were included. Interventions: None. Measurements and Main Results: Patients were weaned from extracorporeal membrane oxygenation after a median of 162 hours (interquartile range, 83-304). Throughout the study, 58% of the patients met the criteria for acute kidney injury (i.e., Risk Injury Failure Loss End-Stage Renal Disease - Risk or higher defined as an increase in serum creatinine corresponding to ≥ 150% when compared with age-specific reference values). Levels of both biomarker patterns changed significantly throughout extracorporeal membrane oxygenation (urinary neutrophil gelatinase-associated lipocalin, p < 0.001 and urinary kidney injury molecule-1, p = 0.005, linear mixed model analyses). Urinary neutrophil gelatinase-associated lipocalin levels were already high before extracorporeal membrane oxygenation, whereas urinary kidney injury molecule-1 levels increased throughout the first extracorporeal membrane oxygenation day and peaked at 12-24 hours. Also, urinary neutrophil gelatinase-associated lipocalin levels at 12-24 hours of extracorporeal membrane oxygenation therapy were higher among patients with acute kidney injury post extracorporeal membrane oxygenation (p = 0.002, Mann-Whitney U test). Biomarker levels did not differ between survivors and nonsurvivors. Conclusions: The increased urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 levels confirm that renal tubular damage occurs in critically ill infants in need of extracorporeal membrane oxygenation. The fact that the maximal urinary neutrophil gelatinase-associated lipocalin levels were measured 24 hours earlier than urinary kidney injury molecule-1 supports the use of biomarker combinations rather than a single biomarker to identify patients at risk of acute kidney injury. Finally, since urinary neutrophil gelatinase-associated lipocalin levels at 12-24 hours of extracorporeal membrane oxygenation therapy were associated with acute kidney injury post extracorporeal membrane oxygenation, this marker may facilitate more timely adjustment of therapeutic interventions.

Additional Metadata
Keywords acute kidney injury, biomarkers, critical care, extracorporeal membrane oxygenation, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin
Persistent URL dx.doi.org/10.1097/PCC.0000000000000476, hdl.handle.net/1765/92440
Journal Pediatric Critical Care Medicine
Citation
Zwiers, A.J.M, Cransberg, K, de Rijke, Y.B, van Rosmalen, J.M, Tibboel, D, & de Wildt, S.N. (2015). Urinary neutrophil gelatinase-associated lipocalin predicts renal injury following extracorporeal membrane oxygenation. Pediatric Critical Care Medicine, 16(7), 663–670. doi:10.1097/PCC.0000000000000476