ASSOCIATION OF LIVER FATTY ACID BINDING PROTEIN WITH ACUTE KIDNEY INJURY IN PAEDIATRIC PATIENTS AFTER CARDIAC SURGERY
AbstractBackground: Acute kidney injury (AKI) is a common complication after cardiac surgery. Like Creatinine level, the role of L-FABP in renal injury and its recovery had been shown by studies, so by using/measuring urinary Liver fatty acid-binding protein (uL-FABP) levels it can be a valuable biomarker for monitoring and diagnosis of various renal diseases. The study aimed to determine L-FABP as a biomarker for early diagnosis of AKI acute kidney injury in paediatric patients after cardiac surgery so that early treatment interventions can prevent AKI morbidity. Methods: This descriptive study was conducted in the Pathology laboratory of Sheikh Zayed Hospital, Lahore from 2015 to 2016. Selected through convenience sampling, patients’ blood and urine were analysed for desired markers. Results: Out of 88, 10 (11.4%) patients developed AKI after cardiac surgery. In patients with AKI, serum creatinine levels started to rise at 24–48 h after surgery whereas uL-FABP was to be high at 4h. The optimal cut-off value of uLFABP was found 269 ng/l, with this cut-off value sensitivity of marker at four hours to recognize AKI was found to be 80% and specificity was 83.3%, the positive and negative predictive values were 38.1% and 97.0% respectively with an accuracy level 83.0%. Conclusion: It may be concluded from this study that uL-FABP may be considered as an early predictor of the development of AKI in paediatric patients undergoing cardiac surgery.
Dalal R, Bruss ZS, Sehdev JS. Physiology, Renal Blood Flow and Filtration. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.
Kdigo A. Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int 2012;2(Suppl 1):1–38.
Alejandro V, Scandling JD Jr, Sibley RK, Dafoe D, Alfrey E, Deen W. et al. Mechanisms of filtration failure during postischemic injury of the human kidney. A study of the reperfused renal allograft. J Clin Invest 1995;95(2):820–31.
Bonventre JV, Weinberg JM. Recent advances in the pathophysiology of ischemic acute renal failure. J Am Soc Nephrol 2003;14(8):2199–2210.
Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med 2004;351(2):159–69.
Le Dorze M, Legrand M, Payen D, Ince C. The role of the microcirculation in acute kidney injury. Curr Opin Crit Care 2009;15(6):503–8.
Mason J, Torhorst J, Welsch J. Role of the medullary perfusion defect in the pathogenesis of ischemic renal failure. Kidney Int 1984;26(3):283–93.
Karlberg L, Norlen BJ, Ojteg G, Wolgast M. Impaired medullary circulation in postischemic acute renal failure. Acta Physiol Scand 1983;118(1):11–7.
Rabelink TJ, de Boer HC, van Zonneveld AJ. Endothelial activation and circulating markers of endothelial activation in kidney disease. Nat Rev Nephrol 2010;6(7):404–14.
Basile DP. The endothelial cell in ischemic acute kidney injury: implications for acute and chronic function. Kidney Int 2007;72(2):151–6.
Blantz RC, Deng A, Miracle CM, Thomson SC. Regulation of kidney function and metabolism:a question of supply and demand. Trans Am Clin Climatol Assoc 2007;118:23–43.
Brezis M 3rd, Rosen S. Hypoxia of the renal medulla its implications for disease. N Engl J Med. 1995;332(10):647–655.
Beeuwkes R, Bonventre JV. Tubular organization and vascular-tubular relations in the dog kidney. Am J Physiol 1975;229(3):695–713.
Bagnasco S, Good D, Balaban R, Burg M. Lactate production in isolated segments of the rat nephron. Am J Physiol 1985;248(4 pt 2):F522–6.
Lok CE, Austin PC, Wang H, Tu JV. Impact of renal insufficiency on short- and long- term outcomes after cardiac surgery. Am Heart J 2004;148(3):430–8.
Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365(9466):1231–8.
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998;104(4):343–8.
Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004;15(6):1597–605.
Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 2009;76(8):885–92.
Goldstein SL, Devarajan P. Acute kidney injury in childhood: should we be worried about progression to CKD? Pediatr Nephrol 2011;26(4):509–22.
Bellomo R, Kellum JA, Ronco C. Defining acute renal failure: physiological principles. Intensive Care Med 2004;30(1):33–7.
McMahon GM, Waikar SS. Biomarkers in nephrology: Core Curriculum 2013. Am J Kidney Dis 2013;62(1):165–78.
Yamamoto T, Noiri E, Ono Y, Doi K, Negishi K, Kamijo A, et al. Renal L-type fatty acid binding protein in acute ischemic injury. J Am Soc Nephrol 2007;18(11):2894–902.
Chmurzyńska A. The multigene family of fatty acid-binding proteins (FABPs): function, structure, and polymorphism. J Appl Genet 2006;47(1):39–48.
Michael DS. Digestion and absorption of dietary triglycerides. In: Leung Po Sing, editor. The gastrointestinal system: gastrointestinal, nutritional and hepatobiliary physiology. New York: E-Publishing Inc, 2014; p.160–78.
Sharma A, Yogavel M, Sharma A. Utility of anion and cation combinations for phasing of protein structures. J Struct Funct Genomics 2012;13(3):135–43.
Basile DP, Leonard EC, Beal AG, Schleuter D, Friedrich J. Persistent oxidative stress following renal ischemia–reperfusion injury increases ANG II hemodynamic and fibrotic activity. Am J Physiol Renal Physiol 2012;302(11):1494–502.
Mohamed Abd E, Lasheen NN. Comparative study on the protective role of vitamin C and L-arginine in experimental renal ischemia reperfusion in adult rats. Int J Physiol Pathophysiol Pharmacol 2014;6(3):153–65.
Kwiecien S, Jasons K, Magierowski M, Sliwowski Z, Pajdo R, Brzozowski B, et al. Lipid peroxidation, reactive oxygen species and antioxidatie factors in the pathogenesis of gastric mucosal lesions and mechanism of protection against oxidative stressindued gastric injury. J Physiol Pharmacol 2014;65(5):613–22.
Belcher JM, Garcia-Tsao G, Sanyal AJ, Thiessen-Philbrook H, Peixoto AJ, Perazella MA, et al. Urinary biomarkers and progression of AKI in patients with cirrhosis. Clin J Am Soc Nephrol 2014;9(11):1857–67.
Yang J, Choi HM, Seo MY, Lee JY, Kim K, Jun H, et al. Urine liver-type fatty acid binding protein predicts graft outcome up to 2 years after kidney transplantation. Transplant Proc 2014;46(2):376–80.
Ivanišević I, Peco-Antić A, Vuličević I, Hercog D, Milovanović V, Kotur-Stevuljević J, et al. L-FABP can be an early marker of acute kidney injury in children. Pediatr Nephrol 2013;28(6):963–9.
Matsui K, Kamijo IA, Sugaya T, Yasuda T, Kimura K. Usefulness of urinary biomarkers in early detection of acute kidney injury after cardiac surgery in adults. Circ J 2012;76(1):213–20.
Krawczeski CD, Goldstein SL, Woo JG, Wang Y, Piyaphanee N, Ma Q, et al. Temporal relationship, and predictive value of urinary acute kidney injury biomarkers after pediatric cardiopulmonary bypass. J Am Coll Cardiol 2011;58(22):2301–9.
Portilla D, Dent C, Sugaya T, Nagothu KK, Kundi I, Moore P, et al. Liver fatty acid binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int 2008;73(4):465–72