تقييم مستويات الليبوكالين المرتبط بالجيلاتينازNGAL وجزيء إصابة الكلى -1 والسيستاتين- C للتنبؤ المبكر بمضاعفات إصابة الكلى الحادة (AKI) للمرضى الاطفال الذكور في محافظة كربلاء

Evaluation of the Levels of Neutrophil Gelatinase-Associated Lipocalin NGAL, Kidney Injury Molecule-1, and Cystatin-C as Early Predicting Complications of Acute Kidney Injury (AKI) in Male Pediatric in Kerbala Province

Abstract

Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine, a decrease in urine output, and a rapid decline in glomerular filtration rate (GFR).
The present study included (120) individuals of pediatric males with a mean of age )5.94±4.9) years patients collected from Karbala Children’s Teaching Hospital during the period from September 2023 to February 2024 divided into two groups (30) intact males used as control and (90) male patients with AKI then categories to three subdivision according to the stages of AKI disease as to Risk, Injury, Failure, Loss End-stage (RIFLE) criteria as follow: stage (1),(2), and (3) include (32), (27), and (31) respactively. Then estimation of the serum concentration of these biochemical markers. The present result found a significant difference at P≤0.001 in increased KIM-1, NGAL, and Cystatin C (1533.36±404.21), (5.69±1.23), (12.50±2.88) respectively as compared to control (716.64±50.72), (2.30±0.28), and (5.32±1.71) respectively in all stages used in the study. The result found a significant difference at P≤0.001 in the age of patients—the younger age found in stage (3) (4.31±4.03) years. Also, BMI showed a high decrease in all patients (14.45±1.9) compared to control. Creatinine, Urea, and Blood Urea Nitrogen (BUN) revealed a significant increase at P≤0.001 (1.61±1.81),(104.38±65.27), and (16.24±10.15) respectively than control (0.42±0.13),(20.61±5.13), and (3.21±0.80) respectively, while significant decrease at P≤0.001 in urine output for all stages compared to control, the higher decline found in stage(3) (0.14±0.09) as compared to control (91.56±0.46), a negative correlation found between KIM-1 and Hemoglobin (Hb), Albumin, and urine output (-0.295),(-0.458), and (-0.629) respectively and positive correlation between KIM-1 with C Reactive Protien (CRP), urea, creatinine, and BUN (0.279),(0.366),(0.236), and (0.366) respectively, a negative correlation found between NGAL and Hb, Red Blood Cells (RBC), Albumin, and urine output (-0.315),(-0.166),(-0.508), and (-0.727) respectively and positive correlation between NGAL with CRP, urea, creatinine, and BUN (0.312),(0.456),(0.231), and (0.455) respectively, a negative correlation found between Cystatin C and Hb, Albumin, and urine output (-0.299),(-0.453), and (-0.675) respectively and positive correlation between Cystatin C with CRP , urea, creatinine, and BUN (0.278),(0.366),(0.214), and (0.366) respectively.
The study finding eGFR by sCr, GFR by sCr & Cyc C, and GFR by Cys C revealed a significant decrease at P≤0.001 (49.60±27.64), (20.68±7.85), and (7.32±2.84) respectively in all patients as compared to control (109.71±13.06), (50.30±7.73), and (16.30±5.07) respectively, and the highest decline for GFR found in Cystatin C for all stages. In conclusion, the present study showed biomarkers containing KIM-1, NGAL, and Cystatin C had the best predictive assurance for AKI. The study revealed that Cystatin C-based GFR reflects a decline in GFR with worsening AKI better than creatinine-based GFR which means a better marker of renal function in early-stage AKI.