Serum KIM-۱ and Cystatin Levels as the Predictors of Acute Kidney Injury in Asphyxiated Neonates

Background: Asphyxia may lead to serious complications, among which acute kidney injury (AKI) is the most common. Early diagnosis of AKI can help prevent impaired acid-base, fluid, and electrolyte balance that may lead to life-threatening complications. This study aimed to evaluate the effect of kidney injury molecule-۱ (KIM-۱) and cystatin-C in the early diagnosis of AKI among asphyxiated neonates. Methods: This case-control study was conducted on ۴۵ asphyxiated neonates, ۲۴ of whom were in the control group and ۲۳ cases were in the case group. Creatinine (Cr), KIM-۱, and cystatin-C were measured for participants within ۸ h and ۴ days after birth and compared between case and control groups. Results: The mean level of Cr-Standardized KIM-۱ measured within ۸ h and ۴ days after birth was significantly higher in the case group, compared to the control group (P-value<۰.۰۵). The mean level of Cr-Standardized cysteine, only ۴ days after birth, was significantly higher in the case group, compared to the control group (P-value<۰.۰۵). A receiver operating characteristic (ROC) curve analysis demonstrated that between the two biomarkers with two measurements, the KIM-۱ Cr-Standardized within ۴ days had the highest area under the curve (AUC) (۰.۷۵۱, ۹۵% CI: ۰.۵۹۷-۰.۹۰۵). Moreover, the results of ROC curve analysis showed that Cr-Standardized KIM-۱ within ۴ days after birth with a critical value of >۰.۶۷ ng/ml allowed to predict kidney failure in newborns with ۵۷.۱ % sensitivity and ۸۶.۴ % specificity. Conclusion: The findings of the present study show that high-specificity KIM-۱ is a good biomarker for the early detection of acute renal failure in asphyxiated infants; however, similar expectations cannot exist with regards to cystatin-C for at least the first ۸ h after birth.    

Keywords:

Acute kidney injury , Asphyxia , Cystatin-C , Kidney injury Molecule-۱