A biomarker test developed at Cincinnati Children’s to identify early
acute kidney injury (AKI) in patients following surgery has now proven successful
in broader clinical use.
In a study published online in the Clinical
Journal of the American Society of Nephrology, the test,
which measures the biomarker neutrophil gelatinase-associated lipocalin (NGAL), was used to
successfully diagnose AKI in adult patients with a variety of illnesses who
were admitted to hospital from the emergency department.
Prasad Devarajan, MD, Director, Division of Nephrology and Hypertension, developed the test and led the study, with
collaborators at Fernando Fonseca Hospital in Portugal.
The study demonstrated that the NGAL test, which uses a single drop of
blood and provides results within 15 minutes, could accurately distinguish AKI
from transient reversible kidney dysfunction. Of 616 patients who participated
in the study, individuals who were subsequently diagnosed with true AKI had the
highest levels of neutrophil gelatinase-associated lipocalin measured at the
time of hospital admission. The study also identified a cutoff point in NGAL
levels above which the risk of acute kidney injury increases tenfold.
Results of a study previously published (2008) by Devarajan showed
that the NGAL test predicted AKI in pediatric heart surgery patients within
hours instead of days, allowing treatment that prevented serious damage to
kidneys. Prior to the NGAL test, serum
creatinine was the only reliable method for detecting kidney damage; however,
the long wait for results often resulted in permanent kidney damage.
With a growing number of patients coming to emergency rooms with
community-acquired AKI, Devarajan says having a rapid, reliable method of
detecting kidney injury is increasingly important.
“This latest study showed that this simple laboratory test provides an
accurate prediction of acute kidney injury and its severity in a heterogeneous clinical
setting,” says Devarajan. “The identification of biomarkers that
differentiate intrinsic AKI from transient reversible forms of renal
dysfunction and predict outcomes is a high priority."