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Urinary markers may indicate kidney injury in preterm infants

July 28, 2016

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  • The amounts of protein excreted in the urine of preterm infants with acute kidney injury differ from similar infants without kidney injury.
  • Acute kidney injury in premature infants is common and predicts poor clinical outcomes.
Washington, DC (July 28, 2016) -- A new study indicates that several proteins are excreted differently in preterm infants with kidney injury compared with those with healthy kidneys. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), could lead to better diagnostics related to kidney health in newborns.

Acute kidney injury (AKI), or a rapid decline in kidney function, is common in premature infants, and newborns with AKI have a higher likelihood of dying or of needing an extended stay in the hospital. Research also indicates that premature infants are twice as likely to develop chronic kidney disease and kidney failure compared with term infants, and experts wonder whether AKI may contribute to this risk. Unfortunately, however, detecting AKI in newborns is challenging.

Because developing better diagnostic tests for AKI could lead to better prevention and treatment, David Askenazi MD, MSPH (University of Alabama at Birmingham) and his colleagues assessed the potential of 14 urine proteins for indicating the presence of kidney damage. Using single drops of urine from 113 preterm infants, they found that several of these proteins are good candidates for further investigation. Maximum levels in the first 4 postnatal days of life were 1.7 to 3.7 times higher in those with AKI than those without AKI for the following markers: cystatin c, neutrophil gelatinase associated lipocalin, osteopontin, clusterin, and alpha glutathione S-transferase.

"Having better diagnostic tests to diagnose kidney injury can have an important impact on how we care for infants, how we prognosticate outcomes, and how we design studies to prevent and/or mitigate AKI in these very vulnerable babies," said Dr. Askenazi.
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Study co-authors include Rajesh Koralkar, MPH, Neha Patil, MD, Brian Halloran, MS, Namasivayam Ambalavanan, MD, and Russell Griffin, PhD.

Disclosures: All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. Dr. Askenazi is a speaker for the Acute Kidney Injury (AKI) foundation, Baxter and BTG. He received a career development award from ASN. That support was critical to the gathering the data for this work.

The article, entitled "Acute Kidney Injury Urine Biomarkers in Very Low Birth Weight Infants," will appear online at http://cjasn.asnjournals.org/ on July 28, 2016, doi: 10.2215/CJN.13381215.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 16,000 members representing 112 countries. For more information, please visit http://www.asn-online.org or contact us at 202-640-4660

American Society of Nephrology

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