Plasma and Urine Neutrophil Gelatinase Associated Lipocalin Levels as Markers of Acute Kidney Injury in Critically Ill Children Aged 1-12 Years at Kenyatta National Hospital (Nairobi).

Abstract

Background Acute kidney injury (AKI) refers to a form of kidney dysfunction that rapidly develops within 7 days or less, the resulting complications being metabolic, systemic and death in the extreme. Kidney damage in AKI is due to ischemia, exposure to toxic substances, inflammatory processes or obstruction of the urinary tract. Critically ill children are susceptible to AKI, incidences range from 1 to 31%. Serum creatinine levels and/or urine output are required to diagnose AKI. In critically ill patient’s population serum creatinine and urine values are considered insensitive and additional tools are required to diagnose AKI. Several AKI biomarkers have been fronted with Neutrophil Gelatinase Associated Lipocalin (NGAL) receiving more attention, the goal is to maximize the opportunity for early identification of AKI and intervention which translates to favorable outcomes. Objective To evaluate the potential of plasma NGAL and urine NGAL as a marker of AKI in critically ill children aged 1 - 12 years at KNH. Methodology This was a prospective cross-sectional study carried out in a population of critically ill children aged 1 -12 years admitted at Kenyatta National Hospital, pediatric unit. Forty-eight study participants were enrolled, urine and blood samples were obtained from study subjects on admission and another blood sample was collected 48 hours post admission. Admission and 48hour post admission plasma creatinine was estimated using Dirui reagents (Dirui industrial company Shenzhen, China) Admission plasma and urine NGAL were analyzed using an NGAL kit (Bio Porto Diagnostics A/S, Denmark). All analyses were done on Biolis 50i (Tokyo Boeki Japan) chemistry analyzer. Data was analyzed using STATA statistical package and included both descriptive and inferential analysis. 11 Results A total of 40 subjects completed the study. Majority of the participants (75%) were aged between 1 and 3 years, most (56%) were females. Seventy-one percent (n=34) of all the admissions had respiratory tract infection as the underlying pathology. Nine participants met the criteria for AKI giving a prevalence of AKI among critically ill children at KNH to be 28.5%, 95%CI [12.8, 41.8] based on plasma creatinine, as well as plasma and urine NGAL. A strong positive and significant correlation between Plasma and Urine NGAL (r = 0.869) was evident. Further statistical analysis showed that Plasma (p = 0.029) and Urine NGAL (p = 0.000) are statistically significant markers of AKI in critically ill children aged 1-12 years. Conclusion Plasma NGAL and Urine NGAL can detect AKI and can predict up to 34.7% of the AKI in