Urinary KIM-1 in children undergoing nephrotoxic antineoplastic treatment: a prospective cohort study.

Autor: Carvalho Pedrosa D; Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil., Macedo de Oliveira Neves F; Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil., Cavalcante Meneses G; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil., Pinheiro Gomes Wirtzbiki G; Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil., da Costa Moraes CA; Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil., Costa Martins AM; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil., Braga Libório A; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil. alexandreliborio@yahoo.com.br.; Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil. alexandreliborio@yahoo.com.br.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2015 Dec; Vol. 30 (12), pp. 2207-13. Date of Electronic Publication: 2015 Aug 07.
DOI: 10.1007/s00467-015-3178-3
Abstrakt: Background: Acute kidney injury (AKI) is a significant complication in patients with cancer, and nephrotoxic drugs are among the most common causes of AKI. To date, there is no study evaluating the potential role of renal biomarkers in children receiving nephrotoxic chemotherapy.
Methods: A prospective study was conducted in children receiving methotrexate (MTX) or platinum-based treatment. Urinary kidney injury molecule-1 (KIM-1) was measured 24 h after the initiation of the chemotherapy infusion, and serum creatinine (sCr) was measured prior to drug infusion and at 24, 48, 72, and 96 h, 1 and 2 weeks, and 3 months post-initiation of treatment.
Results: A total of 64 children were evaluated, of whom 21 (32.8%) developed AKI. The majority had AKI stage 1 (n = 12, 57.1%) and only one developed AKI stage 3. Median values of urinary KIM-1 were higher in patients with AKI than in those without AKI [10.7, interquartile range (IQR) 1.6-17.9 vs. 4.3 (IQR 1.3-6.1) ng/mg creatinine; p < 0.01]. Urinary KIM-1 showed good discrimination for AKI in patients receiving nephrotoxic chemotherapy, with an area under the receiver operator characteristic curve for AKI up to 1 week later of 0.82 (95% confidence interval 0.66-0.95). Even when measured only 24 h after drug infusion, urinary KIM-1 still showed good discrimination to predict persistent renal impairment three months later.
Conclusion: Urinary KIM-1 measured 24 h after the start of drug infusion has the potential to detect early AKI in pediatric patients treated with MTX or platinum-class drugs.
Databáze: MEDLINE
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