Rano otkrivanje akutnog oštećenja bubrega kod preterminskog novorođenčeta pomoću urinarnih biomarkera

Abstract

Uvod: Akutna oštećenje bubrega (AKI), Acute Kidney Injury, je veliki problem u novorođenčadi, posebno preterminske koji značajno povećava perinatalni morbiditet i mortalitet. Takođe AKI može biti faktor rizika za razvoj hronične bubrežne bolesti. Preterminska novorođenčad sa perinatalnom asfiksijom (PNA) su posebno sklona AKI. Incidenca AKI kod preterminske novorođenčadi kreće se od 30% do 70%. Dosadašnja dijagnoza AKI bazira se na porastu vrednostima serumskog kreatinina i smanjenju diureze. Poznato je da su oba, serumski kreatinin i oligurija/anurija kasni markeri smanjene funkcije bubrega i samim tim ne detektuju rano oštećenje bubrega. Stoga dijagnoza AKI obično kasni i ograničava potencijal za rane terapijske intervencije. Očekuje se da će rano otkrivanje AKI poboljšati ishod u jedinicama neonatalne intenzivne nege (NICU). U poslednjoj deceniji su učinjeni značajni napori da se pronađe više pouzdanih ranih biomarkera AKI. Kandidati za nove biomarkere: neutrophil gelatinase-associated lipocalin (NGAL), molekul 1 bubrežnog oštećenja (KIM-1), cistatin C (Cys C), jetreni tip vezujućeg proteina za masne kiseline (L-FABP), interleukin - 6 (IL-6), interleukin -18 (IL-18), hepatocitni faktor rasta (HGF), fibroblastni faktor rasta - 23 (FGF-23), vaskularni endotelijalni faktor rasta ɑ(VEGF), beta - 2 microglobulin (β-2M), alfa -1mikroglobulin (ɑ-1M) i osteopontin (OPN) su ispitivani u poslednje vreme. Čini se da od svih novih biomarkera najviše obećava NGAL. Međutim postoji samo nekoliko studija o NGAL kod novorođenčadi, a veoma mali broj kod preterminske novorođenčadi sa perinatalnom asfiksijom. Cilj istraživanja: Ispitati AKI u preterminske novorođenčadi i nove biomarkere: urinarni NGAL (uNGAL), serumski NGAL (sNGAL), KIM-1, ɑ-1M, β-2M kao markere AKI u asfiktične preterminske novorođenčadi. Materijal i metode: Prospektivna studija izvedena u Institutu za neonatologiju u Beogradu uključila je 108 preterminske novorođenčadi sa perinatalnom asfiksijom i AKI...

Introduction: Acute kidney injury (AKI) is a major problem in neonates, especially in premature infants, that significantly increases perinatal morbidity and mortality. It may also be a risk factor for chronic kidney disease development. Preterm neonates with perinatal asphyxia (PNA) are particularly prone to AKI. The published incidence of AKI in neonates with moderate to severe perinatal asphyxia ranges from 30% to 70%. The current diagnosis of AKI is based on serum creatinine increase and urine output decrease. It is well known that both of them are late markers of reduced kidney function and, therefore, do not detect arly kidney damage. Therefore, AKI diagnosis is usually late, and that limits the potential for arly therapeutic intervention. It is expected that early diagnosis of AKI would improve outcome in neonatal intensive care unit. In the last decade considerable efforts have been made to find more reliable early biomarkers of AKI. Many candidates for new biomarkers, including: neutrophil gelatinaseassociated lipocalin (NGAL), kidney injury molecule -1 (KIM-1), cystatin C (Cys C), liver fatty acid binding protein (L-FABP), interleukin - 6 (IL-6), interleukin -18 (IL- 18), hepatocite growth factor (HGF), fibroblast growth factor -23 (FGF-23), vascular endothelial growth factor (VEGF), alfa -1 microglobulin (ɑ-1M), beta - 2 microglobulin (β-2M) and osteopontin (OPN) have been recently tested. NGAL seems to be the most promising of these new biomarkers. However, there only a few studies on urinary NGAL (uNGAL) focused on neonates, and only a limited numer of premature infants with perinatal asphyxia have been evaluated. Aim: The examine acute kidney injury (AKI) in the premature neonates, and new biomarkers as a marker of AKI in asphyxiated preterm infant. Methods and materials: A prospective study was carried out at the Institute for neonatology Belgrade, and included 108 preterm infants with PNA and AKI...