Serum neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 as potential biomarkers of subclinical nephrotoxicity after gadolinium-based and iodinated-based contrast media exposure in pediatric patients with normal kidney function

Abstract

Background: New renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) show promise in early diagnosis of contrast media induced acute kidney injury (CI-AKI). The purpose of our study was to compare the subclinical nephrotoxicity (a condition without changes in standard renal bio-markers) of gadolinium-based contrast media (Gd-DTPA, gadopentetate dimeglumine) and iodinated-based contrast media (iopromide) in pediatric patients with normal kidney function. Material/Methods: The first group (n=58) of patients included in the study were undergoing angiography with iopromide, and the second group (n=65) were undergoing magnetic resonance (MR) angiography/urography with Gd-DTPA admin-istration. The concentrations of NGAL and KIM-1 were measured four times in the urine (pre-contrast, then at four hours, 24 hours, and 48 hours after contrast administration), and serum NGAL was measured at 0 (base-line), 24 hours, and 48 hours after contrast exposure. Results: After 24 hours, serum NGAL increase of ³25% was noticed in 32.6% of the patients in the iopromide group and in 25.45% of the patients in the gadolinium group, with significantly higher average percent of this increase in first group (62.23% vs. 36.44%, p=0.002). In the Gd-DTPA group, we observed a statistically significant in-crease in urinary KIM-1 24 hours after the procedure. Normalized urinary KIM-1, 24 hours after contrast expo-sure, was a better predictive factor for CI-AKI than other biomarkers (AUC 0.757, cut off 214 pg/mg, sensitivi-ty 83.3%, specificity 54.2%, p=0.035). Conclusions: In children with normal renal function, exposure to iodinated-based and gadolinium-based media might lead to subclinical nephrotoxicity, which could be detected using serum NGAL and urinary KIM-1. © Med Sci Monit.