ESPN 51th Annual Meeting

ESPN 2018


 
Urinary biomarkers for prediction of acute renal damage in infants with urinary tract infection
SINDRI VALDIMARSSON 1 YVONNE SIMRÉN 1 ULF JODAL 1 SVERKER HANSSON 1

1- PEDIATRIC URONEPHROLOGIC CENTER, THE QUEEN SILVIA CHILDREN‘S HOSPITAL, SAHLGRENSKA ACADEMY, UNIVERSITY OF GOTHENBURG, GÖTEBORG, SWEDEN
 
Introduction:

Urinary tract infection (UTI) is a common infection in infants. To reduce the need for invasive investigations we looked for a useful urinary biomarker for prediction of acute renal damage after UTI.

Material and methods:

99mtechnetium dimercapto-succinic acid (DMSA) scintigraphy was performed in the acute phase of UTI. We prospectively examined the ability of eight different biomarkers to predict renal damage at acute DMSA scan after UTI in infants. Urine for biomarker analysis was sampled at admission to the hospital and frozen to −80 °C within 24 hours. All biomarkers were analyzed using commercial enzyme-linked immunosorbent assay kits.

Results:

101 infants, 55 boys and 46 girls, with UTI participated in the study. Mean age was 3.9 months. The acute scan was abnormal with uptake defects in 52% of the infants. Kidney injury molecule 1 (KIM-1) was one of the best biomarkers to predict renal damage at acute DMSA scan. A receiver operating characteristic curve showed an area under the curve of 0.73. With a cut-off of 0.67 ng/ml the sensitivity was 0.76 and the specificity was 0.63. There was an increased risk of renal damage with higher KIM-1 values. The odds ratio per 1 SD was 3.29 (1.70-6.38, 95% CI, p=0.0004). For a KIM-1 value of 2.5 ng/ml the probability of acute renal damage was 80% (60-90%).

Conclusions:

The findings indicate that KIM-1 may be used as a predictor of acute renal damage in infants with UTI.