Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin are early predictors for acute kidney injury among patients admitted to the surgical ICU

Objectives: Evaluation of urinary neutrophil gelatinase-associated lipocalin (UNGAL) and kidney injury molecule 1 (UKIM-1) as early predictors of development of acute kidney injury (AKI) in patients admitted to surgical ICU. Patients & Methods: 188 ICU patients were clinically evaluated and gave blood samples for estimation of at admission (T0) serum creatinine (SCr) and urine samples for estimation of urinary creatinine (UCr), UNGAL and UKIM-1 and their values were adjusted to UCr level. At 48-hr after admission SCr levels were re-estimated and AKI was diagnosed and staged according to the Acute Kidney Injury Network criteria. Study outcomes included the ability of estimated markers for prediction of possible AKI development. Results: At 48-hr after ICU admission, 73 patients (38.8%) developed AKI; 42, 21 and 10 mild, moderate and severe AKI, respectively. At T0, UNGAL and UKIM1, and their UCr ratios showed progressive increase with increased AKI grade. Calculated SCr was positively correlated with clinical data and estimated levels of urinary markers. Regression analysis defined elevated BMI, TISS-28 score, UNGAL and UKIM-1 as early significant predictors for AKI. ROC curve analysis defined UNGAL and UKIM-1 and their ratios to UCr as the significant predictors for AKI development. Conclusion: Development of AKI in ICU patients was related to severity of surgical trauma. High UNGAL and UKIM-1 at time of ICU admission can predict upcoming AKI and its AUC after adjustment to UCr levels had superior predictive value for AKI. A high uKIM-1/UCr ratio can be considered the most significant early predictor for AKI.