Background

Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hospitalized children. A key component of the NINJA quality improvement initiative is systematic daily serum creatinine assessment in non-critically ill children exposed to ≥ 3 nephrotoxic medications on 1 day, or intravenous aminoglycoside or vancomycin for ≥ 3 days. Daily venipuncture is invasive and associated with disposable and personnel healthcare costs. Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a marker of renal tubular injury associated with certain nephrotoxic medications. We investigated whether uNGAL is a reliable screening tool for AKI in NINJA and could decrease the need for daily venipuncture.

Methods

This two-center prospective study enrolled 113 children who met NINJA criteria from May 2018 through March 2019. Daily urine samples were obtained for up to the first 7 days of qualifying exposure and 2 days after exposure ended. Our primary outcome was severe AKI (KDIGO stage 2 or 3 AKI). Maximum uNGAL was highest concentration on the day of, or 3 days prior to, severe AKI. The highest uNGAL level from all assessment days was used for patients who did not develop AKI or severe AKI.

Results

Urine NGAL thresholds of 150 and 300 ng/ml demonstrated excellent specificity (92.4 and 97.1% respectively) and negative predictive values (93.3 and 92.8% respectively) for ruling out severe AKI.

Conclusions

We suggest that uNGAL could be used to supplant some of the daily serum creatinine venipunctures in NINJA. The most optimal combination of serum creatinine and uNGAL assessment requires further study.

中文翻译：

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尿中性粒细胞明胶酶相关载脂蛋白可排除儿童肾毒性急性肾损伤

背景

肾毒性药物暴露是住院儿童急性肾损伤 (AKI) 的常见原因。NINJA 质量改进计划的一个关键组成部分是对暴露于 1 天 ≥ 3 种肾毒性药物或静脉注射氨基糖苷类药物或万古霉素 ≥ 3 天的非危重儿童进行系统的每日血清肌酐评估。每日静脉穿刺是侵入性的，并且与一次性和人员医疗保健费用相关。尿中性粒细胞明胶酶相关载脂蛋白 (uNGAL) 是与某些肾毒性药物相关的肾小管损伤的标志物。我们调查了 uNGAL 是否是 NINJA 中 AKI 的可靠筛查工具，是否可以减少对日常静脉穿刺的需求。

方法

这项双中心前瞻性研究招募了 2018 年 5 月至 2019 年 3 月期间符合 NINJA 标准的 113 名儿童。在合格暴露的前 7 天和暴露结束后的 2 天，每天采集尿样。我们的主要结局是严重的 AKI（KDIGO 2 或 3 期 AKI）。最大 uNGAL 是严重 AKI 当天或前 3 天的最高浓度。所有评估日的最高 uNGAL 水平用于未发生 AKI 或严重 AKI 的患者。

结果

尿液 NGAL 阈值 150 和 300 ng/ml 表现出极好的排除严重 AKI 的特异性（分别为 92.4 和 97.1%）和阴性预测值（分别为 93.3 和 92.8%）。

结论

我们建议 uNGAL 可用于替代 NINJA 中的一些每日血清肌酐静脉穿刺。血清肌酐和 uNGAL 评估的最佳组合需要进一步研究。