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. 2023 Jan-Feb;39(1):34-40.
doi: 10.12669/pjms.39.1.6930.

Efficacy of multiple Biomarkers: NGAL, KIM1, Cystatin C and IL18 in predicting pregnancy related acute kidney injury

Rubina Naqvi  1 , Nazli Hossain  2 , Sofia Butt  3 , Zeenat Bhellar  4 , Erum Fatima  5 , Sanam Imtiaz  6 , Palwasha Ghulam Moosa  7 , Khawar Abbas  8 , Salma Batool Jafri  9 , Sadia Khan  10
Affiliations

Efficacy of multiple Biomarkers: NGAL, KIM1, Cystatin C and IL18 in predicting pregnancy related acute kidney injury

Rubina Naqvi et al. Pak J Med Sci. 2023 Jan-Feb.

Abstract

Objective: Several biomarkers like NGAL, KIM-1, IL-18, and Cystatin C has been previously reported as reliable marker to predict AKI. However, their predictive accuracy varies widely. We aim to observe the efficacy of multiple markers, NGAL, KIM-1, Cystatin C and IL-18, in obstetric population who are at risk of developing AKI.

Methods: This prospective study was carried out between June 2021 to March 2022 at Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital and Sindh Institute of Urology & Transplant (SIUT), Karachi Pakistan. On women brought to OBGYN-ER with the diagnosis of hemorrhage (antepartum and postpartum), hypertension (pre-eclampsia and eclampsia) and sepsis. The urine samples and 3cc blood was collected at the time of admission, blood sample processed for biochemistry at time of admission and repeat blood samples for serum creatinine at 24 and 48 hours. Urine was stored at -80ºC and later evaluated for NGAL, KIM-1, Cystatin C and IL-18. Serum Cystatin C was also processed for the time zero sample. The biomarkers were tested using ELISA assays.

Results: A total of 149 women were included in the study, 83% of these women were non-booked. Twenty-six (17%) women developed AKI. Serum Cystatin C, urinary Cystatin C and urinary NGAL were found significantly raised in women who developed AKI. While KIM-1 and IL-18 were not raised to statistical significance in this population. However, urinary KIM-1 along with urinary Cystatin C were significantly raised in women with positive quick sequential organ failure assessment (qSOFA).

Conclusion: This study validates the use of serum and urinary Cystatin C and urinary NGAL as highly predictable biomarkers for the development of AKI and nullifies urinary IL-18 and KIM-1 in this regard.

Keywords: Acute Kidney injury (AKI); Cystatin C; IL-18; KIM-1; NGAL.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Fig.1
Fig.1
AUC-ROCC showing probability of different biomarkers with development of AKI.
Fig.2
Fig.2
AKI vs no AKI. Box plot showing Natural Log (Ln) transformed copies at zero time (whiskers represent min/max value).
Fig. 3
Fig. 3
Combination of all five biomarkers to predict AKI.
See this image and copyright information in PMC

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