The usefulness of urinary netrin-1 determination as an early marker of acute kidney injury in children after cardiac surgery

• Published in: Archives of medical science Vol. 21; no. 1; pp. 84 - 91
• Main Authors: Leszczyńska, Beata, Buczyński, Michał, Deja, Anna, Daniel, Maria, Zawadzki, Michał, Katarzyna, Szymańska-Beta, Anna, Stelmaszczyk-Emmel, Gaj, Martyna, Pańczyk-Tomaszewska, Małgorzata
• Format: Journal Article
• Language: English
• Published: Poland Termedia Publishing House 01.01.2025
• Subjects: acute kidney injury; Clinical Research; netrin-1; pediatric cardiac surgery; pediatric cardiac surgery; acute kidney injury; netrin-1
• ISSN: 1734-1922; 1896-9151
• DOI: 10.5114/aoms/188293

Netrin-1 (NTN-1) is an anti-inflammatory protein secreted by proximal tubule epithelial cells in reaction to hypoxic or toxic injury. We determined the utility of urinary NTN-1 as an early marker for detecting acute kidney injury (AKI) in patients after cardiac surgery. Our study included 40 children at age 1-36 months and 20 healthy controls. We measured serum creatinine and urinary NTN-1 in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB). Urinary NTN-1 was higher in the study group than in the control group. The detection rate of urinary NTN-1 was higher before surgery than 6 and 24 h after (55%, 27.5%, and 32.5%, respectively). We found no correlations between NTN-1 at any point and ΔeGFR, decline in eGFR, or AKI after 48 h. The initial NTN-1/creatinine ratio negatively correlated with ΔGFR ( = -0.36, = 0.031), NTN-1/creatinine ratio after 24 h did not correlate with aortic clamping time, CPB time, ΔGFR. In our study, AKI occurred in 12.5% of patients and none required renal replacement therapy (RRT). The occurrence of AKI correlated with CPB time ( = 0.35, = 0.027) and aortic clamping time ( = 0.44, = 0.005). NTN-1 concentration and NTN-1/creatinine ratio in the AKI group were not significantly higher preoperatively and 24 h post-surgery than in patients without AKI. The role of urinary NTN-1 in children after cardiac surgery as an early marker of AKI was not confirmed. No factors affecting the NTN-1/creatinine ratio were found in the study group. Patients who have longer CPB time and aortic clamping time belong to the high-risk group of AKI after surgery.