Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
Pediatr Res. 2011 Aug;70(2):203-7. doi: 10.1203/PDR.0b013e31822188b4.
NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of whom were without AKI. Although 18 (7%) had AKI by pRIFLE, 50% may not have had it identified by the SCr value alone at the time of visit. Median urinary nitrate was lower for injury versus risk (p = 0.03); this difference remained significant when the injury group was compared against the combined risk and no AKI groups (p = 0.01). Urinary nitrite was not significantly different between groups. Thus, low urinary nitrate is associated with AKI in the pediatric ED even when SCr is normal. Predictive potential of this putative urinary biomarker for AKI needs further evaluation in sicker patients.
NO 参与正常肾功能，在急性肾损伤 (AKI) 中受到干扰。我们假设，当血清肌酐 (SCr) 无信息时，在急诊科 (ED) 就诊的早期 AKI 患儿的尿 NO 代谢物亚硝酸盐和硝酸盐浓度较低。如果患者进行了常规护理的尿液分析和 SCr 检测，则招募年龄在 19 岁以下的患者。主要结局是 AKI，由儿科风险、损伤、衰竭、失能、终末期肾病 (pRIFLE) 标准定义。通过 HPLC 测定尿亚硝酸盐和硝酸盐。共纳入 252 例患者，其中大多数（93%）患者无 AKI。尽管 18 例（7%）患者根据 pRIFLE 患有 AKI，但 50%的患者在就诊时仅根据 SCr 值可能无法识别 AKI。与风险组相比，损伤组的尿硝酸盐中位数较低（p=0.03）；当将损伤组与风险和无 AKI 两组进行比较时，这种差异仍然具有统计学意义（p=0.01）。各组间尿亚硝酸盐无显著差异。因此，即使 SCr 正常，尿硝酸盐降低也与儿科 ED 中的 AKI 相关。该潜在尿生物标志物对 AKI 的预测潜力需要在病情更严重的患者中进一步评估。
