Volovelsky Oded, Gist Katja M, Terrell Tara C, Bennett Michael R, Cooper David S, Alten Jeffrey A, Goldstein Stuart L
Clin Nephrol. 2018 Sep;90(3):165-171. doi: 10.5414/CN109359.
Acute kidney injury (AKI) occurs in 30 - 40% of children after cardiac surgery (CS) and is associated with poor prognosis. Fibroblast growth factor 23 (FGF23) is a bone-derived hormone with a pivotal role in phosphorus and vitamin D metabolism. We assessed FGF23 as an early marker for severe AKI (sAKI) in infants after CS.
Samples were previously collected in a multicenter observational study from children after CS. Serum FGF23 (n = 41) and urine AKI biomarker levels (n = 35) were assessed 4 - 8 hours after bypass. sAKI was defined as ≥ 100% rise in serum creatinine over baseline. Non-parametric and ROC analyses were used to evaluate the association between FGF23, urine AKI markers, and sAKI in the week after CS.
Serum FGF23, urine NGAL, and urine KIM1 were higher in sAKI patients. The AUC-ROC for urine NGAL (0.74, [0.49 - 0.99]), urine KIM1 (0.79, [0.68 - 0.98]), and serum FGF23 (0.74, [0.5 - 0.9]) showed fair prediction of sAKI.
CONCLUSION: Early measurement of FGF23 has predictive ability in infants who develop sAKI after CS with cardiopulmonary bypass. .
急性肾损伤（AKI）发生于心内直视手术后30%-40%的儿童中，且与预后不良相关。成纤维细胞生长因子23（FGF23）是一种骨源性激素，在磷和维生素D代谢中起关键作用。我们评估FGF23作为心内直视手术后婴儿严重急性肾损伤（sAKI）的早期标志物。
样本先前在一项多中心观察性研究中收集自心内直视手术后的儿童。在体外循环后4-8小时评估血清FGF23（n = 41）和尿AKI生物标志物水平（n = 35）。sAKI定义为血清肌酐较基线升高≥100%。采用非参数分析和ROC分析来评估CS后一周内FGF23、尿AKI标志物与sAKI之间的关联。
sAKI患者的血清FGF23、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和尿肾损伤分子-1（KIM1）水平较高。尿NGAL（0.74，[0.49 - 0.99]）、尿KIM1（0.79，[0.68 - 0.98]）和血清FGF23（0.74，[0.5 - 0.9]）的曲线下面积（AUC-ROC）显示对sAKI有较好的预测能力。
早期检测FGF23对在体外循环下心内直视手术后发生sAKI的婴儿具有预测能力。
