Urinary aprotinin as a predictor of acute kidney injury after cardiac surgery in children receiving aprotinin therapy

Mai T. Nguyen, Catherine L. Dent, Gary F. Ross, Nathan Harris, Peter B. Manning, Mark M. Mitsnefes, Prasad Devarajan

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Proteomic analysis has revealed potential early biomarkers of acute kidney injury (AKI) in children undergoing cardiopulmonary bypass (CPB), the most prominent one with a mass-to-charge ratio of 6.4 kDa. The objective of this study was to identify this protein and test its utility as a biomarker of AKI. Trypsin-digested protein bands were analyzed by tandem mass spectrometry (MS/MS) to identify the protein in urine samples. Surface-enhanced laser desorption/ionization time-of-flight analysis and a functional activity assay were performed to quantify urinary levels in a pilot study of 106 pediatric patients undergoing CPB. The protein was identified as aprotinin. Urinary aprotinin levels 2 h after initiation of CPB were predictive of AKI (for functional assay: 92% sensitivity, 96% specificity, area under the curve of 0.98). By multivariate analysis, the urinary aprotinin level 2 h after CPB was an independent predictor of AKI (β=0.001, P < 0.0001). The 2 h urinary aprotinin level correlated with serum creatinine, duration of AKI, and length of hospital stay. We concluded that urinary aprotinin levels 2 h after initiation of CPB predict the development of AKI and adverse clinical outcomes.

Original languageEnglish
Pages (from-to)1317-1326
Number of pages10
JournalPediatric Nephrology
Volume23
Issue number8
DOIs
StatePublished - Aug 2008

Keywords

  • Acute kidney injury
  • Acute renal failure
  • Aprotinin
  • Biomarker
  • Cardiac surgery

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