Early Detection of Acute Kidney Injury after Cardiac Surgery—Discovery of New Urinary Biomarker

Background: Acute kidney injury (AKI) is a frequent complication after congenital heart surgery with an incidence up to 40%. It is associated with an increased morbidity and mortality. Early recognition is crucial but is often delayed by biomarker used in clinical routine leading to delayed therapy, especially in subclinical AKI. Urine is easy and non-invasive to collect and provides exclusive insights on kidney function and systemic status. Here, we sought to profile the urine of patients undergoing cardiac surgery for congenital heart disease with the goal of identifying new diagnostic markers.

Methods: Patients with congenital heart disease undergoing cardiac surgery at our institution were included. Urine was analyzed before operation, direct after operation, 6 and 24 hours postoperatively using high-accuracy mass spectrometry proteome profiling.

Results: 67 patients (25 female; 0–65 years) were consecutively enrolled of whom 13 developed AKI according to KDIGO definition. 18 candidate biomarkers for AKI were identified directly after surgery. Among these Kallikrein-1 (KLK-1), vascular endothelial growth factor (VEGF) and receptor-type tyrosine-protein phosphatase-like N (PTPRN) are the most promising ones with an 11.6- (KLK-1), 9.0- (VEGF) and 7.3- (PTPRN) fold change in AKI patients

Conclusion: High-accuracy mass spectrometry urine proteome profiling allowed identification of diagnostic markers of acute kidney injury direct after congenital heart surgery. Usage of urinary KLK-1, VEGF and PTPRN may improve the diagnostic accuracy and allow early detection of patients at risk for AKI. Further studies are warranted to confirm these results.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024