ABSTRACT
Objective To evaluate the value of early diagnosis of acute kidney injury (AKI) in children by the detection of the serum prohibition (PHB),urinary neutrophil gelatinnase-associated lipocalin (NGAL),kidney injury molecule-1 (KIM-1)levels.Methods One hundred and eighty-six cases of patients including allergic purpura 80 cases,drrug poisoning 50 cases,kidney disease 40 cases,cardiopulmonary bypass surgery 16 cases were selected.The levels of serum PHB,urinary NGAL,KIM-I and serum creatinine (Scr) were detected,and the children were divided into the AKI and non-AKI group according to AKI criteria.The dynamic changes in serum PHB,urinary NGAL,KIM-1 and the Scr levels were observed,and ROC curve was used to evaluate the specificity and sensitivity of serum PHB,urinary NGAL,KIM-1 in the diagnosis of AKI.Results The incidence of AKI of patients with allergic purpura,drug poisoning,kidney disease and cardiopulmonary bypass surgery were 35.00％ (28/80 cases),36.00％ (18/50 cases),60.00％ (24/ 40 cases) and 43.75％ (7/16 cases),respectivcly; 3 days before the diagnosis of AKI,the urine NGAL,KIM-1 And blood PHB in AKI group han no significant difference compared with those in non-AKI group,urine NGAL increased siggificantly 2 days before diagnosis of AKI compared with non-AKI group (P ＜ 0.05),urine KIM-1 and blood PHB increased significantly in the diagnosis of AKI before 1 day (all P ＜ 0.05) ; the levels of blood PHB,urine NGAL,KIM-1 and Scr inceased in AKI children in the different stages of AKI-R,AKI-I,AKI-F compared with non-AKI group,and the differences were statistically significant (all P ＜ 0.05),changes in blood PHB,urine NGAL,KIM-1 level had significant difference among different AKI periods (all P ＜ 0.05) ; By ROC curve analysis,the unea under the curve of blood PHB,NGAL and KIM-1 was 0.614,0.802 and 0.627 respectively 2 days before diagnosis of AKI,the area under the curve of blood PHB,NGAL and KIM-1 was 0.926,0.958 and 0.906 respectively,1 day before diagnosis of AKI; the sensitivity and specificity of blood PHB were 84％ and 89％ respectively,those of urinary NGAL were 96％ and 93％,and that of urinary KIM-1 was 91％ and 92％ respectively; the error rate of serum PHB detection combined with urinary NGAL,KIM-1 was 0 in diagnosis of AKI.Conclusions Serum PHB detection combined urinary NGAL,KIM-1 on the basis of predisposes to AKI is important in the process and can be used as the diagnostic biomarkers for predicting the occurrence of AKI and the severity of the illness.