Application value of urinary calprotectin in differential diagnosis between prerenal and intrinsic pediatric acute renal injury / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the value of urinary calprotectin in differential diagnosis between prerenal and intrinsic pediatric acute renal injury(AKI).Methods A total of 68 cases with AKI were enrolled in this study,and they were divided into prerenal AKI group(25 cases) and intrinsic AKI group(43 cases) according to their tissue perfusion.The general data was collected,and the blood urea nitrogen(BUN),serum creatinie(Scr),BUN/Scr,potassium,fractional excretion of filtrated sodium(FENa),urine osmotic pressure,B-type natriuretic peptide (BNP),urinary calprotectin,neutrophil gelatinase-associated lipocalin (NGAL),kidney injury molecule 1 (Kim-1) were recorded and compared between the 2 groups.Results There were significant differences between prerenal AKI group and intrinsic AKI group in Scr[(439.0 ± 278.0) μmol/L vs.(603.0 ± 286.0) μmol/L,t =2.30,P ＜ 0.05],BUN/Scr (20.58 ±5.62 vs.14.93 ±4.32,t =4.65,P＜0.05),FENa[(1.5 ±0.6)％ vs.(8.1 ±2.6)％,t =12.46,P＜ 0.05],BNP[95.6(54.0,109.4) ng/L vs.512.3(320.1,520.3) ng/L,Z =2.21,P ＜0.05],urinary calprotectin [20.7(4.3,42.4) μg/L vs.402.4(60.1,498.7) μg/L,Z=3.13,P＜0.05] and NGAL[74.9(14.5,365.5) μg/L vs.684.2(56.2,1 502.5) μg/L,Z =2.35,P ＜0.05].Receiver operating characteristic curve analysis showed that urinary calprotectin[area under the curve(AUC) =0.940] and BNP(AUC =0.909) both had higher value in differential diagnosis.When the cut off value of calprotectin was 240.6 μg/L,its specificity was 96.0％ and the sensitivity was 86.0％.When the cut off value of BNP was 120.6 ng/L,its specificity was 92.0％ and the sensitivity was 90.7％.The diagnostic accuracy was low in Scr,but moderate in BUN,Scr,FENa and NGAL.BUN,potassium,urine osmotic pressure and Kim-1 had no diagnostic value.Conclusions Urinary calprotectin may have higher diagnostic value in the differential diagnosis between prerenal and intrinsic pediatric AKT.It can be used in the clinical diagnosis as a reference index.