Serum and urine FGF23 and IGFBP-7 for the prediction of acute kidney injury in critically ill children.

BACKGROUND: Fibroblast growth factor 23 (FGF23) and insulin-like growth factor binding protein 7 (IGFBP-7) are suggested to be biomarkers for predicting acute kidney injury (AKI). We compared them with proposed AKI biomarker of cystatin C (CysC), and aimed (1) to examine whether concentrations of these biomarkers vary with age, body weight, illness severity assessed by pediatric risk of mortality III score, and kidney function assessed by estimated glomerular filtration rate (eGFR), (2) to determine the association between these biomarkers and AKI, and (3) to evaluate whether these biomarkers could serve as early independent predictors of AKI in critically ill children. METHODS: This prospective single center study included 144 critically ill patients admitted to the pediatric intensive care unit (PICU) regardless of diagnosis. Serum and spot urine samples were collected during the first 24 h after PICU admission. AKI was diagnosed based on the AKI network (AKIN) criteria. RESULTS: Twenty-one patients developed AKI within 120 h of sample collection, including 11 with severe AKI defined as AKIN stages 2 and 3. Serum FGF23 levels were independently associated with eGFR after adjustment in a multivariate linear analysis (P < 0.001). Urinary IGFBP-7 (Adjusted OR = 2.94 per 1000 ng/mg increase, P = 0.035), serum CysC (Adjusted OR = 5.28, P = 0.005), and urinary CysC (Adjusted OR = 1.13 per 1000 ng/mg increase, P = 0.022) remained significantly associated with severe AKI after adjustment for body weight and illness severity, respectively. Urinary IGFBP-7 level was predictive of severe AKI and achieved the AUC of 0.79 (P = 0.001), but was not better than serum (AUC = 0.89, P < 0.001) and urinary (AUC = 0.88, P < 0.001) CysC in predicting severe AKI. CONCLUSIONS: Serum FGF23 levels were inversely related to measures of eGFR. In contrast to serum and urinary FGF23 which are not associated with AKI in a general and heterogeneous PICU population, an increased urinary IGFBP-7 level was independently associated with the increased risk of severe AKI diagnosed within the next 5 days after sampling, but not superior to serum or urinary CysC in predicting severe AKI in critically ill children.

[Round window area temporal bone section versus CT].

OBJECTIVE: To locate round window area and its related structure on auris transection and CT for anatomical evidence of image diagnosis and clinical operation. METHODS: Fifteen normal head specimen fixed with 10% dehyde were scanned by high-resolution computed tomography on canthomeatal line. CT image (depth 1.00 mm, thick 1.00 mm) was obtained. Temporal bone-centered tissues were taken, decalcified, desiccated and socked with collodion, then embedded and made into sequential transactions (thick 1.00 mm). Lower surface of section was observed by both naked eyes and microscope, then scanned and photographed. Versus CT image, auditory ossicle, osseous semicircular canals, vestibule, round window, niche, cochlea, pyramidal eminence, internal acoustic meatus and cochlear aqueduct were identified respectively. RESULTS: There were 18-22 layers of temporal transection on CT image. Round window and round window niche always appeared on the 10th layer (R) and the 11th layer (L). The mean of the depth of anterior wall was 0.92 mm (R) and 0.90 mm (L), and depth 1.89 mm (R) and 2.04 mm (L). The average distance from niche to jugular fossa wall was 2.10 mm (R) and 2.39 mm (L). No significant difference among of thickness, depth and distance from niche to jugular fossa wall. CONCLUSIONS: Temporal bone transection specimen had a clear picture of anatomical position between round window area and its related structure. Versus CT, the result contributed to image diagnosis and operation on auris diseases.