The usefulness of urinary netrin-1 determination as an early marker of acute kidney injury in children after cardiac surgery

Netrin-1 (NTN-1) is an anti-inflammatory protein secreted by proximal tubule epithelial cells in reaction to hypoxic or toxic injury. We determined the utility of urinary NTN-1 as an early marker for detecting AKI in patients after cardiac surgery.Our study included 40 children at age 1-36 months and 20 healthy controls. We measured serum creatinine and urinary NTN-1 in patients, who underwent cardiac surgery in cardiopulmonary bypass (CPB).Urinary NTN-1 was higher in the study group than in the control group. The detection ratio of urinary NTN-1 was higher pre-surgery than 6 and 24 hours after (55%, 27.5%, and 32.5%, respectively). We found no correlations between NTN-1 at any point ΔeGFR, decline eGFR, AKI after 48 h. The initial NTN-1/creatinine ratio negatively correlated with ΔGFR (r=-0.36, p=0.031), NTN-1/creatinine ratio after 24 h did not correlate with aortic clamping time, CPB time, ΔGFR. In our study, AKI occurred in 12.5% of patients and none required RRT. The occurrence of AKI correlated with CPB time (r=0.35, p=0.027) and aortic clamping time (r=0.44, p=0.005). NTN-1 concentration and NTN-1/creatinine ratio in the AKI group were not significantly higher preoperatively and 24 hours post-surgery than in patients without AKI.The role of urinary NTN-1 in children after cardiac surgery as an early marker of AKI was not confirmed. No factors affecting the NTN-1/creatinine ratio were found in the study group. Patients who have longer CPB time and aortic clamping time belong to the high-risk group of AKI after surgery.