Yale Bulletin and Calendar

February 15, 2008|Volume 36, Number 18

Researchers seeking new test for detecting kidney injury associated with cardiac surgery

Researchers at Yale School of Medicine have received a five-year, $4 million National Institutes of Health grant to study novel ways to improve the diagnosis of acute kidney injury (AKI), a common complication of cardiac surgery that results in increased mortality.

Results from serum creatinine, the current diagnostic test for AKI, are usually normal until two to three days after cardiac surgery.

To speed the detection of AKI in cardiac surgery patients, Yale researchers, led by nephrologist Dr. Chirag Parikh, are studying three biomarkers: urine interleuken 18 (IL-18), urine neutrophil gelatinase associated lipocalin (NGAL), and serum cystatin C.

Parikh and his colleagues are doing the work in conjunction with a clinical consortium called Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury, a multidisciplinary group of investigators from five major academic centers with expertise in pre-clinical, translational, epidemiologic and health services research.

“Having new biomarkers to replace serum creatinine will allow for the early and accurate diagnosis of AKI,” says Parikh, associate professor in the Department of Internal Medicine’s section of nephrology at Yale School of Medicine.

“Findings from this study will pave the way for larger multi-center studies of these biomarkers in other clinical conditions, and for clinical trials to prevent or to treat AKI,” he adds.

The consortium will study urine and serum samples, along with clinical data during hospitalization, from approximately 1,800 adults and children receiving cardiac surgery.

Parikh and colleagues will compare the timing of increases in biomarker levels with the clinical diagnosis of AKI and will look for the ability of biomarkers to give an early diagnosis — within 24 to 48 hours. They will also test whether serum cystatin C could better predict pre-operative risk of AKI, and whether urine IL-18 and NGAL levels will be better post-operative markers of AKI occurrence and severity.

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