Endothelin-1 levels and renal function in newborns of various gestational ages

摘要

BACKGROUND: Renal failure is common in the NICU; Acute Kidney Injury (AKI) occurs in 8-24% of admissions. Although AKI is preventable with early diagnosis, no reliable AKI biomarkers exist. Endothelin-1 (ET-1) has been implicated in renal pathogenesis, and elevated urinary ET-1 (uET-1) levels may correlate with progression of renal dysfunction. The study objectives were to determine whether uET-1 levels correlate with renal function parameters and/or fetal growth restriction, and if uET-1 is a potential neonatal AKI biomarker. METHODS: Sixty-three neonates were enrolled and divided into gestational age (GA) groups by weeks: 1) (24-30 6/7; n = 24); 2) (31-36 6/7; n = 26); and 3) (37-42; w=13). Additional preterm subgroups for fetal growth restriction analysis included: 1) Appropriate for GA (AGA; n = 40), and 2) Small for GA (SGA; n= 10). ET-1 levels, measured using enzyme linked immunosorbent assay, were collected at birth (cord blood) and 24 h (±4) of life (blood/urine). RESULTS: No correlation was found between uET-1 and blood plasma levels at birth (r=0.15; p>0.05) or 24h (r=0.17; p>0.05). uET-1 negatively correlated with GA (r=-0.44; beta<0.001) and GFR (r=-0.34; p<0.01). uET-1 levels did not correlate with creatinine (r=0.13; p>0.05), BUN (r=0.19; p>0.05), BUN/Cr ratio (r=0.15; p>0.05), or urinary output (r=0.12; p > 0.05). In fetal growth restriction subgroup analyses: uET-1 levels negatively correlated with GFR in the PT-AGA subgroup (r=-0.38; beta = 0.017), but not with PT-SGA (r=0.01; p > 0.05). CONCLUSION: Plasma and uET-1 levels did not correlate; therefore, renal ET-1 excretion may reflect renal ET-1 production. uET-1 levels correlated negatively with GA and GFR. uET-1 may be a marker of impaired neonatal circulatory regulation and consequent renal injury.