Urinary alpha-GST and pi-GST for prediction of dialysis requirement or in-hospital death in established acute kidney injury
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2011-12-01
Autores
Seabra, Victor F. 
Santos, Oscar F. P. dos
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Context: Urinary alpha-glutathione S-transferase (alpha-GST) and pi-glutathione S-transferase (pi-GST) are promising proximal and distal tubular leakage markers for early detection of acute kidney injury (AKI).Objective: To examine the performance of these markers for predicting the composite of dialysis requirement or in-hospital death in patients with an established diagnosis of AKI.Materials and methods: Prospective cohort study of 245 adults with AKI. A single urinary alpha-GST and pi-GST measurement was obtained at time of nephrology consultation.Results: Overall, urinary pi-GST performed better than alpha-GST for prediction of dialysis requirement (AUC 0.59 vs. 0.56), and the composite outcome (AUC 0.58 vs. 0.56). in subgroup analyses, pi-GST displayed better discrimination for prediction of dialysis requirement in patients with baseline eGFR < 60 mL/min/1.73 m(2) (AUC 0.61) and oliguria (AUC 0.72). Similarly, alpha-GST performed better in patients with stage-1 (AUC 0.66) and stage-2 AKI (AUC 0.80).Conclusions: in patients with an established diagnosis of AKI, a single urinary pi-GST measurement performed better than alpha-GST at predicting dialysis requirement or death, but neither marker had good prognostic discrimination.
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Biomarkers. London: Informa Healthcare, v. 16, n. 8, p. 709-717, 2011.