Glutathione S- Transferase as a Marker of Acute Kidney Injury in Pediatric Intensive Care, Zagazig University Children Hospital

Abstract

Background: Glutathione S-transferases (GST) are major phase II detoxification enzymes having central roles in the cellular detoxication of a diverse group of exogenous and endogenous harmful compounds. Objective: The aim of the work was to investigate the role of GST in development of acute kidney injury in PICU, Zagazig University Children Hospital. Patients and Methods: A prospective cohort study was conducted on 50 pediatric patients admitted to PICU who were divided into two groups according to incidence of Acute Kidney Injury (AKI). Patients were subjected to clinical, laboratory, and plasma & urinary GST evaluation. Results: AKI developed in 24% of patients. There was no significant relation between presence of AKI and patient age, gender, weight, height, or clinical outcome. There were significant relations between plasma and urine GST and presence of AKI. There is statistically non-significant relation between Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease (pRIFLE) staging and plasma and urine GST. There were statistically significant negative correlations between each of plasma and urine GST on one side and both heart rate and estimated creatinine clearance on the other side. Plasma GST can predict presence of AKI at cutoff ≥30.5, with AUC 0.964, sensitivity 100%, specificity 84.%, PPV 66.7%, NPV 100% , accuracy 88%. Urinary GST in prediction of AKI was ≥12.5, with AUC 0.95, sensitivity 91.7%, specificity 84.2%, with accuracy 86%. Conclusion: It could be concluded that AKI had significant incidence in PICU admission. High levels of plasma and urine GST Pi after admission in PICU are associated with an increased development of AKI and GST Pi is a valuable tool for early diagnosis of AKI.