Urinary L-type fatty acid-binding protein is a predictor of cisplatin-induced acute kidney injury

Masaaki Yanishi; Hidefumi Kinoshita

doi:10.1186/s12882-022-02760-4

Urinary L-type fatty acid-binding protein is a predictor of cisplatin-induced acute kidney injury

BMC Nephrol. 2022 Mar 31;23(1):125. doi: 10.1186/s12882-022-02760-4.

Authors

Masaaki Yanishi¹, Hidefumi Kinoshita²

Affiliations

¹ Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan. masaaki.yanishi@gmail.com.
² Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.

Abstract

Background: Although cisplatin-based chemotherapy is a standard treatment for urothelial carcinoma, it often causes acute kidney injury (AKI). AKI and dysfunction are observed in 25-35% of cisplatin-based chemotherapy patients, who may require treatment down-titration or withdrawal. In this study, we evaluated whether urinary L-FABP is a marker for early diagnosis of cisplatin-caused AKI.

Methods: We included 42 adult patients who underwent cisplatin-based chemotherapy for bladder cancer or upper tract urothelial carcinoma from January 2018 to March 2019. Urinary L-FABP and serum creatinine were measured at 2 and 6 h, and 1, 2, 3, 7 and 28 days after taking cisplatin.

Results: In the first week after receiving cisplatin, 10 patients (23.8%) were diagnosed with AKI (AKI⁺ group). Pre-treatment (baseline) measurements did not significantly differ between the AKI⁺ and AKI^- groups. However, urinary L-FABP concentrations rapidly increased in the AKI⁺ group and were significantly greater than in the AKI^- group at Hour 2, Hour 6, Day 1 and Day 2. Serum creatinine also significantly differed between the AKI⁺ group and the AKI^- group on Days 3 and 7. ROC analysis was performed to evaluate the superiority of urinary L-FABP magnification which had the highest at the hour 6. The urinary L-FABP magnification and levels of aria under curve was 0.977. Based on ROC analysis, the best cut-off value of urinary L-FABP magnification was 10.28 times urinary L-FABP levels at the hour 0 (base line urinary L-FABP).

Conclusions: Acute renal function deterioration was predicted by increased urinary L-FABP excretion within 6 h after receiving CIS-CT and, in those with AKI, the increase in urinary L-FABP excretion preceded the rise in sCr by over 2 days. In contrast, no appreciable changes in urinary L-FABP levels were observed in patients with stable renal function throughout the whole observation period. So early increase in urinary L-FABP may identify patients at risk of cisplatin-induced AKI, who might benefit from treatment to prevent nephrotoxicity.

Trial registration: This study was retrospectively registered.

Keywords: Acute kidney injury; Cisplatin; L-type fatty acid-binding protein; Renal function; Urinary biomarker.

MeSH terms

Acute Kidney Injury* / chemically induced
Acute Kidney Injury* / diagnosis
Adult
Carcinoma, Transitional Cell* / complications
Cisplatin / adverse effects
Early Detection of Cancer / adverse effects
Fatty Acid-Binding Proteins / urine
Humans
Urinary Bladder Neoplasms* / complications
Urinary Bladder Neoplasms* / drug therapy

Substances

Fatty Acid-Binding Proteins
Cisplatin