Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease

Musalula Sinkala; Mildred Zulu; Trevor Kaile; Marah Simakando; Chisanga Chileshe; Doris Kafita; Panji Nkhoma

doi:10.4103/2229-516X.205811

Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease

Int J Appl Basic Med Res. 2017 Apr-Jun;7(2):94-99. doi: 10.4103/2229-516X.205811.

Authors

Musalula Sinkala¹, Mildred Zulu², Trevor Kaile², Marah Simakando², Chisanga Chileshe³, Doris Kafita¹, Panji Nkhoma¹

Affiliations

¹ Department of Biomedical Science, School of Health Sciences, University of Zambia, Lusaka, Zambia.
² Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia.
³ KS-HHV8 Research and Diagnostic Laboratory, University Teaching Hospital, Lusaka, Zambia.

Abstract

Context: The diagnosis and evaluation of impaired renal function remains a challenge owing to lack of reliable biomarker for assessment of kidney function. The existing panel of biomarkers currently displays several limitations, and recently kidney injury molecule-1 (KIM-1) has been suggested as a sensitive biomarker of renal function and proposed to enter clinical practice.

Aims: This study was conducted to determine the diagnostic value of serum creatinine, urea, and microalbuminuria (MAU) in relation to the novel biomarker, KIM-1.

Materials and methods: Serum creatinine, urea, MAU, and KIM-1 were measured in forty individuals with and forty without kidney disease. Data were analyzed using multivariate methods of assessing diagnostic efficiency, test agreement, condition effects, and variability.

Results: The area under the receiver-operator characteristic curve revealed a diagnostic advantage of creatinine (0.924 ± 0.0066) and urea (0.925 ± 0.0068) over MAU (0.880 ± 0.078) and KIM-1 (0.35 ± 0.124). Overall diagnostic efficiency was higher for creatinine and urea (89.5% and 90.9%, respectively), followed by MAU (85.7%) and then KIM-1 (56.3%). Logistic regression analysis showed that creatinine and urea (R² = 0.75 and R² = 0.72, respectively, P < 0.001 for both) were better predictors of kidney disease than MAU (R² = 0.64, P < 0.001) and KIM-1 (R² = 0.046, P = 0.116). Further analysis of agreement showed that urea had an excellent agreement with creatinine (kappa r = 0.835, P < 0.001), with KIM-1 (kappa r = -0.198, P = 0.087) showing a poor agreement with creatinine.

Conclusion: Our results indicate that elevated serum creatinine and urea above specific cutoff points reliably identifies patients with acute kidney injury or chronic kidney disease. However, more researches are warranted to further validate the diagnostic efficiency and application of MAU and for KIM-1 before its implementation in clinical practice.

Keywords: Creatinine; diagnostic accuracy; kidney disease; kidney injury molecule-1; microalbuminuria; urea.