Abstract:
Paediatric renal injury is an emergent health concern, particularly in the regions with high burden
of Chronic Kidney Disease of uncertain etiology (CKDu) in global hotspots. Kidney injury
molecule (KIM-1) appears more sensitive and specific particularly at early diagnosis of renal
injury. Hence, the aim of the present study was to assess the utility of KIM-1 in diagnosing renal
injury against the conventional marker, albumin creatinine ratio (ACR). We conducted a cross
sectional study with 200 school children (boys: 92, girls: 108; 12-16 years of age) from CKDu
endemic regions in North Central Province and 154 children (boys:67, girls: 83) from regions
where CKDu is not evident in Moneragala District. First void, non-fasting early morning urine
samples were collected from the children and the samples were analysed for creatinine, albumin
and KIM-1. The median (IQR) ACR values of boys, 2.81 (1.65-4.79) and girls, 2.68 (1.94-4.17)
mg/g in CKDu endemic areas showed no significant difference (p>0.05) compared to the ACR
values of boys 2.09 (1.40-3.22) and girls, 3.09 (1.93-4.77) in CKDu non-prevalent areas.
However, median (IQR) urinary KIM-1 level of boys 0.16 (0.06-0.28) ng/mgCr in CKDu
affected areas was significantly higher (p=0.0012) than the median KIM-1 level of boys 0.09
(0.001-0.21) ng/mgCr in CKDu non-affected areas. Further, Similarly Significantly increased
(p<0.0001) KIM-1 level was observed in girls 0.29 (0.14-0.49) ng/mgCr in CKDu affected
regions compared to the girls 0.05 (0.001-0.15) ng/mgCr in CKDu non-endemic areas. Urinary
ACR of children was very low and indicated no albuminuria. However, significantly high levels
of urinary KIM-1 in children in CKDu affected regions, may indicate abnormal renal function
in the absence of albuminuria, rendering high sensitivity over ACR. Our study provides evidence
on potentially high risk of developing renal injury, for the children in CKDu prevalent areas and
we recommend further interventions on this concern.
