A Metabolomic Signature of Acute Kidney Injury in Preterm Infants

The NIH Common Fund Eastern Regional Comprehensive Metabolomics Resource Core (ERCMRC) generated new findings related to the metabolic signatures of acute kidney injury (AKI) in pre-term infants. The findings were recently published in the journal Pediatric Nephrology.

ERCMRC is directed by metabolomics expert Susan Sumner, PhD, who is a professor of nutrition at the UNC Nutrition Research Institute (NRI). Partners include the David H. Murdock Research Institute (DHMRI) on the North Carolina Research Campus (NCRC) in Kannapolis, NC, and RTI International in Raleigh, NC.  

The purpose of this study was to use metabolomics data obtained from the urine of pre-term infants to uncover biomarkers that may be validated in future studies for use in diagnosing or predicting the development of AKI. AKI has a high level of incidence in premature infants because full nephrogenesis is often not completed until week 36 of gestation.  The number of incidences varies between 12.5 and 39.8 percent of all infants born prematurely. 

Study Findings

The study demonstrated that metabolomics could be used to determine differences in levels of metabolites in urine collected from infants who developed or did not develop AKI. Metabolite profiles could also be correlated with gestational age.  Certain compounds were shown to be possible indicators of gestational age, possibly related to growth in utero, and other metabolites were observed that were different between the babies with and without AKI.

Kevin Knagge, PhD, group leader of the DHMRI Analytical Sciences Laboratory, assisted in aspects of data acquisition using the 950MHz NMR spectrometer located at the DHMRI facility.

Importance of the Study

Although urinary metabolomics studies are used in many disease-related research areas, the study provided additional evidence of their usefulness for studies involving neonates and children, mostly due to the ease of sample collection. 

Children who survive AKI as infants are often more susceptible to chronic kidney disease later in life. Sumner sees the findings as contributing to the verification of biomarkers and better understanding of the mechanisms associated in the development of AKI that can potentially help with early diagnosis and better long-term outcomes for these children.  

“Although this study utilized samples from a relatively small number of neonates,” she explained, “such feasibility studies are important to helping us understand the value of metabolomics in providing biomarkers for early detection and early diagnosis of disease. Studies in larger cohorts are needed to verify and expand on these results.”

Sumner credits the success of this study to the collaboration between the three ERCMRC partners, and Patrick Brophy, M.D., from the University of Iowa and David Askenazi, M.D., from the University of Alabama, who are both neonatal doctors specializing in kidney disease.

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