Early prediction of cisplatin nephrotoxicity in head and neck cancer patients - an evaluation with urinary biomarkers

Background: Nephrotoxic Acute Kidney Injury (AKI) is a common condition associated with considerable morbidity and mortality. Acute exposure to potentially nephrotoxic drugs requires early appraisal of the extent of renal injury to determine the need for specific interventions. Hence this study was designed to evaluate two urinary biomarkers for the early diagnosis of AKI due to cisplatin chemotherapy, including Neutrophil gelatinase-associated lipocalin (uNGAL) and Cystatin C (uCysC). Methods: Urinary biomarker levels in cisplatin treated cancer patients were estimated before and at 2hrs, 6hrs, 12hrs, 24hrs and 48hrs after cisplatin administration. Diagnostic performances of biomarkers were studied by ROC analysis with AUC and predictive values. Results: uNGAL was identified as the earlier biomarker of AKI induced by cisplatin as it detected kidney injury as early as 2hrs after the exposure of nephrotoxic drug with an AUC of 0.8, which is 46hrs before the elevation of serum creatinine. uCysC detected AKI 6hrs after cisplatin administration with AUC 0.73. Conclusion: Indication of AKI by biomarker elevations can provide an early warning signal which may have implications in therapy by either stopping the nephrotoxic drug or reducing its dose or even by substituting it with a less nephrotoxic one. The research in this direction should focus on evolving rapid procedures with an eventual point-of-care test for urinary biomarker determinations that will transform the scope of biomarkers significantly in the field of early renal injury.