This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Background: Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is a significant cause of morbidity and mortality. The incidence of AKI after cardiac surgery is up to 40% in both adults and children depending on how AKI is defined. AKI-associated morbidity occurs commonly in this population, and AKI is associated with an up to 80% increase in mortality. Early identification of patients likely to develop AKI could facilitate the opportunity for prevention and/or early intervention, resulting in decreased AKI-associated morbidity and mortality in patients undergoing CPB. Hypothesis: The risk of developing acute kidney injury (AKI) within 72 hours following cardiopulmonary bypass (CPB) can be predicted in children through the identification of a unique protein or set of proteins in the urine within 6 hours following CPB. Methods: We plan to conduct a prospective cohort study of pediatric cardiac surgery patients 18 years of age and under who require cardiopulmonary bypass at The Children's Hospital in Denver. AKI following CPB will be defined as a 50% or greater increase in preoperative serum creatinine concentration within 72 hours following CPB. Urinary proteomics, specifically, two-dimensional fluorescent difference gel electrophoresis (DIGE) will be used to compare the study group, those that go on to develop AKI, to controls at baseline (preoperatively) and at 2- and 6-hours following CPB. Differential protein expression between these two groups will be used to identify a specific urine protein or set of proteins predictive of AKI.
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