Human kidney injury molecule-1 and interleukin-18 as predictive markers of nephrotoxicity in acute organophosphorus poisoned patients in Zagazig University hospitals

Organophosphorus (OP) poisoning is a major common cause of mortality and morbidity in most countries. Some clinical cases developed renal injury after acute OP poisoning. The aim of our study is to evaluate the levels of kidney injury molecule-1(KIM-1) and interleukin -18(IL-18) in acute OP poisoned patients as early predictors of OP induced nephrotoxicity. Over a period of one year, the observational cross sectional study was conducted at the Poison Control Center, Zagazig University hospitals, Zagazig, Egypt. The study group consisted of 95 patients who fulfilled the inclusion criteria; the patients were categorized according to Peradeniya organophosphorus poisoning (POP) scale. The serum pseudocholine esterase enzyme (PChE), serum creatinine, urinary KIM-1 and IL-18 were assayed at 0, 12, 24 and 48 h after admission. There were progressive increases in the mean values of KIM-1 and IL-18 at different time intervals especially in severe poisoned patients compared to the increased levels of serum creatinine. The cutoff values of urinary KIM-1 and IL-18 that determined patients with potential AKI were 2.8 ng/ml creatinine (86.9% sensitivity, 94.6% specificity and 0.859% area under curve) and 59 pg/dl creatinine (90% sensitivity, 92% specificity and 0.946& area under curve), respectively. A positive correlation was observed between KIM-1 and IL-18 and serum creatinine. Moreover, KIM-1 is positively correlated with IL- 18. Urinary KIM-1 and IL-18 may be considered as valid markers for prediction of acute kidney injury among acute OP poisoned patients. Key words: Organophosphorus poisoning, IL-18, KIM-1, acute kidney injury.