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Doctor of Biomedical Sciences Studies Combination of Urinary Biomarkers and Doppler Ultrasound for Early Detection of Acute Kidney Injury Risk in Postoperative Patients in the ICU
Doctor of Biomedical Sciences Studies Combination of Urinary Biomarkers and Doppler Ultrasound for Early Detection of Acute Kidney Injury Risk in Postoperative Patients in the ICU
Held in the Meeting Room on the Third Floor of the Postgraduate Program Building, Jl. PB Sudirman, Denpasar, Bali, the Doctor of Biomedical Sciences Study Program, Faculty of Medicine, Udayana University, held an open doctoral promotion examination with Dr. Pontisomaya Parami, Sp.An., MARS, FIC, as the candidate for the promotion. The examination was titled "Neutrophil Gelatinase Associated Lipocalin, Kidney Injury Molecule-1, Urine Interleukin-18, and High Doppler Ultrasound Renal Resistive Index as Risk Factors for Acute Kidney Injury in Postoperative Patients in the Intensive Care Unit." (11/3/2026)
Acute kidney injury (AKI) is a serious complication in patients after major surgery treated in the intensive care unit, with high morbidity and mortality rates. Early detection of AKI is crucial for preventing progressive kidney damage. Kidney biomarkers such as Neutrophil Gelatinase Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1), Interleukin-18 (IL-18), and Renal Resistive Index (RRI) via Doppler ultrasound have potential as early risk factors, but their simultaneous role in patients after major surgery has not been widely studied.
This nested case-control study involved 86 patients from a cohort of post-major surgery patients admitted to the intensive care unit of Ngoerah General Hospital between January and August 2025. The incidence of AKI was defined based on the KDIGO criteria. Urinary NGAL and IL-18 were measured 24 hours postoperatively, while urine KIM-1 was examined 24-48 hours postoperatively using ELISA. RRI was then assessed 24 and 24-48 hours postoperatively during intensive care. Analysis was conducted to assess the association of these biomarkers with AKI incidence.
Of the 86 patients, 43 subjects experienced postoperative AKI according to KDIGO. High urinary NGAL values were significantly associated with the risk of AKI with an odds ratio of 8.72 and a 95% confidence interval of 3.27-23.26 (p< 0.001). High urinary KIM-1 values were a risk factor for AKI with an odds ratio of 2.65 and a 95% confidence interval of 1.10-6.43 (p< 0.029). High urinary IL-18 values were a risk factor for AKI with an odds ratio of 7.82 and a 95% confidence interval of 2.96-20.71 (p< 0.001). RRI values within 24 and 24–48 hours postoperatively were also shown to increase the risk of AKI, with an odds ratio of 6.03 (95% confidence interval 2.36–15.37; p< 0.001) and an odds ratio of 5.96 (95% confidence interval 2.35–15.13; p< 0.001), respectively.
We found that NGAL, KIM-1, urinary IL-18, and RRI levels are independent risk factors for AKI in post-major surgery patients in the intensive care unit through the mechanisms of ischemia-reperfusion injury and inflammation. The combination of biological and vascular markers can better assess risk factors than single tests, thus potentially being used for early detection in clinical practice.
This examination was led by the Vice Dean for General Affairs and Finance, Faculty of Medicine, Udayana University, Prof. Dr. dr. I Made Muliarta, S.Ked., M.Kes., with the following examiners:
1. Prof. Dr. dr. Tjok Gde Agung Senapathi, Sp.An-TI, Subsp.An.R(K) (Promoter)
2.Dr. Dr. Gede Wirya Kusuma Duarsa, Sp.U, Subsp.Ped., M.Kes., MARS (Copromotor I)
3.Dr. Dr. I Nyoman Wande, S.Ked., Sp.PK (Copromotor II)
4. Prof. Dr. Dr. I Made Jawi, M. Kes
5. Prof. Dr. Dr. Tjokorda Gde Bagus Mahadewa, M.Kes., Sp.BS (K)Spinal, FICS, FINSS
6.Dr. Dr. Elysanti Dwi Martadiani, S.Ked., Sp.Rad(K)
7.Dr. Dr. Ida Ayu Ika Wahyuniari, M.Kes
8.Dr. Dr. I Putu Pramana Suarjaya, Sp.An., M.Kes, KMN, KNA, FIPM
9.Dr. Dr. I Made Gede Widnyana, M.Kes., Sp.An-TI, Subsp.An.R(K)
By academic invitation:
1.Dr. Dr. I Made Mulyawan, Sp.B-KBD
2.Dr. Dr. I Gusti Agung Gede Utara Hartawan, Sp.An-TI., MARS., SH
2.Dr. Dr. I Wayan Juli Sumadi, Sp.PA, Subsp.M.S(K)
3.Dr. Dr. Agus Roy Rusly Hariantana Hamid, Sp.BP-RE(K)
5. dr. I Gusti Ngurah Mahaalit Aribawa, Sp.An-TI., Subsp.An.R.(K), FIP
In this exam, Dr. Dr. Pontisomaya Parami, Sp.An., MARS, FIC., was declared the 487th Doctoral Graduate of the Biomedical Science Doctoral Study Program, Faculty of Medicine, Udayana University with Cum Laude honors.
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