Acute Kidney Injury AKI is a prevalent and serious condition associated with significant morbidity and mortality. It affects 30 to 50 percent of critically ill patients and those requiring renal replacement therapy have a mortality rate exceeding 50 percent. Among pediatric oncology patients AKI is a common complication affecting approximately 15 to 25 percent of patients. It can be caused by chemotherapeutic agents such as cisplatin methotrexate and ifosfamide as well as by sepsis dehydration and tumor lysis syndrome. Early detection of AKI is crucial to prevent progression to chronic kidney disease dialysis dependency and increased morbidity and mortality.

Currently serum creatinine is the most commonly used marker for detecting AKI. However it has significant limitations due to its low sensitivity and specificity. Its levels can be influenced by various factors including age sex muscle mass hydration status and dietary intake. Moreover it tends to rise only after substantial kidney injury has occurred and often with a delay.

Recent research has highlighted the potential of novel urinary biomarkers such as kidney injury molecule-1 uKIM-1 and N-acetyl-beta-D-glucosaminidase uNAG in identifying early tubular damage before changes in serum creatinine occur. These biomarkers can detect subclinical forms of AKI thereby allowing for earlier intervention.

The aim of our study is to evaluate the incidence of AKI including subclinical AKI in pediatric oncology patients undergoing chemotherapy and to assess the diagnostic utility of urinary biomarkers uKIM-1 and uNAG compared to serum creatinine in the early detection of AKI.