{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T18:36:29Z","timestamp":1778006189055,"version":"3.51.4"},"reference-count":51,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,4]],"date-time":"2019-02-04T00:00:00Z","timestamp":1549238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["274755"],"award-info":[{"award-number":["274755"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012285","name":"BC Children's Hospital Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012285","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Acute kidney injury (AKI) is a major concern in pediatric kidney transplant recipients, where non\u2010alloimmune causes must be distinguished from rejection. We sought to identify a urinary metabolite signature associated with non\u2010rejection kidney injury (NRKI) in pediatric kidney transplant recipients. Urine samples (n\u00a0=\u00a0396) from 60 pediatric transplant participants were obtained at time of kidney biopsy and quantitatively assayed for 133 metabolites by mass spectrometry. Metabolite profiles were analyzed via projection on latent structures discriminant analysis. Mixed\u2010effects regression identified laboratory and clinical predictors of NRKI and distinguished NRKI from T cell\u2013mediated rejection (CMR), antibody\u2010mediated rejection (AMR), and mixed CMR\/AMR. Urine samples (n\u00a0=\u00a0199) without rejection were split into NRKI (n\u00a0=\u00a026; \u0394SCr \u226525%), pre\u2010NRKI (n\u00a0=\u00a035; \u0394SCr \u226510% and &lt;25%), and no NRKI (n\u00a0=\u00a0138; \u0394SCr &lt;10%) groups. The NRKI discriminant score (dscore) distinguished between NRKI and no NRKI (AUC\u00a0=\u00a00.86; 95% CI\u00a0=\u00a00.79\u20100.94), confirmed by leave\u2010one\u2010out cross\u2010validation (AUC\u00a0=\u00a00.79; 95% CI\u00a0=\u00a00.68\u20100.89). The NRKI dscore also distinguished between NRKI and pre\u2010NRKI (AUC\u00a0=\u00a00.82; 95% CI\u00a0=\u00a00.71\u20100.93). In a linear mixed\u2010effects regression model to account for repeated measures, the NRKI dscore was independent of concurrent rejection, but there was a non\u2010statistical trend for higher dscores with rejection severity. A second exploratory classifier developed to distinguish NRKI from clinical rejection had similar test characteristics (AUC\u00a0=\u00a00.81, 95% CI\u00a0=\u00a00.70\u20100.92, confirmed by LOOCV). This study demonstrates the potential of a urine metabolite classifier to detect NRKI in pediatric kidney transplant patients and non\u2010invasively discriminate NRKI from rejection.<\/jats:p>","DOI":"10.1111\/petr.13364","type":"journal-article","created":{"date-parts":[[2019,2,5]],"date-time":"2019-02-05T10:35:46Z","timestamp":1549362946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Non\u2010invasive differentiation of non\u2010rejection kidney injury from acute rejection in pediatric renal transplant recipients"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5936-566X","authenticated-orcid":false,"given":"Ben","family":"Archdekin","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences Queen\u2019s University Kingston Ontario 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