Additive value to clinical judgement of blood neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury and prediction of mortality in patients hospitalized from the emergency department

Background The early prediction of acute kidney injury (AKI) by current clinical and laboratory methods remains inadequate. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising non-invasive biomarker of kidney injury. We systematically reviewed the utility of plasma and urine NGAL measurements for the prediction of AKI in humans. Methods We searched MEDLINE, PubMed and EMBASE for human biomarker studies that included NGAL (January 2005 to October 2013). Studies reporting on the use of NGAL for the early prediction and prognosis of AKI were analysed in three common clinical settings: cardiac surgery, critical illness and kidney transplantation. Results We identified 58 manuscripts that met our inclusion and exclusion criteria, reporting on more than 16,500 patients. Following cardiac surgery, NGAL measurement in over 7000 patients was predictive of AKI and its severity, with an overall area under the receiver operator characteristic curve (AUC) of 0.82–0.83. Similar results were obtained in over 8500 critically ill patients. In over 1000 patients undergoing kidney transplantation, NGAL measurements predicted delayed graft function with an overall AUC of 0.87. In all three settings, NGAL significantly improved the prediction of AKI risk over the clinical model alone. Conclusions We identified several studies that collectively strongly support the use of NGAL as a biomarker for the prediction of AKI. However, we noted some limitations, including lack of published studies that adhere to diagnostic study guidelines, heterogeneity in AKI definition, the lack of uniformly applicable cut-off values and variability in the performance of commercially available NGAL assays.

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SERUM NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A PREDICTIVE BIOMARKER OF KIDNEY INJURY IN RENAL TRANSPLANTED PATIENTS and CHRONIC KIDNEY DISEASE

Al-Shamma

Alklyali

Alani

2017

Int J Pharm Pharm Sci

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Objective: Neutrophil gelatinase-associated lipocalin has emerged as a promising biomarker of kidney injury better than creatinine to early predict the acute kidney injury in both chronic kidney diseases and early diagnosis of kidney allograft dysfunction. Methods:Neutrophil gelatinase-associated lipocalin was evaluated as a new biomarker for acute renal injury in 69 patients were divided in two groups chronic kidney disease patients (stage5), (n=34), and renal transplant patients, (n=35) comparing with apparently healthy control (n= 35) of matching age and weight. Neutrophil gelatinase-associated lipocalin, hsCRP and Cystatin-C were measured by enzyme-linked immune sorbent assay which is included first incubating the test serum in an antigen-coated polystyrene plate, then enzyme labelled anti-immunoglobulin is added and the enzyme then remaining in plate after washing provides a measure of the amount of specific antibody in the serum and in the final step a substance is added that the enzyme can convert to some detectable signal, most commonly a color change in a chemical substrate. Results:There was a significant increase in serum NGAL of renal transplantation patients, and CKD patients (stage5) than in healthy control subjects (455±145 ng/ml vs. 296.4±83.5 ng/ml 486±153 ng/ml vs296. 4±83.5 ng/ml) respectively. A high serum Neutrophil gelatinase-associated lipocalin is noted in renal transplanted patients after one month, then after six months (480±188ng/ml vs. 409±78ng/ml). There was a significant negative correlation between serum Neutrophil gelatinase-associated lipocalin in renal transplanted patients, and chronic kidney disease patients (stage 5) with an estimated glomerular filtration rate (p<0.05). Conclusion:Serum neutrophil gelatinase-associated lipocalin seems to be an early predictor of kidney injury and post-transplantation management, including dialysis and grafting function of the kidney.

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Additive value to clinical judgement of blood neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury and prediction of mortality in patients hospitalized from the emergency department

Cited by 3 publications

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Correlation of Impedance Threshold Device use during cardiopulmonary resuscitation with post-cardiac arrest Acute Kidney Injury

Correlation of Impedance Threshold Device use during cardiopulmonary resuscitation with post-cardiac arrest Acute Kidney Injury

Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status

SERUM NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A PREDICTIVE BIOMARKER OF KIDNEY INJURY IN RENAL TRANSPLANTED PATIENTS and CHRONIC KIDNEY DISEASE

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