Are serum and urine neutrophil gelatinase‐associated lipocalin predictive of renal graft function in short term?

Abstract

NGAL is a member of the lipocalin protein family that has diverse function but similar structure. The functions of NGAL are not clear, but it appears to be expressed in stress conditions and in tissues undergoing involution. Varied studies have shown increased levels of plasma or urinary NGAL in diverse renal damages. The aim of this study was the serial measurement of serum and urinary NGAL within the first week after renal transplantation in children to predict immediate and short-term graft function. A total of 27 patients were assessed. These patients were classified into those with rapid reduction in serum creatinine (more than 50% reduction in serum creatinine in the first day after transplantation) and patients with slow reduction in serum creatinine (<50% reduction in serum creatinine). We also assessed the absolute reduction in serum creatinine before and after transplantation. Serum and urinary NGAL on the first day post-transplantation were higher in recipients with slow reduction in serum creatinine (urinary NGAL at the first day: 197 ± 153 [s.e.m.] vs. 22.54 ± 8.5 [s.e.m.], p = 0.04; serum NGAL at the first day: 199 vs. 69.8, p = 0.003). The cutoff point of serum NGAL at the first day after transplantation for prediction of slow creatinine reduction was 174 ng/mL with a sensitivity of 100% and specificity of 95.5%. However, we did not find association between the absolute reduction in serum creatinine before and after transplantation with the amount of serum and urinary NGAL post-transplant. Additionally, we did not find any effect of high serum and urine NGAL concentration on the graft function at the first year post-transplant. Although it is supposed that high serum and urine NGAL may predict ischemia of graft in early phases; however, it appears that this mild ischemic injury to graft without DGF or SGF cannot affect the graft function in short-term period. Further studies are needed using larger transplant recipients in pediatric age group. It is also needed to determine the effects of mild ischemic injuries on the graft function in long-term period in future studies.

C-Terminal Agrin Fragment - A New Fast Biomarker for Kidney Function in Renal Transplant Recipients

“…Urine NGAL and IL-18 have been positively evaluated for the same purpose [28,29,30], but urine is often hard to assess. Whereas serum IL-18 failed to be of great value for the prediction of DGF in renal transplant patients [31,32], results on NGAL are conflicting [32,33,34,35]. Blood cystatin C concentrations were beneficial in some studies [32,36,37], but failed in others to correlate accurately with allograft function in the early postoperative phase [21,27,38].…”

Neutrophil Gelatinase‐Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights

“…Which one between uNGAL or pNGAL might represent the best biomarker for graft outcome remains an open issue. In Table 1, we have summarized the main published studies performed in renal transplant recipients, where the predictivity of uNGAL and pNGAL in terms of cut-off levels, sensitivity and specificity were available (34,36,38,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52).…”

Effect of continuous renal replacement therapy on kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury

“…Although Kim-1 and NGAL are predictive biomarkers for AKI in a variety of clinical contexts, including intensive care, cardiac surgery and renal transplantation (13)(14)(15)(16), they are seldom investigated in patients with septic AKI treated with CRRT. Therefore, the present single-center randomized controlled study was conducted to evaluate the therapeutic efficacy of CRRT and observe its effect on Kim-1 and NGAL levels in patients with septic AKI, in order to provide evidence-based recommendations on the clinical applications of CRRT for septic AKI.…”