Evaluation of the Optimal Neutrophil Gelatinase-Associated Lipocalin Value as a Screening Biomarker for Urinary Tract Infections in Children

Kim, Bo Hyun; Yu, Nae; Kim, Hye Ryun; Yun, Ki Wook; Lim, In Seok; Kim, Tae Hyoung; Lee, Mi Kyung

doi:10.3343/alm.2014.34.5.354

Cited by 23 publications

(31 citation statements)

References 18 publications

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“…Following transurethral inoculation with strains of uropathogenic E. coli, NGAL knock-out mice have a higher bacterial burden for a significantly longer period of time compared to wild type mice, highlighting the importance of NGAL in local bacteriostasis [7]. However, there are conflicting reports of the utility of NGAL as a marker of UTI within the literature, as some studies have not shown a difference in uNGAL levels between children with UTI and controls [8]. This may be related in part to the specificity of uNGAL for gram-negative bacteriuria, or due to misclassification bias given that the UTI group in the study in which no difference was reported included patients with asymptomatic bacteriuria in the UTI group [8].…”

Section: Ngal and Urinary Tract Infectionsmentioning

confidence: 99%

“…However, there are conflicting reports of the utility of NGAL as a marker of UTI within the literature, as some studies have not shown a difference in uNGAL levels between children with UTI and controls [8]. This may be related in part to the specificity of uNGAL for gram-negative bacteriuria, or due to misclassification bias given that the UTI group in the study in which no difference was reported included patients with asymptomatic bacteriuria in the UTI group [8]. In the earlier cited study by Yilmaz et al [6], all of the patients had E. coli as the causative agent of their UTIs, whereas bacteriology data were not reported in the latter study by Kim et al [8], and may potentially confound the results.…”

Section: Ngal and Urinary Tract Infectionsmentioning

confidence: 99%

“…This may be related in part to the specificity of uNGAL for gram-negative bacteriuria, or due to misclassification bias given that the UTI group in the study in which no difference was reported included patients with asymptomatic bacteriuria in the UTI group [8]. In the earlier cited study by Yilmaz et al [6], all of the patients had E. coli as the causative agent of their UTIs, whereas bacteriology data were not reported in the latter study by Kim et al [8], and may potentially confound the results. Despite these conflicting reports, both mouse and human data overwhelmingly support the association between UTIs with gram-negative bacteria and elevated uNGAL levels [6, 7, 9, 10].…”

Section: Ngal and Urinary Tract Infectionsmentioning

confidence: 99%

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Neutrophil gelatinase-associated lipocalin: utility in urologic conditions

Forster

Devarajan

2016

Pediatr Nephrol

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Neutrophil gelatinase-associated lipocalin (NGAL) is best known as a non-invasive early marker of acute kidney injury (AKI). However, recent reports in the literature have described additional utility of both plasma NGAL (pNGAL) and urine NGAL (uNGAL) in various pathologic conditions within the pediatric urinary tract, including urinary tract infection (UTI), vesicoureteral reflux (VUR), renal scarring, and obstructive uropathy. These two forms of NGAL have different applications related to their mechanisms of upregulation: pNGAL can serve as a marker of systemic inflammatory conditions, whereas uNGAL is specific for insults to the renal epithelium. Therefore, pNGAL has good predictive accuracy in systemic inflammation associated with pyelonephritis and renal damage, while uNGAL is effective in identifying infection with the genitourinary environment as well as subclinical renal damage as a result of scarring or obstruction. Continued work should focus on the effect of trending NGAL values in patients with pyelonephritis, VUR, and hydronephrosis, to determine if longitudinal NGAL patterns have value in predicting adverse outcomes.

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Section: Ngal and Urinary Tract Infectionsmentioning

confidence: 99%

Section: Ngal and Urinary Tract Infectionsmentioning

confidence: 99%

Section: Ngal and Urinary Tract Infectionsmentioning

confidence: 99%

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Neutrophil gelatinase-associated lipocalin: utility in urologic conditions

Forster

Devarajan

2016

Pediatr Nephrol

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“…Subsequently, novel biomarkers are emerging as alternative tools in the diagnosis of UTI (6)(7)(8)(9)(10)(11)(12)(13), and as predictors of its complications such as vesico-ureteric reflux (VUR) (14)(15)(16)(17)(18) as well as renal parenchymal injury (19)(20)(21)(22). Reports also show that febrile UTI in children activate an interleukin 6 (IL-6) and interleukin 8 (IL-8) responses, thus adding the estimation of these cytokines in the diagnostic trajectory of the disease (23,24).…”

Section: Introductionmentioning

confidence: 99%

Urinary Tract Infection in Children: Diagnostic and Prognostic Utility of Biomarkers

Uwaezuoke

2017

J Compr Ped

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In the diagnostic evaluation of urinary tract infection (UTI) in children, dipstick urinalysis and urine microscopy/culture are the initial steps. Although these investigations are not without their drawbacks, urine culture remains the gold standard. Biomarkers may also be used as diagnostic tools, predictors of complications, and renal parenchymal injury. This paper aims to review the studies reporting the utility of biomarkers in the diagnosis and prognostication of UTI. Using the key words-'urinary tract infection', 'children', and 'biomarkers'-the PubMed database was searched for systematic reviews/meta-analyses and original studies, which were published within the past 25 years. Information was also gathered from relevant textbooks published within the same period. Serum procalcitonin, urine/serum interleukin 6 (IL-6) and 8 (IL-8), as well as urine neutrophil gelatinase-associated lipocalin (NGAL) are the major biomarkers of febrile UTI. In addition, procalcitonin and these cytokines are reported to be early predictors of vesicoureteric reflux (VUR) and renal parenchymal injury, while procalcitonin and IL-6 can also help to differentiate between lower UTI and upper UTI (pyelonephritis). Despite the wide range in the sensitivity and specificity of these biomarkers reported in the reviewed studies, the values are still acceptable. Some of these biomarkers may, in the future, obviate the need for invasive radiological tests, although their utility still require validation by further research. However, given the ability of imaging studies to detect structural abnormalities of the urinary tract, their use still remains relevant in the investigation of UTI despite the radiation risks associated with majority of them.

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“…22 Several novel biomarkers have recently been documented as diagnostic and prognostic tools in diseases such as pediatric acute kidney injury, [23][24][25][26][27][28][29][30][31][32][33][34][35][36] and urinary tract infection. [37][38][39][40][41][42][43] Similarly, the utility of biomarkers in childhood idiopathic nephrotic syndrome has been reported; [12][13][14][15][16][17][18][19][20] their application constitutes a noninvasive approach in diagnostic nephrology, as they can be used as diagnostic and prognostic tools in idiopathic nephrotic syndrome, as well as discriminatory tools in distinguishing SRNS from SSNS (Table 1).…”

Section: The Diagnostic Prognostic and Discriminatory Roles Of Biommentioning

confidence: 99%

The role of novel biomarkers in childhood idiopathic nephrotic syndrome: a narrative review of published evidence

Uwaezuoke

2017

IJNRD

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Two histological subtypes of idiopathic nephrotic syndrome are commonly recognized in children, namely minimal change nephropathy and focal segmental glomerulosclerosis. Children with minimal change nephropathy (the majority of whom are steroid-sensitive) and focal segmental glomerulosclerosis (the majority of whom are steroid-resistant) require early identification in order to ensure appropriate therapeutic intervention and better outcome. Although renal biopsy and histology remain the ideal diagnostic steps to identify these histological subtypes, reports indicate that serum and urinary biomarkers are now being utilized in the investigation of childhood idiopathic nephrotic syndrome. This paper aims to review the diagnostic and prognostic utility of novel biomarkers in childhood idiopathic nephrotic syndrome and to highlight their role in differentiating steroid-sensitive nephrotic syndrome (SRNS) from steroid-resistant nephrotic syndrome (SSNS). Using the terms "idiopathic nephrotic syndrome," "children," and "biomarkers" the PubMed database was searched for relevant studies related to the topic. Biomarkers such as adiponectin, neopterin, β2-microglobulin, and N-acetyl-β-D glucosaminidase were reported as diagnostic markers. In addition to neopterin and N-acetyl-β-D glucosaminidase, urine vitamin D-binding protein and α1β-glycoprotein were shown to differentiate SRNS from SSNS while N-acetyl-β-D glucosaminidase and β2-microglobulin could predict steroid responsiveness and renal outcome in SRNS. Although progress has been made in demonstrating the diagnostic and prognostic utility of these biomarkers, their limited availability in most laboratories has precluded a complete paradigm shift from the conventional renal biopsy. Nevertheless, further longitudinal studies are required to establish their usefulness as noninvasive predictors of disease response to immunosuppressive therapy.

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Evaluation of the Optimal Neutrophil Gelatinase-Associated Lipocalin Value as a Screening Biomarker for Urinary Tract Infections in Children

Cited by 23 publications

References 18 publications

Neutrophil gelatinase-associated lipocalin: utility in urologic conditions

Neutrophil gelatinase-associated lipocalin: utility in urologic conditions

Urinary Tract Infection in Children: Diagnostic and Prognostic Utility of Biomarkers

The role of novel biomarkers in childhood idiopathic nephrotic syndrome: a narrative review of published evidence

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