Neutrophil Gelatinase-Associated Lipocalin as a Biomarker of Acute Kidney Injury in Patients with Morbid Obesity Who Underwent Bariatric Surgery

Abstract

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as a biomarker of acute kidney injury (AKI) that could contribute to early diagnosis and effective management of AKI. The purpose of this study was to evaluate NGAL as a predictive marker of AKI in patients with clinically severe obesity (BMI >50) who underwent biliopancreatic diversion surgery. Patients and Methods: We prospectively studied 23 patients with clinically severe obesity who underwent biliopancreatic bypass surgery. NGAL was measured using chemiluminescent microparticle immunoassay in three urine samples collected from each patient before surgery (first sample), 2-6 h after surgery (second sample) and on the first postoperative day (third sample). Results: Renal function was evaluated using serum creatinine values, which were 0.91 ± 0.26 mg/dl before surgery, 0.87 ± 0.31 mg/dl immediately after surgery and 0.92 ± 0.62 mg/dl on the fifth postoperative day. During the immediate postoperative period, AKI was observed in 2 patients, one of whom required renal replacement therapy with hemodialysis. In both patients, urine NGAL increased within the first postoperative hours before the values of serum creatinine increased. Conclusion: Urine NGAL in patients with clinically severe obesity, which was surgically treated, might be a potential biomarker of early AKI detection. Further research is required in order to confirm these results observed in a small number of patients who developed postoperative AKI and make recommendations for predictive NGAL values in patients who underwent bariatric surgery.

Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity

“…Importantly, with the resolution of acute kidney insult, these novel subclinical biomarkers of kidney injury decline to pre‐injury concentrations in the urine, demonstrating that these biomarkers are not permanently altered by a kidney insult but instead may be useful for tracking the resolution of the insult . Interestingly, one small adult study have reported development of clinical AKI within 2‐3 days after bariatric surgery which was associated with an increase in NGAL levels on the first postoperative day . We did not measure urinary biomarkers in the peri‐operative period however we did not observe clinically evident AKI in any of our subjects either.…”

Short Term Effect Of Laparoscopic Sleeve Gastrectomy on Clinical, Renal Parameters and Urinary Ngal Levels in Diabetic and Non Diabetic Obesity

“…The studies evaluating the relationship between bariatric surgery and urinary NGAL levels are limited in the literature. Koukoulaki et al evaluated the effect of NGAL on acute kidney injury and observed that urinary NGAL levels increased before serum creatinine elevation in the first 24 hours after biliopancreatic diversion in patients with acute kidney injury (19). The comparison of NGAL levels with diabetic and nondiabetic patients after bariatric surgery is the strength of our study.…”

Renal experiences of bariatric surgery in patients with type 2 diabetes mellitus

“…Другими биомаркерами повреждения почки являются Kim-1, RPA-1, цистатин С, остеопонтин и фибриноген. В экспериментальном исследовании показано, что такие биомаркеры, как альбумин, NAG, остеопонтин, фибриноген, значимо повышались при прогрессировании нефропатии у крыс с гипертензией и ожирением и коррелировали со степенью выраженности нефропатии [72].…”