Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure

Abstract

IntroductionElevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%.AimThe aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance).Material and MethodThe study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU TîrguMures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring.ResultsThe patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items.ConclusionsNGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

Reduction of Intra-abdominal Hypertension Is Associated with Increase of Cardiac Output in Critically Ill Patients Undergoing Mechanical Ventilation

“…20,21 Other studies demonstrated that IAH is associated with the development of acute renal failure in critically ill patients. 22,23 In line with these results and with our previous experience, we also proved that the levels of NGAL, a biomarker associated with acute renal failure, are increased in patients with IAH compared to the patients with normal IAP. Interestingly, we recorded significantly higher levels of NGAL in patients with IAH (571.7 ± 411.6 vs. 324.1 ± 299.0, p = 0.02), without any significant difference in other serum biomarkers characterizing renal function such as creatinine clearance, GRF, or urea.…”

The Postoperative Plasmatic Level of Neutrophil Gelatinase-associated Lipocalin Does not Reflect its Tissue Expression in Critically ill Patients with High Abdominal Pressure

“…In all of the cases, the clinical and laborator y investigations were performed from the first 24 h following surgery. The abdominal pressure was invasively evaluated NGAL was firstly described as being a matrix protein released from the granules of activated neutrophils [1][2][3][4]. It was later observed that NGAL can be also derived at the glomerular endothelial/mesangial cells, freely filtered through the glomerular membrane and reabsorbed by endocytosis in the proximal tubule [6].…”

“…It was later observed that NGAL can be also derived at the glomerular endothelial/mesangial cells, freely filtered through the glomerular membrane and reabsorbed by endocytosis in the proximal tubule [6]. In patients with decreased glomerular filtration rate, it is considered a biomarker of kidney injury, that increases in plasma 12-24 hours before increasing of serum creatinine concentration [2,3,6,7]. NGAL can be also expressed in epithelial cells, liver and adipose tissue, normal brochial epithelia and epidermal keratinocytes [3,8,9] but the exact role of this protein and the stimuli responsible for its circulation are not yet understood [3].…”

“…The plasma level of NGAL does not reflect the severity of acute renal failure but can be an using an uretero-vesical catheter and the device AbViser (ConvaTec, Salt Lake City, USA) for measuring the pressure for at least two days after surgery. Those cases with a pressure higher than 12 mmHg in at least one of the two days were considered as having high abdominal pressure [2].…”

“…Based on the obtained data, we have postulated a hypothesis regarding the potential NGAL-mediated mechanism of shock. As we have previously proved that high serum level of NGAL associates a decreased filtration rate and is associated with the intraabdominal pressure [2], the possible role of NGAL in inducing abdominal compartment syndrome was also explored.…”