Serum and Urinary NGAL in Septic Newborns

Smertka, Mike; Wróblewska, Jolanta; Suchojad, Anna; Majcherczyk, Małgorzata; Jadamus-Niebrój, Danuta; Owsianka-Podleśny, Teresa; Brzozowska, Aniceta; Maruniak‐Chudek, Iwona

doi:10.1155/2014/717318

Cited by 41 publications

(42 citation statements)

References 29 publications

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“…We showed a strong correlation between inflammatory markers such as CRP and PCT and lipocalin-2 assessed both in urine and serum. Similar results were previously obtained in term newborns by us 24 and other researchers. 22,23,25 In our project, sNGAL and uNGAL values were checked as a surrogate, hence possibly more sensitive parameter of kidney injury.…”

Section: Discussionsupporting

confidence: 92%

“…In our opinion it is too soon to relay on s/uNGAL values solely in early recognition of AKI, but we definitely should not neglect this marker. Inflammatory conditions such as BPD 10 and sepsis, and especially urinary tract infection 24,27 are probably the most important limitation for the interpretation of NGAL values, decreasing its specificity in the diagnosis of AKI. However this does not diminish uNGAL value in detection of AKI of non-septic origin in premature infants.…”

Section: Discussionmentioning

confidence: 99%

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Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns

et al. 2015

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Background: Neutrophil gelatinase-associated lipocalin (NGAL) is postulated to be a highly sensitive and specific marker of acute kidney injury (AKI). The aim of this study was to assess the factors affecting serum and urine total NGAL in preterm newborns, limiting the role of this new potential marker of AKI. Methods: Serum and urinary total NGAL concentrations were determined in 57 preterm infants admitted to the Neonatal Intensive Care Unit in the following points of time: first week of life, between 8 and 14 days of life, and after the fourth week of life. Patients' clinical conditions were evaluated based on NTISS (Neonatal Therapeutic Intervention Scoring System). Two gestational age subgroups were distinguished: 29 and 30 to 35 weeks of gestation. We sought correlation between total NGAL values and gestational age, birth weight, Apgar score and severity of clinical condition, with particular interest in inflammatory status. Results: Serum and urinary total NGAL concentration correlated with inflammatory markers, such as CRP and procalcitonin, as well as with NTISS values. Birth weight and gestational age influence urinary NGAL (uNGAL) values in the first two weeks of life. In AKI (N ¼ 8) patients uNGAL values were significantly higher than in non-AKI newborns. Conclusions: We conclude that inflammatory status and prematurity limits the specificity of total NGAL measurement as a marker of AKI.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns

et al. 2015

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“…Prior literature has shown that in premature infants without AKI, urine proteins will be highest among those with the lowest GA, probably because of the passive loss of proteins in the context of immature tubular function (6)(7)(8). Previously, we (7) and others (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) have published data on the ability of urine biomarkers to predict AKI in neonates; however, these studies are limited by the size of the cohort or the use of nested case-control methods, with most of these studies evaluating only one biomarker. In addition, previous studies were subject to risk of misclassification bias, given that many infants had only a few SCr levels measured to determine AKI.…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury Urine Biomarkers in Very Low-Birth-Weight Infants

Askenazi

Koralkar

Patil

et al. 2016

CJASN

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Background and objectives Serum creatinine (SCr)-based AKI definitions have important limitations, particularly in very low-birth-weight (VLBW) neonates. Urine biomarkers may improve our ability to detect kidney damage. We assessed the association between 14 different urine biomarkers and AKI in VLBW infants.Design, setting, participants, & measurements We performed a prospective cohort study on 113 VLBW infants (weight #1200 g or ,31 weeks' gestation) admitted to a regional neonatal intensive care unit at the University of Alabama at Birmingham between February 2012 and June 2013. SCr was measured on postnatal days 1, 2, 3, and 4 and was combined with clinically measured SCr to determine AKI according to Kidney Disease Improving Global Outcomes AKI definition (increase in SCr $0.3 mg/dl or $50% increase from previous lowest value). Urine was collected on the first 4 days (average number of urine collections, 3; range, 1-4). The maximum urine biomarkers and urine biomarker/creatinine levels were calculated for 12 urine biomarkers, and the minimum urine biomarker and biomarker/creatinine levels were assessed for two urine biomarkers. We compared these values between infants with and those without AKI. Ideal cutoffs, area under the receiver-operating characteristic curve , and area under the curve adjusted for gestational age were calculated.Results Cumulative incidence of AKI during the first 2 postnatal weeks was 28 of 113 (25%). Infants with AKI had higher maximum levels of urine cystatin C, neutrophil gelatinase-associated lipocalin, osteopontin, clusterin, and a glutathione S-transferase (2.0, 1.8, 1.7, 1.7, and 3.7 times higher, respectively) than infants without AKI. In addition, infants with AKI had lower minimum levels of epithelial growth factor and uromodulin than those without AKI (1.4 and 1.6 times lower, respectively). Most but not all participants had their maximum (or minimum) biomarker values preceding AKI. These associations remained after adjustment for gestational age.Conclusions Urine biomarkers measured in the first 4 days of life are associated with AKI during the first postnatal weeks. Further evaluations are necessary to determine whether these biomarkers can predict important clinical outcomes. In addition, intervention studies that use biomarkers to stratify enrollment groups are needed before bedside evaluations can be incorporated into care.

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“…25,26 In our study, ten patients (11.4%) did not progress beyond the AKIN stage II, indicating that some patients in this group probably had functional renal failure (transient AKI or prerenal azotemia) without any significant renal tubular injury. The incidence of transient AKI was similar to the study done by Hoste et al 27 (18%).…”

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confidence: 54%

Diagnostic accuracy of urinary neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury

Patel¹,

Sachan²,

Shyam

et al. 2016

IJNRD

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Background: Sepsis is the most common cause of acute kidney injury (AKI). Very few studies have investigated the predictive properties of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a marker of AKI in septic patients. The aim of this study is to examine uNGAL in septic patients with and without AKI and to evaluate its predictive value. Methods: We prospectively studied 155 patients with sepsis over a period of 1 year. Urine was analyzed for neutrophil gelatinase-associated lipocalin at 12, 24, and 48 hours after admission. Patients with <24-hour stay and those with chronic kidney disease were excluded. AKI was classified according to the Acute Kidney Injury Network guidelines. Results: The differences in mean change of uNGAL at 12, 24, and 48 hours were 80.00±7.00 ng/mL and 128.13±22.46 ng/mL, respectively in septic AKI, and 02.07±0.80 ng/mL and 26.13±15.12 ng/mL, respectively in septic non-AKI. At baseline or 12 hours, the cutoff value of 34.32 ng/mL had a sensitivity and specificity of 86.36 and 80.60, respectively and an area under curve of 0.81 (95% CI: 0.73-0.89) for predicting AKI. At the cutoff value 199.99 ng/mL sensitivity and specificity of 90.0 and 64.66, respectively and an area under curve of 0.82 (95% CI, 0.75-0.88) for predicting AKI. Conclusion:The baseline or 12-hour uNGAL is highly sensitive but a less specific predictor of AKI in septic patients.

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Serum and Urinary NGAL in Septic Newborns

Cited by 41 publications

References 29 publications

Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns

Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns

Acute Kidney Injury Urine Biomarkers in Very Low-Birth-Weight Infants

Diagnostic accuracy of urinary neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury

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