Urinary neutrophil gelatinase-associated lipocalin as a marker for disease activity in lupus nephritis

Shahawy, Mohamed S El; Hemida, Mahmoud Haddad; Abdel-Hafez, Hafez; Elbaz, Tarek; Lotfy, Abdelwahab M.; Emran, Tarek M.

doi:10.1080/00365513.2018.1449242

Cited by 23 publications

(28 citation statements)

References 10 publications

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“…Our result of enhanced serum values of NGAL in LN is in line with those reported in the literature; however, their results were not statistically significant (24,27,28,35). This may be due to different sample sizes.…”

Section: Discussionsupporting

confidence: 90%

“…In a mouse model of LN, NGAL level in the kidney, urine, and serum is elevated in connection with disease severity (20). Likewise, human studies have displayed that urinary NGAL (uNGAL) levels can reflect the decline of renal function and the disease activity in LN (5,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Furthermore, it may predict poor response after induction therapy (31).…”

Section: Introductionmentioning

confidence: 99%

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The importance of serum neutrophil gelatinase-associated lipocalin level in patients with lupus nephritis

et al. 2019

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Introduction: The neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a biomarker of renal damage. Objectives: The aim of this study was to assess the serum levels of NGAL (sNGAL) as a marker of disease activity in individuals with lupus nephritis (LN). Patients and Methods: This study contained 50 systemic lupus erythematosus (SLE) individuals with (n = 25) and without (n = 25) nephritis, and 39 healthy controls. The sNGAL levels were measured by ELISA. Renal function test, urinary parameters, lupus serology activity, and also calculated SLE disease activity index (SLEDAI) were analyzed to determine their associations with sNGAL. Results: The results revealed that the SLE individuals with or without nephritis had a raised serum NGAL levels as compared to control subjects (P<0.001). Additionally, sNGAL levels in LN individuals were meaningfully higher compared to those in non-LN patients (P<0.001). Serum NGAL showed a significant correlation with the SLEDAI, serum creatinine, and 24-h urinary protein (P<0.05). More importantly, sNGAL had a significant positive correlation with the activity index of LN (r = 0.616, P=0.001). In the ROC curve analysis, the measurement of sNGAL level showed a good diagnostic performance for distinguishing individuals with LN from SLE patients without renal involvement with AUC=0.902 (P<0.001), 72% sensitivity, and 99% specificity. Moreover, sNGAL could identify all of SLE patients from controls with high accuracy, AUC= 0.99, P<0.001, with 99% sensitivity, and 97% specificity. Conclusion: Serum NGAL had an association with clinical parameters and could discriminate LN from SLE patients without renal involvement. Our result suggests that serum NGAL can be used for early diagnosis of LN and identifying active LN.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The importance of serum neutrophil gelatinase-associated lipocalin level in patients with lupus nephritis

et al. 2019

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“…The detailed process of literature searching is illustrated by a flowchart (Figure 1). Initially, 315 articles were identified from electronic databases including [25,27,28,32,38], 5 in African countries [26,31,33,34,36], and 1 in South American country [37]. Four studies were conducted in children [20,22,26,30], and 17 studies investigated adults [ or "low concern": 1 score; "no"…”

Section: Resultsmentioning

confidence: 99%

Elevated Urinary Neutrophil Gelatinase-Associated Lipocalin Is a Biomarker for Lupus Nephritis: A Systematic Review and Meta-Analysis

Gao

Wang

Cao

et al. 2020

BioMed Research International

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Objective. Lupus nephritis (LN) is a major and severe complication of systemic lupus erythematosus (SLE). Neutrophil gelatinase-associated lipocalin (NGAL), as a promising next-generation biomarker in clinical nephrology, has received extensive attention. However, its diagnostic performance in LN has high variability. Therefore, we performed an updated meta-analysis to further evaluate the diagnostic accuracy of urinary NGAL (uNGAL). Materials and Methods. PubMed, Embase, and Cochrane Library were searched from inception to October 27, 2019. Meta-analysis was performed with a bivariate random effects model. Additionally, the summary receiver operating characteristic (SROC) curves were established. The sources of heterogeneity were explored by meta-regression, subgroup analysis, and sensitivity analysis. Publication bias was assessed using the Deeks test. Results. 19 articles consisting of 21 eligible studies were included. In diagnosing LN, the estimates (95% confidence interval (CI)) were as follows: sensitivity, 0.84 (0.71-0.91); specificity, 0.91 (0.70-0.98); and the SROC-AUC value, 0.92 (0.90-0.94). In identifying active LN, the estimates were as follows: sensitivity, 0.72 (0.56-0.84); specificity, 0.71 (0.51-0.84); and the AUC value, 0.77 (0.74-0.81). With respect to predicting renal flare, the estimates were as follows: sensitivity, 0.80 (0.57-0.92); specificity, 0.67 (0.58-0.75); and the AUC value, 0.74 (0.70-0.78). For the studies to distinguish proliferative LN, the estimates were as follows: sensitivity, 0.87 (0.66-0.97), and specificity, 0.69 (0.39-0.91). Deeks’ funnel plot suggested that there was no significant publication bias. Conclusions. Our meta-analysis indicates that uNGAL was a useful biomarker for diagnosis, estimation of activity, and prediction of renal flare of LN. In addition, the usefulness of uNGAL to distinguish pathological types of LN needs to be further investigated.

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“…Brunner et al [38] [38]. The ability of urinary NGAL to differentiate between LN and non-LN patients with a high degree of sensitivity and specificity has been recently confirmed in other cohorts with different patient ethnicities [39,40]. In a subsequent longitudinal study by Brunner et al, urinary NGAL levels were associated with worsening renal disease in SLE patients.…”

Section: Neutrophil Gelatinase-associated Lipocalin (Ngal)mentioning

confidence: 90%

“…Conversely, Kiani et al reported the lack of association between urinary NGAL and measures of LN in a study of 107 SLE patients [43]. However, the majority of studies that utilized this marker reported its usefulness in predicting LN activity, flares, and worsening renal disease [38][39][40][41][42], rendering it a desirable target in this field.…”

Section: Neutrophil Gelatinase-associated Lipocalin (Ngal)mentioning

confidence: 99%

Proteomic profiling of urine: implications for lupus nephritis

Aljaberi

Bennett

Brunner

et al. 2019

Expert Review of Proteomics

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Introduction: Lupus nephritis (LN) is a common and significant manifestation, affecting 60% of adults and 80% of children with systemic lupus erythematosus, with up to 30% of patients progressing to end stage renal disease. There remains an unmet need for non-invasive markers of disease activity, damage, and response to therapy. In addition, non-invasive biomarkers that predict therapeutic efficacy are needed to enable cost-effective clinical trials of novel agents. Areas covered: This review examines the methodological aspects of urinary proteomics, the role of proteome profiling in identifying promising urinary biomarkers in LN, and the translation of research findings into clinically useful tools in the management of LN. Expert opinion: Targeted and unbiased proteomics have identified several promising urinary biomarkers that predict LN activity, damage (chronicity), and response to therapy. In particular, a combination of biologically plausible urinary biomarkers termed as RAIL (Renal Activity Index for Lupus) has emerged as an excellent predictor of LN activity as well as response to therapy, being able to predict efficacy within 3 months of therapy. If validated in additional large prospective studies, the RAIL biomarkers will transform the care of patients with LN, allowing for a personalized and predictive approach and improved outcomes.

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Urinary neutrophil gelatinase-associated lipocalin as a marker for disease activity in lupus nephritis

Cited by 23 publications

References 10 publications

The importance of serum neutrophil gelatinase-associated lipocalin level in patients with lupus nephritis

The importance of serum neutrophil gelatinase-associated lipocalin level in patients with lupus nephritis

Elevated Urinary Neutrophil Gelatinase-Associated Lipocalin Is a Biomarker for Lupus Nephritis: A Systematic Review and Meta-Analysis

Proteomic profiling of urine: implications for lupus nephritis

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