Urinary Neutrophil Gelatinase-Associated Lipocalin at Birth Predicts Early Renal Function in Very Low Birth Weight Infants

Manna, Gaetano La; Galletti, Silvia; Capelli, Irene; Vandini, Silvia; Nisi, Katia; Aquilano, Giulia; Mancini, Rita; Carretta, Elisa; Montini, Giovanni; Faldella, Giacomo; Stefoni, Sergio

doi:10.1203/pdr.0b013e31822941c7

Cited by 21 publications

(18 citation statements)

References 37 publications

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“…A difference in correlations of uNGAL with uNGAL/uCre and sCre were found (26), but our results support those of previous studies showing that correction of uNGAL with uCre was not necessary (15,17,27). An increase in uNGAL (a marker of proximal tubular epithelium disorder) may occur before an increase in sCre (a marker of glomerular disorder), because nephrogenic renal dysfunction may develop when prerenal failure is protracted (28).…”

Section: Discussionsupporting

confidence: 86%

Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants

Kuribayashi

Suzumura

Sairenchi

et al. 2016

Experimental and Therapeutic Medicine

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Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is produced in response to tubular epithelial injury and is a biomarker of tubulointerstitial injury. The aim of the present study was to examine whether acute kidney injury (AKI) could be predicted by measuring uNGAL in very low-birth weight (VLBW) infants. Forty VLBW infants with birthweight below 1,500 g were enrolled in the present study. uNGAL and serum creatinine (sCre) were measured daily from postnatal days 0 to 8. Infants with sCre ≥1.2 mg/dl were diagnosed with AKI. The relationship of uNGAL with sCre was measured on the day after uNGAL measurement (next-day sCre) was examined. The results showed that 16 infants had sCre ≥1.2 mg/dl in this period. Logistic regression analysis revealed that uNGAL on postnatal days 2, 3, 4, 5 and 6 was correlated with next-day sCre (P<0.05). uNGAL corrected by urinary Cre (uCre) (uNGAL/uCre) was only correlated with an increase in next-day sCre on postnatal days 5 and 6 (P<0.05). For the logistic analysis, subjects with high and low uNGAL levels based on the median value for each day, uNGAL on postnatal days 2, 3 and 6 in the high uNGAL group was correlated with an increase in next-day sCre. Thus, AKI may be predicted by measuring uNGAL in VLBW infants. This measurement was non-invasive, and is potentially useful for the evaluation of renal function in VLBW infants.

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Section: Discussionsupporting

confidence: 86%

Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants

Kuribayashi

Suzumura

Sairenchi

et al. 2016

Experimental and Therapeutic Medicine

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“…Gubhaju et al recently described an association between U-NGAL and urine total protein, but contrary to us they did not find a positive association between U-NGAL and urine albumin [30]. Increased U-NGAL in extremely preterm neonates may be associated with infection, inflammation or indicate differentiation and growth of renal epithelium caused by immature nephrons stimulating glomerulogenesis [38, 41, 42]. We found U-NGAL to be associated with sepsis in very preterm neonates.…”

Section: Discussionmentioning

confidence: 82%

Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study

et al. 2017

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BackgroundA patent ductus arteriosus (PDA) is frequently found in very preterm neonates and is associated with increased risk of morbidity and mortality. A shunt across a PDA can result in an unfavorable distribution of the cardiac output and may in turn result in poor renal perfusion. Urinary Neutrophil Gelatinase-associated Lipocalin (U-NGAL) is a marker of renal ischemia and may add to the evaluation of PDA. Our primary aim was to investigate if U-NGAL is associated with PDA in very preterm neonates. Secondary, to investigate whether U-NGAL and PDA are associated with AKI and renal dysfunction evaluated by fractional excretion of sodium (FENa) and urine albumin in a cohort of very preterm neonates.MethodsA cohort of 146 neonates born at a gestational age less than 32 weeks were consecutively examined with echocardiography for PDA and serum sodium, and urine albumin and sodium were measured on postnatal day 3 and U-NGAL and serum creatinine day 3 and 6. AKI was defined according to modified neonatal Acute Kidney Injury Network (AKIN) criteria. The association between U-NGAL and PDA was investigated. And secondly we investigated if PDA and U-NGAL was associated with AKI and renal dysfunction.ResultsU-NGAL was not associated with a PDA day 3 when adjusted for gestational age and gender. A PDA day 3 was not associated with AKI when adjusted for gestational age and gender; however, it was associated with urine albumin. U-NGAL was not associated with AKI, but was found to be associated with urine albumin and FENa.ConclusionsBased on our study U-NGAL is not considered useful as a diagnostic marker to identify very preterm neonates with a PDA causing hemodynamic changes resulting in early renal morbidity. The interpretation of NGAL in preterm neonates remains to be fully elucidated.

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“…Of note, under suboptimal conditions, Ngal can facilitate tubular development and maturation through its iron binding capacity and regulation of genes involved in mesenchymal-epithelial transition (21)(22)(23). This developmental role of Ngal was suggested by La Manna et al, as a possible reason for increased urinary Ngal concentrations in very low birth weight preterm infants with impaired renal function (24). Therefore, the increased Ngal expression may be a compensatory and adaptive response to tubular injury that follows the stunting of tubular growth, possibly by the cellular energy depletion that occurs after birth asphyxia.…”

Section: Birth Asphyxia Leads To Kidney Damage and Delayed Maturationmentioning

confidence: 88%

Creatine pretreatment prevents birth asphyxia–induced injury of the newborn spiny mouse kidney

et al. 2012

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Background: acute kidney injury (aKI) is a major complication for infants following an asphyxic insult at birth. We aimed to determine if kidney structure and function were affected in an animal model of birth asphyxia and if maternal dietary creatine supplementation could provide an energy reserve to the fetal kidney, maintaining cellular respiration during asphyxia and preventing aKI. Methods: Pregnant spiny mice were maintained on normal chow or chow supplemented with creatine from day 20 gestation. On day 38 (term ~39 d), pups were delivered by cesarean section (c-section) or subjected to intrauterine asphyxia. Twenty-four hours after insult, kidneys were collected for histological or molecular analysis. Urine and plasma were also collected for biochemical analysis. results: aKI was evident at 24 h after birth asphyxia, with a higher incidence of shrunken glomeruli (P < 0.02), disturbance to tubular arrangement, tubular dilatation, a twofold increase (P < 0.02) in expression of Ngal (early marker of kidney injury), and decreased expression of the podocyte differentiation marker nephrin. Maternal creatine supplementation prevented the glomerular and tubular abnormalities observed in the kidney at 24 h and the increased expression of Ngal. conclusion: Maternal creatine supplementation may prove useful in ameliorating kidney injury associated with birth asphyxia.

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Urinary Neutrophil Gelatinase-Associated Lipocalin at Birth Predicts Early Renal Function in Very Low Birth Weight Infants

Cited by 21 publications

References 37 publications

Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants

Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants

Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study

Creatine pretreatment prevents birth asphyxia–induced injury of the newborn spiny mouse kidney

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