Urinary Neutrophil Gelatinase-Associated Lipocalin Levels in Comparison with Glomerular Filtration Rate for Evaluation of Renal Function in Patients with Diabetic Chronic Kidney Disease

Abstract

BackgroundNeutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury. There is a growing body of evidence suggesting that NGAL is also a marker of kidney disease and severity in chronic kidney disease (CKD). We studied the utility of urinary NGAL in more accurately predicting renal function in patients with diabetic CKD.MethodsWe studied possible relationships between urinary NGAL, estimated glomerular filtration rate (eGFR), and proteinuria in diabetic CKD patients and in healthy populations.ResultsUrinary NGAL levels were significantly higher in CKD patients than in healthy controls (96.0 [2.7 to 975.2] ng/mL vs. 18.8 [1.3 to 81.9] ng/mL, P=0.02), and the GFR was lower among CKD patients (49.3 [13.1 to 78.3] mL/min/1.73 m2 vs. 85.6 [72 to 106.7] mL/min/1.73 m2, P<0.0001). The urinary NGAL level showed a significant inverse correlation with GFR (r=-0.5634, P<0.0001). The correlation analyses between urinary protein level and urinary NGAL levels and GFR were as follows: urine protein and urinary NGAL (r=0.3009, P=0.0256), urine protein and GFR (r=-0.6245, P<0.0001), urine microalbumin and urinary NGAL (r=0.1794, P=0.2275), and urine microalbumin and GFR (r=-0.5190, P=0.0002).ConclusionFrom these results, we concluded that urinary NGAL is a reliable marker of renal function in diabetic CKD patients. However, urinary NGAL did not provide more accurate information regarding renal function than GFR.

Urinary Neutrophil Gelatinase Associated Lipocalin as a Marker of Tubular Damage in Type 2 Diabetic Patients with and without Albuminuria

“…Some studies found significant inverse correlation between UNGAL and eGFR like our finding however in contrast to our results they found also significant correlation with albuminuria [10] [36]. Similar to our results Woo et al found inverse correlation between UNGAL with eGFR while he did not find any correlation with albuminuria [37]. In contrast to our results, Zachwieja J. et al found correlation between UNGAL and UAE while he did not find any correlation with eGFR and HbA1c [32].…”

High expression of neutrophil gelatinase-associated lipocalin (NGAL) in the kidney proximal tubules of diabetic rats

“…Additional studies have proved uNGAL concentration had a stronger positive correlation with urinary albumin-to-creatine ratio than uNAG (r = 0.556 vs. 0.305, both P < 0.05) [18]. Most clinical researches provide initial evidence to support that uNGAL can be useful for the evaluation of renal involvement in the course of diabetes, especially for the ''normoalbuminuric'' or ''short-term'' diabetes mellitus patients [19][20][21][22]. However, since Nielsen et al have reported a lack of an independent correlation between uNGAL and glomerular filtration rate in a 3-year intervention study of 63 type 1 diabetic patients with kidney disease, more clinical observations are required to further assess it [23].…”

Novel urinary biomarkers in pre-diabetic nephropathy

“…Similarly average value (12.65 ng/mL) for NGAL was calculated from studies by Lacquaniti et al and Wo et al [31,32]. The values of NGAL and Cystatin C in diabetes and pre-diabetes with normoalbuminuria were higher than the values in healthy subjects found by previous studies [28][29][30][31][32]. The values of Cystatin C in diabetes subjects with normoalbuminuria and microalbuminuria were 0.06 ± 0.06 and 0.32 ± 1.14 mg/L, respectively according to Jeon et al [9].…”