Urinary NGAL in Premature Infants

Lavery, Adrian; Meinzen‐Derr, Jareen; Anderson, Edward; Ma, Qing; Bennett, Michael; Devarajan, Prasad; Schibler, Kurt

doi:10.1203/pdr.0b013e318181b3b2

Cited by 122 publications

(123 citation statements)

References 22 publications

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“…In line with previous studies 8,9 we found in univariate analyses a negative association between BW and GA, and uNGAL, but not sNGAL. This finding has been confirmed by multiple regression models on the first and second week of life, but not a month after birth.…”

Section: Discussionsupporting

confidence: 93%

“…6,7 Few studies have analyzed total sNGAL and uNGAL levels in preterm newborns. Huynh et al 8 revealed that uNGAL levels are declining with gestational age (GA) by 17.8% by each week in very low birth weight infants (VLBW) with birth weight (BW) ranges from 790 to 1490 g. Similar results were obtained by Lavery et al 9 who showed uNGAL to be inversely related to BW and GA in 20 infants with BW range from 500 to 1500 g. Contradictory data has also been published. Inoue et al 10 reported a strong positive correlation between GA and sNGAL in 52 infants (mostly preterm) at birth, admitted to a tertiary neonatal intensive care unit (NICU).…”

Section: Introductionmentioning

confidence: 60%

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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: 93%

Section: Introductionmentioning

confidence: 60%

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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“…131 Identification and validation of biomarkers would allow earlier detection of AKI in premature infants and permit generalizability between single-center studies. [132][133][134] Biomarkers including urine cystatin C, uromodulin, epithelial growth factor, neutrophil gelatinase-associated lipocalin, and osteopontin predict AKI in specific neonatal populations. 135,136 …”

Section: Acute Kidney Injurymentioning

confidence: 99%

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

2013

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Thanks to remarkable advances in neonatal intensive care, infants who once had little chance for survival can now enter adulthood. Yet the consequences of premature birth or low birth weight (LBW) on nephrogenesis, final nephron number, and long-term kidney function are unclear. This review focuses on the theory, experimental evidence, and observational data that suggest an increased risk of chronic kidney disease (CKD) for infants born prematurely. Many premature and LBW infants begin life with an incomplete complement of immature nephrons. They are then exposed to a variety of external stressors that can hinder ongoing kidney development or cause additional nephron loss such as hemodynamic alterations, nephrotoxic medications, infections, and suboptimal nutrition. Acute kidney injury, in particular, may be a significant risk factor for the development of CKD. According to Brenner' s hypothesis, patients with decreased nephron number develop hyperfiltration that results in sodium retention, hypertension, nephron loss, and CKD due to secondary focal segmental glomerulosclerosis. Because the risk of CKD in premature and LBW infants has not been accurately determined, there are no evidence-based recommendations for screening or management. Yet with the first generation of infants from the surfactant era only now reaching adulthood, it is possible that there is already an unrecognized epidemic of CKD. We suggest individualized, risk-based assessments of premature and LBW infants due to the increased risk of CKD and call for additional research into the long-term risk for CKD these infants face.

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“…We speculate that in this study greater care may have been taken in collecting specimens to be used for urine culture than in the prior study, in which urine was not usually cultured. Third, GA and AKI (30)(31)(32) have been associated with changes in UNGAL concentrations in infants, independent of infection. Regression models controlling for the effects of GA, sex, and AKI found no significant interactions between these covariates and culture results; however, our study was neither designed nor powered to detect such effects.…”

Section: Limitationsmentioning

confidence: 99%

Urinary neutrophil gelatinase-associated lipocalin: potential biomarker for late-onset sepsis

et al. 2015

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Background:To assess the ability of urinary neutrophil gelatinase-associated lipocalin (UNGAL) to discriminate between culture-positive vs. culture-negative late-onset sepsis evaluations. Methods: This is a prospective observational study of 136 neonates who underwent ≥1 sepsis evaluation at >72 h of age. Urine was obtained at the time of sepsis evaluation to measure UNGAL concentration. Using generalized estimating equations controlling for gender, gestational and postnatal age, acute kidney injury, and within-patient correlations, pair-wise contrasts between mean log UNGAL concentrations of infants with negative sepsis evaluations vs. culture-positive sepsis and presumed sepsis were assessed. Discrimination characteristics at several UNGAL cutoff concentrations were assessed using receiver-operating characteristic curves. results: The predicted mean log UNGAL values of culture-positive sepsis and presumed sepsis vs. negative sepsis evaluations differed significantly (P < 0.001 and P = 0.02, respectively). At a cutoff ≥ 50 ng/ml, UNGAL discriminated between culture-positive sepsis and culture-negative sepsis evaluations with sensitivity = 86%, specificity = 56%, positive predictive value = 41%, negative predictive value = 92%, and number needed to treat = 3. conclusion: UNGAL is a noninvasive biomarker with high negative predictive value at the time of late-onset sepsis evaluation in neonates and could be a useful adjunct to traditional components of sepsis evaluations.l ate-onset sepsis, by definition, occurs at >72 h of life and can affect as many as 20-30% of infants hospitalized in the neonatal intensive care unit (NICU), with varying mortality rates depending on gestational age (GA) (1,2). Accurate diagnosis of late-onset sepsis in this vulnerable population can be difficult due to nonspecific signs and symptoms, as well as due to difficulties in obtaining sufficient diagnostic specimens, such as an adequate volume of blood samples. In order to determine which infants are most likely to be infected, biomarkers have been utilized with varying success. The ideal biomarker should have rapid onset of expression, reversibility of expression when the disease abates, ease of collection and measurement, high sensitivity, and high negative predictive value (NPV). Currently, C-reactive protein (CRP) is the most frequently used serum biomarker in the NICU population. As described by Benitz et al. (3), a single CRP at the time of a sepsis evaluation has a modest sensitivity (65%) and NPV (79%). In septic infants, CRP peaks 24-48 h after the onset of symptoms; a second sample obtained during this time period increases the sensitivity to 97%. Although CRP can help determine which neonates may not be septic, it is a relatively invasive, late biomarker and the results of the second sample may have limited additional diagnostic utility compared with blood culture results, which are often available about the same time. A noninvasive biomarker with high sensitivity, high NPV, and results available at the time of sepsis evalu...

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Urinary NGAL in Premature Infants

Cited by 122 publications

References 22 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

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

Urinary neutrophil gelatinase-associated lipocalin: potential biomarker for late-onset sepsis

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