Urine Neutrophil Gelatinase-Associated Lipocalin as a Marker of Acute Kidney Injury After Kidney Surgery

Abstract

Purpose Evaluate uNGAL as a marker for AKI in patients undergoing PN to identify the preoperative clinical features and surgical factors during PN that are associated with renal injury as measured by increased uNGAL levels compared to controls. Methods Using RN and thoracic surgery patients as control groups, we prospectively collected and analyzed urine and serum of PN, RN, and thoracic surgery patients between April 2010 and April 2012. Urine was collected preoperatively and at multiple time points postoperatively. Differences in uNGAL levels between the 3 surgical groups were analyzed using a GEE model. The PN group was subdivided based on preoperative eGFR <60 or ≥60 ml/min/1.73m2. Results Of 162 patients included in the final analysis, >65% had CVD, and median eGFR was >60 ml/min/1.73m2 for all groups (RN=61, PN=78, thoracic surgery=84.5 ml/min/1.73m2). Preoperatively, a 10-unit increase in eGFR was associated with a 4- unit decrease in uNGAL in the PN group. Postoperatively, uNGAL levels in the PN group were not higher than thoracic surgery or RN control groups, and did not correlate with duration of ischemia. PN patients with preoperative eGFR <60 developed higher uNGAL levels postoperatively compared to those with a higher preoperative eGFR. Conclusion uNGAL does not appear to be a useful marker for detection of renal injury in healthy PN patients. However, patients with poorer preoperative renal function have higher baseline uNGAL levels and appear more susceptible to AKI as detected by uNGAL levels and AKIN criteria compared to those with normal eGFR.

A novel approach to off-clamp partial nephrectomy demonstrates significant improvements in renal injury in an experimental porcine model

“…[16][17][18] Increased expression of these biomarkers was observed in our experiments, and KIM-1 was significantly elevated after IRI compared to off-clamp PN. This biomarker has been proven to be more sensitive than serum creatinine for AKI diagnosis and it may be a better method of evaluating renal function in the setting of IRI.…”

Neutrophil Gelatinase-Associated Lipocalin Significantly Correlates with Ischemic Damage in Patients Undergoing Laparoscopic Partial Nephrectomy

“…sCr and accompanying eGFR changes in diagnosis of AKI may frequently be missed out particularly when the opposite kidney is healthy (1) and thus could not predict the initial time of damage neither the degree of severity. sCr starts to increase when the kidney function decreases by 50% The detection of less damage in their study might be due to several factors, such as performing cold ischemia, which has a better kidney protection effect, in most patients during the renal artery clamping, and infusion of intraoperative mannitol (13). We conducted tumor resection using laparoscopic method and under the warm ischemia in all patients.…”

“…The sCr levels increase as early as 24-48 hours after the development of kidney injury. In this regard, researchers have used other specific biomarkers for identification of kidney injury to make early diagnosis (12)(13)(14). Neutrophil gelatinase-associated (NGAL) is a significant biomarker that has diagnostic and prognostic significance in early diagnosis of kidney ischemia-reperfusion injury.…”

“…In the present study, we used serum NGAL value. As indicated by Sprenkle, monitoring the NGAL increase in serum may be less misleading because the increase in the production in ischemic kidney in partial nephrectomies of healthy patients with two functional kidneys might be diluted if the opposite kidney produces a high volume of urine(13). To date, few clinical studies have demonstrated the importance of NGAL in diagnosis of possible AKI in partial nephrectomies.…”

Prospective assessment of urinary neutrophil gelatinase‐associated lipoprotein in living kidney donors: toward understanding differences between chronic kidney diseases of surgical and medical origin

“…NGAL produced by renal cells is excreted in the urine and does not circulate in the blood . Therefore, many studies reporting changes in NGAL with acute kidney injury, kidney surgery, or renal ischaemia–reperfusion injury have analysed urinary NGAL (uNGAL) rather than (or in addition to) sNGAL . Several observational studies have evaluated uNGAL in kidney donors, but none have definitively reported how uNGAL relates to renal function of the living kidney donor .…”