Urine NGAL Predicts Severity of Acute Kidney Injury After Cardiac Surgery

Bennett, Michael; Dent, Catherine L.; Ma, Qing; Dastrala, Sudha; Grenier, Frank C.; Workman, Ryan; Syed, Hina; Ali, Salman; Barasch, Jonathan; Devarajan, Prasad

doi:10.2215/cjn.04010907

Cited by 698 publications

(603 citation statements)

References 40 publications

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“…30,31 Several small studies have found that a range on novel kidney injury-specific biomarkers, including urinary cystatin C, a1-microglobulin, N-acetylbeta-(D)-glucosaminidase, and retinol-binding protein correlate with severe AKI requiring RRT in hospitalized patients. 29,31,32 Overall, these candidate biomarkers are very promising; however, currently they are not widely available.…”

Section: Acute Kidney Injury Predictionmentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Section: Acute Kidney Injury Predictionmentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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“…NGAL is produced and secreted into the urine in response to ischemic kidney damage and is therefore a promising early indicator of tubulointerstitial damage [4,5]. Recent clinical studies show that U-NGAL reflect acute renal damage early [6][7][8][9] but may also signal chronic renal damage [10][11][12][13]. When mild to moderate increases in U-NGAL concentrations are expected it is of essence to know whether U-NGAL should be measured as absolute values or as a ratio to urinary Creatinine (U-Cr).…”

Section: Introductionmentioning

confidence: 99%

Day-to-day variation of urinary NGAL and rational for creatinine correction

Helmersson‐Karlqvist

Ärnlöv

Larsson

2013

Clinical Biochemistry

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Day-to-day variation of urinary NGAL and rational for creatinine correction. Objectives: Clinical studies evaluating the new tubular biomarker urinary neutrophil gelatinase-associated lipocalin (U-NGAL) in urine increase and there is no consensus whether absolute U-NGAL concentrations or urinary NGAL/creatinine (U-NGAL/Cr) ratios should be used when chronic tubular dysfunction is studied. The aim was to study the biological variation of U-NGAL in healthy subjects and the rational for urinary Creatinine (U-Cr) correction in two different study samples. Design and Methods:To study biological variation of U-NGAL and U-NGAL/Cr ratio and the association between U-NGAL and U-Cr in healthy subjects 13 young males and females (median age 29 years) collected morning urine in 10 consecutive days. Additionally, a random subsample of 400 males from a population-based cohort (aged 78 years) collecting 24-hour urine during one day was studied. Results:The calculated biological variation for absolute U-NGAL was 27% and for U-NGAL/Cr ratio 101%. Absolute U-NGAL increased linearly with U-Cr concentration (the theoretical basis for creatinine adjustment) in the older males (R = 0.19, P<0.001) and with borderline significance in the young adults (R = 0.16, P = 0.08). The U-NGAL/Cr ratio was, however, negatively associated with creatinine in the older males (R = -0.14, P<0.01) and in the young adults (R = -0.16, P = 0.07) indicating a slight "overadjustment". Conclusions:The study provide some support for the use of U-NGAL/Cr ratio but the rather large biological variation and risk of possible overadjustment need to be considered. Both absolute U-NGAL and U-NGAL/Cr ratios should be reported for the estimation of chronic tubular dysfunction.

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“…Thus, the levels of HNL/NGAL were significantly increased in serum/plasma and urine after cardiac surgery and paralleled reduction in renal function (12,16,19). Several immunoassays have been developed for the measurement of HNL/NGAL.…”

mentioning

confidence: 99%

The Origin of Multiple Molecular Forms in Urine of HNL/NGAL

Cai

Rubin

Wang

et al. 2010

Clinical Journal of the American Society of Nephrology

253

213

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Results: The major molecular form of HNL/NGAL secreted by neutrophils is dimeric, whereas the major form secreted by HK-2 cells is monomeric. This was reflected by a predominance of the monomeric form in urine from patients with AKI and the dimeric form in patients with UTIs. The epitope specificities of the antibody used in the ELISAs had a profound effect on assay performance and paralleled differences of the antibodies to identify the different forms of urine HNL/NGAL.Conclusions: The monomeric form is the predominant form secreted by tubular epithelial cells, and the dimeric form is the predominant form secreted by neutrophils. The development of molecular form-specific assays for HNL/NGAL may be a means to identify the origin of HNL/NGAL in urine and construct more specific tools for the diagnosis of AKI.

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Urine NGAL Predicts Severity of Acute Kidney Injury After Cardiac Surgery

Cited by 698 publications

References 40 publications

Review article: Acute kidney injury in critical illness

Review article: Acute kidney injury in critical illness

Day-to-day variation of urinary NGAL and rational for creatinine correction

The Origin of Multiple Molecular Forms in Urine of HNL/NGAL

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