Impact of sepsis-associated cytokine storm on plasma NGAL during acute kidney injury in a model of polymicrobial sepsis

Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.

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Diagnostic relevance of neutrophil gelatinase-associated lipocalin in early detection of acute kidney injury

Journal of Emergency Practice and Trauma ◽

10.34172/jept.2020.38 ◽

2020 ◽

Vol 7 (2) ◽

pp. 88-92

Author(s):

Madhusudhan Mahadevaiah ◽

Murali Mohan Nidasale Thimmaiah ◽

Venu Sashank Yerramsetty ◽

Jeevan Kumar ◽

Ranjith Kumar

Keyword(s):

Acute Kidney Injury ◽

Diagnostic Accuracy ◽

Point Of Care ◽

Area Under The Curve ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Point Of Care Test ◽

Reliable Marker ◽

Neutrophil Gelatinase

Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker. Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC). Results: In this study, 100 patients with the mean age of 49.56±19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n=55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65±734.72 vs. 255.62±440.09 μg/L; P<0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%. Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.

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SP250CLINICAL SIGNIFICANCE OF THE INTERVAL CHANGE OF PLASMA NGAL IN PATIENTS WITH ACUTE KIDNEY INJURY AND ACUTE KIDNEY INJURY SUPERIMPOSED ON CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx144.sp250 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii190-iii190

Author(s):

Seong Kwon Ma ◽

Ha Yeon Kim ◽

Eun Hui Bae ◽

Soo Wan Kim

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Interval Change ◽

Plasma Ngal

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Exacerbates kidney injury in mice subjected to sepsis: critical impact of used heparin

American Journal of BioMedicine ◽

10.18081/2333-5106/018-323-335 ◽

2018 ◽

Vol 6 (4) ◽

pp. 323-335

Author(s):

Peter Weighardt ◽

Niels Hayashi

Keyword(s):

Oxidative Stress ◽

Acute Kidney Injury ◽

Cytokine Production ◽

Multiorgan Failure ◽

Kidney Injury ◽

Tubular Dysfunction ◽

Cytokine Storm ◽

Peritubular Capillary ◽

Inflammatory Reactions ◽

Local Cytokine

Sepsis is the leading cause of death in critically ill patients, and the incidence of sepsis is increasing causes multiorgan failure, including acute kidney injury (AKI) and patients with both sepsis and AKI have an especially high mortality rate. Several different pathophysiological mechanisms have been proposed for sepsis-induced AKI: vasodilation-induced glomerular hypoperfusion, dysregulated circulation within the peritubular capillary network, inflammatory reactions by systemic cytokine storm or local cytokine production, and tubular dysfunction induced by oxidative stress animal sepsis models have been developed using LPS infusion. Renal dysfunction evaluated by serum creatinine and BUN was found in acute non-survivors (<24 hours) and decreased urine output in subacute non-survivors (24–96 hours). The study show that increased AKI in animal with blood collected heparin (P=0.002) compared to citrate, furthermore; sham mice that received heparin did not develop AKI.

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Plasma NGAL predicts early acute kidney injury no earlier than s-creatinine or cystatin C in severely burned patients

Burns ◽

10.1016/j.burns.2015.11.006 ◽

2016 ◽

Vol 42 (2) ◽

pp. 322-328 ◽

Cited By ~ 5

Author(s):

Ilmari Rakkolainen ◽

Jyrki Vuola

Keyword(s):

Acute Kidney Injury ◽

Cystatin C ◽

Kidney Injury ◽

Plasma Ngal

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Incidence, Risk Factors, the Role of Plasma NGAL and Outcome of Contrast-Induced Acute Kidney Injury in Critically Ill Children

The Indian Journal of Pediatrics ◽

10.1007/s12098-020-03414-9 ◽

2020 ◽

Vol 88 (1) ◽

pp. 34-40

Author(s):

Yamini Agarwal ◽

Ramachandran Rameshkumar ◽

Sriram Krishnamurthy ◽

Gandhipuram Periyasamy Senthilkumar

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children ◽

Plasma Ngal ◽

Incidence Risk

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Value of Plasma NGAL and Creatinine on First Day of Admission in the Diagnosis of Cardiorenal Syndrome Type 1

Cardiology Research and Practice ◽

10.1155/2020/2789410 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Hao Phan Thai ◽

Bao Hoang Bui ◽

Tien Hoang Anh ◽

Minh Huynh Van

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Predictive Value ◽

Kidney Injury ◽

Cardiorenal Syndrome ◽

Admission Diagnosis ◽

Multivariable Logistic Regression Analysis ◽

Plasma Ngal ◽

Model Average ◽

Study Results

Background. The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is a very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. This study was aimed to evaluate the diagnostic efficacy of plasma NGAL in the diagnosis of CRS1. Methods. There were 139 patients with AHF or ADHF in the department of Cardiovascular Resuscitation and Interventional Cardiology at Ho Chi Minh City 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study. Results. There were 48 cases (rate 34.5%) with CRS1, mean age was 66.12 ± 15.77 and men accounted for 50.4%. There were no significant differences of vital signs at admission, diagnosis, and EF-based heart failure between CRS1 and non-CRS1 groups. The urea, creatinine on first day (creatinine D1) and third day (creatinine D3), NT-proBNP, and NGAL levels were higher in the CRS1 group than the non-CRS1 group, p < 0.05 . The optimal cutoff plasma NGAL for diagnosing CRS1 was >353.23 ng/ml, area under curve (AUC) 0.732 (95% CI 0.65–0.80, p < 0.001 ), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, and negative predictive value 84%. Multivariable logistic regression analysis eGFRCKDEPID1 remained the strongest independent predictor of CRS1. Building the optimal regression model (without eGFRCKDEPID1) by the BMA (Bayesian model average) method with two variables NGAL and Creatinine D1, we had the equation: odds ratio = ey while y = −2.39 + 0.0037 × NGAL + 0.17 × Creatinine D1. The nomogram (without eGFRCKDEPID1) was designed to predict the likelihood of CRS1 with AUC 0.79. Conclusions. The combination of plasma NGAL and creatinine D1 on the first day at admission had a high accuracy of predictive model for CRS1.

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