Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery

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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Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury after cardiac surgery

Biochemia Medica ◽

10.11613/bm.2018.030701 ◽

2018 ◽

Vol 28 (3) ◽

Cited By ~ 2

Author(s):

Giovanni Introcaso ◽

Matteo Nafi ◽

Alice Bonomi ◽

Camilla L’Acqua ◽

Luca Salvi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Sensitivity And Specificity ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase ◽

Plasma Measurements

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Neutrophil Gelatinase-Associated Lipocalin for the Early Prediction of Acute Kidney Injury in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

Cardiorenal Medicine ◽

10.1159/000506378 ◽

2020 ◽

Vol 10 (3) ◽

pp. 154-161

Author(s):

Ilan Merdler ◽

Keren-Lee Rozenfeld ◽

David Zahler ◽

Moshe Shtark ◽

Ilana Goldiner ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Kidney Injury ◽

Sensitivity And Specificity ◽

Kidney Injury ◽

Coronary Intervention ◽

Tubular Damage ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Renal Tubular ◽

Neutrophil Gelatinase

Introduction and Objective: Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein released by renal tubular cells, can be used as a marker of early tubular damage. We evaluated plasma NGAL level utilization for the identification of acute kidney injury (AKI) among ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). Methods: 131 STEMI patients treated with PCI were prospectively included. Plasma NGAL levels were drawn prior to PCI (0 h) and 24 h afterwards. AKI was defined per KDIGO criteria of serum creatinine increase. Receiver-operating characteristic (ROC) methods were used to identify optimal sensitivity and specificity for the observed NGAL range. Results: Overall AKI incidence was 14%. NGAL levels were significantly higher for patients with AKI at both 0 h (164 ± 42 vs. 95 ± 30; p < 0.001) and 24 h (142 ± 41 vs. 93 ± 36; p < 0.001). Per ROC curve analysis, an optimal cutoff value of NGAL (>120 ng/mL) predicted AKI with 80% sensitivity and specificity (AUC 0.881, 95%, CI 0.801–0.961, p < 0.001). In a multivariate logistic regression model, NGAL levels were independently associated with AKI at 0 h (OR 1.044, 95% CI 1.013–1.076; p = 0.005) and 24 h (OR 1.018, 95% CI 1.001–1.036; p = 0.04). Conclusions: Elevated NGAL levels, suggesting renal tubular damage, are independently associated with AKI in STEMI patients undergoing primary PCI.

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Increase of Neutrophil gelatinase-associated Lipocalin and Cystatin C after cardiac surgery – new options for detecting acute kidney injury

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297556 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

H Baumgarten ◽

C Liebetrau ◽

A Van Linden ◽

B Njezic ◽

T Walther ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cystatin C ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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Neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in children after cardiac surgery

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2019-20-1-26-32 ◽

2019 ◽

Vol 20 (1) ◽

pp. 26-32

Author(s):

A.A. Ivkin ◽

R.A. Kornelyuk ◽

D.L. Shukevich

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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Faculty Opinions recommendation of Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1116099.573927 ◽

2008 ◽

Author(s):

Ravindra Mehta

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Sensitivity And Specificity ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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NGAL Usefulness in the Intensive Care Unit Three Hours after Cardiac Surgery

ISRN Nephrology ◽

10.5402/2013/865164 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Geoffray Delcroix ◽

Nicole Gillain ◽

Martial Moonen ◽

Luc Radermacher ◽

François Damas ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Low Sensitivity ◽

Neutrophil Gelatinase

Objective. Neutrophil gelatinase-associated lipocalin (NGAL) measured by a research ELISA is described as an early marker of acute kidney injury (AKI). The aim of this study is to define the usefulness of plasma NGAL (pNGAL) and urine NGAL (uNGAL) measured with platform analysers to detect AKI 3 hours after cardiac surgery in fifty adult patients. Methods and Main Results. pNGAL and uNGAL were measured before and 3 hours after cardiac surgery. AKI, defined following the acute kidney injury network definition, was observed in 17 patients. pNGAL was >149 ng/mL in 8 patients with AKI, two of them died in the follow-up. We also observed elevated pNGAL in 8 patients without AKI. Only one uNGAL was >132 ng/mL among the 15 AKI patients. Sensitivity of pNGAL for prediction of AKI is 47% and specificity is 75.7%. The positive likelihood ratio (LR+) is 1.9 and negative likelihood ratio (LR−) is 0.7. uNGAL performance is slightly improved when reported to urinary creatinine. Following this study, a ratio >62 ng/mg assure a sensitivity of 66.6% and a specificity of 78.5%. LR+ is 3 and a LR− is, 0.42. Conclusions. Three hours after cardiac surgery, pNGAL predicts AKI with a low sensitivity and specificity.

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