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

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 The blood samples were withdrawn from the patients 24 and 44 hours after admission.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.

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

2016 ◽  
Vol 56 (4) ◽  
pp. 230
Author(s):  
Meta Herdiana Hanindita ◽  
Riskky Vitria Prasetyo ◽  
Ninik Asmaningsih Soemyarso ◽  
I Ketut Alit Utamayasa ◽  
Paul Tahalele
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Creatinine Clearance ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Schwartz Formula ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Neutrophil Gelatinase

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.

scholarly journals Evaluation of serum neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in critically ill patients

2017 ◽  
Vol 45 (3) ◽  
pp. 1231-1244 ◽  
Author(s):  
Chen-Chen Hang ◽  
Jun yang ◽  
Shuo Wang ◽  
Chun-Sheng Li ◽  
Zi-Ren Tang
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Objective This investigation evaluated the real-time point-of-care testing (RT-POCT) of neutrophil gelatinase-associated lipocalin (NGAL) for detecting acute kidney injury (AKI) and prognosis of critically ill patients. Methods A total of 249 critically ill patients in the emergency department (ED), who were diagnosed with acute decompensated heart failure, sepsis or diabetic ketoacidosis were enrolled in this study. All enrolled patients were followed up for 28 days or to death and the mortalities were recorded. Serum creatinine (sCr) and NGAL were measured. Results 40.6% enrolled patients deteriorated to AKI during the observation period. The NGAL level was significantly higher in the AKI versus non-AKI group. The NGAL levels in the non-survivors group at 7-day and 28-day were significantly higher than in the survivors group. NGAL was detected as an independent risk factor of AKI, and 7-day and 28-day morality. The receiver operating characteristic curve of NGAL was calculated for diagnosing AKI; the area under the curve (AUC) was significantly higher than that of 1-day eGFR. Conclusions NGAL is an independent predictor of AKI, and 7-day and 28-day mortality in critically ill ED patients, and can be an early alert for AKI and useful for determining prognosis.

scholarly journals Cystatin C and α-1-Microglobulin Predict Severe Acute Kidney Injury in Patients with Hemorrhagic Fever with Renal Syndrome

Pathogens ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 666 ◽  
Author(s):  
Magnus Hansson ◽  
Rasmus Gustafsson ◽  
Chloé Jacquet ◽  
Nedia Chebaane ◽  
Simon Satchell ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cystatin C ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Hemorrhagic Fever ◽  
Roc Curve Analysis ◽  
Abrupt Decrease ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Puumala orthohantavirus causes hemorrhagic fever with renal syndrome (HFRS) characterized by acute kidney injury (AKI), an abrupt decrease in renal function. Creatinine is routinely used to detect and quantify AKI; however, early AKI may not be reflected in increased creatinine levels. Therefore, kidney injury markers that can predict AKI are needed. The potential of the kidney injury markers urea, cystatin C, α1-microglobulin (A1M) and neutrophil gelatinase-associated lipocalin (NGAL) to detect early AKI during HFRS was studied by quantifying the levels of these markers in consecutively obtained plasma (P) and urine samples (U) for 44 HFRS patients. P-cystatin C and U-A1M levels were significantly increased during early HFRS compared to follow-up. In a receiver operating characteristic (ROC) curve analysis, P-cystatin C, U-A1M and P-urea predicted severe AKI with area under the curve 0.72, 0.73 and 0.71, respectively, whereas the traditional kidney injury biomarkers creatinine and U-albumin did not predict AKI. Nearly half of the HFRS patients (41%) fulfilled the criteria for shrunken pore syndrome, which was associated with the level of inflammation as measured by P-CRP. P-cystatin C and U-A1M are more sensitive and earlier markers compared to creatinine in predicting kidney injury during HFRS.

scholarly journals Beta-Trace Protein as a Potential Marker of Acute Kidney Injury: A Pilot Study

2021 ◽  
pp. 1-11
Author(s):  
Katrien Leyssens ◽  
Niels Van Regenmortel ◽  
Ella Roelant ◽  
Khadija Guerti ◽  
Marie Madeleine Couttenye ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Roc Analysis ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Great Accuracy ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Potential Marker ◽  
Significant Difference ◽  
Neutrophil Gelatinase

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous glomerular filtration rate marker. The aim of this study was to explore the role of BTP as a marker of AKI. <b><i>Methods:</i></b> Patients admitted to the ICU undergoing surgery were included. BTP, sCr, Cystatin C (CysC), and neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively, postoperatively (post-op), and at the first (D1) and second (D2) post-op day. AKI was defined as an increase of sCr to ≥1.5-fold from baseline within 2 days after surgery. <b><i>Results:</i></b> Of the 52 patients studied, 10 patients (19%) developed AKI. Patients with AKI were older (69.6 ± 10.7 vs. 58.1 ± 16.7 years, <i>p</i> = 0.043) and had a longer length of ICU stay (13 [IQR 6–49] vs. 6 [IQR 5–8] days, <i>p</i> = 0.032). Between the 2 groups, the evolution of BTP, sCr, CysC, and NGAL over time differed significantly, with overall higher values in the AKI group. ROC analysis for the detection of AKI within 2 days after surgery showed a great accuracy for BTP. The area under the curve (AUC) for BTP post-op; D1; and D2 was, respectively, 0.869 ± 0.049; 0.938 ± 0.035; and 0.943 ± 0.032. The discriminative power of a BTP measurement on D1 was superior in detecting AKI compared to NGAL (adjusted <i>p</i> value = 0.027). We could not detect a significant difference between the AUCs of other biomarkers (NGAL, sCr, and CysC). <b><i>Conclusion:</i></b> Serum BTP is a promising marker for diagnosing AKI in ICU patients undergoing surgery.

scholarly journals Urine Neutrophil Gelatinase-Associated Lipocalin Measured at Admission to Predict Recovery from Acute Kidney Injury of Vietnamese ICU Patients

2019 ◽  
Vol 12 (1) ◽  
pp. 60-65
Author(s):  
Le V. Thang ◽  
Nguyen T. Kien ◽  
Pham N. H. Tuan ◽  
Nguyen T. T. Dung ◽  
Truong Q. Kien ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Lipocalin 2 ◽  
Serum Urea ◽  
Urine Ngal ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Aims: To evaluate the predictive value of urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at the time of admission during the recovery from Acute Kidney Injury (AKI) after 90 days. Materials and Methods: This study includes 101 adult patients admitted to the Intensive Care Unit (ICU) who were diagnosed as AKI (96 patients had been collected 24-hour urine and 5 patients with anuria). Acute kidney injury was diagnosed using the Acute Kidney Injury Network (AKIN) criteria. Urine NGAL was measured at admission using the BioVendor Human Lipocalin-2/NGAL ELISA. Results: The ratio of complete recovery patients after 90 days reached 71.9%. The mean of urine NGAL concentration in the recovery group was 242.04 ng/ml, lower significantly than that of non-recovery patients (371.1 ng/ml), p=0.007. At the cut-off value for 740.03 ng/ml, urine NGAL measured at admission predicted complete recovery with the area under the curve of ROC for urine NGAL = 0.888, p<0.001. Based on the multivariate regression analysis, serum urea, serum creatinine and urine NGAL were independent factors that effected the proportion of recovery in AKI patients (OR=0.856, p=0.023; OR=1.014, p=0.012 and OR=0.993, p<0.001, respectively). Conclusion: Serum urea, serum creatinine and urine NGAL were independent factors that effected the proportion of recovery in AKI patients. Urine NGAL in AKI patients measured at the time of the admission time to ICU can be used as a prognostic biomarker of recovery.

scholarly journals Role of Urine Neutrophil Gelatinase-Associated Lipocalin in the Early Diagnosis of Amphotericin B-Induced Acute Kidney Injury

2015 ◽  
Vol 59 (11) ◽  
pp. 6913-6921 ◽  
Author(s):  
Paulo Novis Rocha ◽  
Michael Nascimento Macedo ◽  
Carla Dinamérica Kobayashi ◽  
Lis Moreno ◽  
Luiz Henrique Santos Guimarães ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Clinical Settings ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Urine Biomarkers ◽  
Early Biomarker ◽  
Neutrophil Gelatinase

ABSTRACTDetermination of the neutrophil gelatinase-associated lipocalin (NGAL) level can be used to detect acute kidney injury (AKI) earlier than determination of the serum creatinine (SCr) level in settings such as cardiac surgery, contrast nephropathy, and intensive care units. We hypothesized that urine NGAL (UrNGAL) would be an early biomarker of drug nephrotoxicity. To test this, we studied hemodynamically stable patients treated with amphotericin B (AmB). We measured the SCr and UrNGAL levels at the baseline and daily after initiation of AmB up to day 14 or development of AKI by the use of the SCr criterion. AKI was defined according to a Kidney Disease: Improving Global Outcomes (KDIGO) criterion (an increase in the SCr level by ≥0.3 mg/dl within 48 h or an SCr level ≥1.5 times the baseline level within 7 days). We studied 24 patients with a mean age of 48.4 ± 16.4 years. Most patients were male, and the patients received AmB (12 received AmB deoxycholate and 12 received liposomal AmB) for the treatment of leishmaniasis (91.7%). Overall, 17/24 patients fulfilled a KDIGO criterion for AKI. Peak UrNGAL levels were higher in patients with AKI than in patients without AKI and in recipients of AmB deoxycholate than in recipients of liposomal AmB. The diagnostic performance of the UrNGAL level on day 5 for the detection of AKI was moderate, with the area under the curve (AUC) being 0.68 (95% confidence interval [CI], 0.41 to 0.95). In the subgroup receiving AmB deoxycholate, however, the AUC rose to 0.89 (95% CI, 0.67 to 1.00). In a patient-level analysis, we found that AKI could be detected 3.2 days earlier by the use of the UrNGAL criterion than by the use of the SCr criterion (times to AKI by the UrNGAL and SCr criteria, 3.7 ± 2.5 versus 6.9 ± 3.3 days, respectively;P= 0.001). Future studies should evaluate if a treatment strategy oriented toward evaluation of UrNGAL levels will improve outcomes. These findings for AmB-induced AKI in leishmaniasis patients could serve as a basis for the investigation of urine biomarkers in the early detection of drug nephrotoxicity in other clinical settings.

scholarly journals Plasma neutrophil gelatinase-associated lipocalin at intensive care unit admission as a predictor of acute kidney injury progression

2020 ◽  
Vol 13 (6) ◽  
pp. 994-1002 ◽  
Author(s):  
Jacqueline Koeze ◽  
Iwan C C van der Horst ◽  
Frederik Keus ◽  
Renske Wiersema ◽  
Wim Dieperink ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Roc Curve ◽  
Kidney Injury ◽  
Operating Characteristics ◽  
Icu Admission ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Neutrophil Gelatinase

Abstract Background Acute kidney injury (AKI) is a common complication in patients during intensive care unit (ICU) admission. AKI is defined as an increase in serum creatinine (SCr) and/or a reduction in urine output. SCr is a marker of renal function with several limitations, which led to the search for biomarkers for earlier AKI detection. Our aim was to study the predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) at admission as a biomarker for AKI progression during the first 48 h of ICU admission in an unselected, heterogeneous ICU patient population. Methods We conducted a prospective observational study in an academic tertiary referral ICU population. We recorded AKI progression in all ICU patients during the first 48 h of ICU admission in a 6-week period. Plasma NGAL was measured at admission but levels were not reported to the attending clinicians. As possible predictors of AKI progression, pre-existing AKI risk factors were recorded. We examined the association of clinical parameters and plasma NGAL levels at ICU admission with the incidence and progression of AKI within the first 48 h of the ICU stay. Results A total of 361 patients were included. Patients without AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 115 ng/mL [interquartile range (IQR) 81–201]. Patients with AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 156 ng/mL (IQR 97–267). To predict AKI progression, a multivariant model with age, sex, diabetes mellitus, body mass index, admission type, Acute Physiology and Chronic Health Evaluation score and SCr at admission had an area under the receiver operating characteristics (ROC) curve of 0.765. Adding NGAL to this model showed a small increase in the area under the ROC curve to 0.783 (95% confidence interval 0.714–0.853). Conclusions NGAL levels at admission were higher in patients with progression of AKI during the first 48 h of ICU admission, but adding NGAL levels at admission to a model predicting this AKI progression showed no significant additive value.

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