The value of neutrophil gelatinase-associated lipocalin and neutrophil-to-lymphocyte and platelet ratio in the early prediction of kidney injury in elderly patients with Diquat poisoning / 中华老年医学杂志

Objective:To explore the value of neutrophil gelatinase-associated lipocalin(NGAL)and neutrophil-to-lymphocyte and platelet ratio(NLPR)for early prediction of kidney injury with Diquat(DQ)poisoning in elderly patients.Methods:In this retrospective study, a total of 106 elderly patients with DQ poisoning treated in the Emergency Intensive Care Unit(EICU)of Harrison International Peace Hospital Affiliated to Hebei Medical University between October 2019 and October 2021 were divided into an acute kidney injury group(AKI group, n=62)and a non-acute kidney injury group(NAKI group, n=44). Meanwhile, 40 non-elderly patients with DQ poisoning served as the control group.Samples of 5 ml venous blood were collected from patients admitted to the EICU to measure NGAL and NLPR levels and Logistic regression analysis was conducted to analyze independent risk factors for AKI in elderly DQ poisoning patients.The area under the curve(AUC)was calculated via the receiver operating characteristic(ROC)curve, and the value of NGAL and NLPR for early prediction of AKI in elderly patients with DQ poisoning and patient prognosis was assessed.Results:Blood NGAL and NLPR levels in the AKI group were significantly higher than in the NAKI group[(387.1±46.6)μg/L vs.(103.5±18.6)μg/L, (13.5±3.4) vs.(5.3±1.1), t=38.243, 15.608, P<0.001 for both]. Logistic regression analysis results showed that elevated levels of NGAL( OR=1.009, 95% CI: 1.003-1.015, P<0.001)and NLPR( OR=1.263, 95% CI: 1.039-1.536, P<0.001)were risk factors for AKI in elderly patients with DQ poisoning.The areas under the ROC curves of NGAL, NLPR and NGAL+ NLPR for AKI prediction were 0.834, 0.803 and 0.873 respectively.The predictive power of NGAL and NLPR for the death of elderly patients with DQ poisoning was higher than that of creatinine clearance(Ccr). The sensitivity of the combination of the two to predict the risk of death was 0.850, the specificity was 0.828, and the AUC was 0.887. Conclusions:NGAL and NLPR are independent risk factors for the occurrence of AKI in elderly patients with DQ poisoning.Combined detection of NGAL and NLPR improves AKI prediction and prognosis assessment in elderly patients with DQ poisoning.

Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients / 대한소화기병학회잡지

BACKGROUND/AIMS: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC). METHODS: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups. RESULTS: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI. CONCLUSIONS: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients / 대한소화기학회지

BACKGROUND/AIMS: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC).METHODS: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups.RESULTS: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI.CONCLUSIONS: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

Accuracy of different biomarkers for early diagnosis of acute kidney injury in patients undergoing cardiovascular surgery under cardiopulmonary bypass / 中华麻醉学杂志

Objective To evaluate the accuracy of different biomarkers for early diagnosis of acute kidney injury ( AKI ) in the patients undergoing cardiovascular surgery under cardiopulmonary bypass ( CPB) . Methods A total of 200 patients, aged 22-86 yr, weighing 46-87 kg, scheduled for elective cardiovascular surgery under CPB, were enrolled in this study. The concentration of serum creatinine was determined at 1 day before operation and 1-7 days after operation. At 1 day before operation and 0, 2, 6 and 12 h after operation, the concentrations of urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C ( Cys C) , tissue inhibitor of matrix metalloproteinase type 2 ( TIMP-2) and insulin-like growth factor binding protein-7 ( IGFBP-7) were determined. The TIMP-2 and IGFBP-7 product ( TI) was calcu-lated. AKI was diagnosed after surgery according to Kidney Disease Improving Global Outcomes criteria. The receiver operating characteristic curve was plotted, and the area under receiver operating characteristic curve ( AUC) was calculated. Results The incidence of AKI was 20. 5％. The AUC of AKI diagnosed by the concentration of urine NGAL was 0. 689, 0. 709, 0. 713 and 0. 803 at 0, 2, 6 and 12 h after opera-tion, respectively ( P<0. 05) . The AUC of AKI diagnosed by the concentration of urine Cys C was 0. 639, 0. 762, 0. 774 and 0. 812 at 0, 2, 6 and 12 h after operation, respectively ( P<0. 05) . The AUC of AKIdiagnosed by TI was 0. 687, 0. 721, 0. 740 and 0. 779 at 0, 2, 6 and 12 h after operation, respectively ( P<0. 05) . The AUC of AKI diagnosed by combined three indices the parallel test was 0. 694, 0. 773 and 0. 794 at 0, 2 and 6 h after operation, respectively ( P<0. 05) . The AUC of AKI diagnosed by the serial test was 0. 610, 0. 631 and 0. 667 at 0, 2 and 6 h after operation, respectively. Conclusion Urine NGAL or Cys C concentrations or TI single detection and parallel test have a certain accuracy for early diag-nosis of AKI in the patients undergoing cardiovascular surgery under CPB.

Value of combined measurement of serum cystatin C and urinary neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury secondary to cirrhotic ascites / 临床肝胆病杂志

Objective To investigate the value of combined measurement of serum cystatin C (Cys C) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of AKI secondary to cirrhotic ascites. Methods A total of 105 patients with cirrhotic ascites who were admitted to Sichuan Provincial People's Hospital from January 2015 to June 2016 were enrolled and divided into AKI group with 56 patients and non-AKI group with 49 patients. Meanwhile, 40 healthy persons who underwent physical examination were enrolled as controls. The indices including serum Cys C, urinary NGAL, serum creatinine (Scr), and glomerular filtration rate (GFR) were observed. The 105 patients with cirrhotic ascites were divided into subgroups according to Child-Pugh class, and the changes in serum Cys C, urinary NGAL, Scr, and GFR were compared between these subgroups. The independent samples t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and a Pearson correlation analysis was also performed. Results There were significant differences in the levels of serum Cys C and urinary NGAL between the AKI group and the non-AKI group, as well as between the AKI group and the healthy control group (all P ＜ 0. 01) . AKI stage was determined for all AKI patients, and the AKI patients with a higher stage had significantly higher levels of serum Cys C and urinary NGAL than those with a lower stage (all P ＜ 0. 05) . Of all 56 AKI patients, 11 (19. 6％ ) died; the patients who died had significantly higher levels of serum Cys C and urinary NGAL than those who survived (t =-7. 742 and-3. 209, both P ＜ 0. 01) . The correlation analysis showed that the levels of serum Cys C and urinary NGAL were negatively correlated with GFR (r =-0. 915 and-0. 793, both P ＜ 0. 01) . The levels of serum Cys C and urinary NGAL increased significantly and GFR decreased significantly with the increase in Child-Pugh class (all P ＜0. 05) . Conclusion Combined measurement of serum Cys C and urinary NGAL can be used for the early diagnosis of AKI secondary to cirrhotic ascites and the evaluation of the severity and prognosis of AKI.

Clinical study of serum NGAL and CysC levels in patients with morning hypertension / 心血管康复医学杂志

Objective: To measure serum levels of neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (CysC) in patients with morning hypertension (MH) and explore their clinical value. Methods: A total of 120 outpatients or inpatients with essential hypertension (EH) were selected from our department of cardiology. According to MH definition, they were divided into MH group (n=62) and non-MH group (n=58). Levels of serum NGAL and CysC, blood lipids and blood glucose were measured and compared between two groups. Results: There were no significant difference in levels of blood lipids, blood glucose etc. between two groups, P＞0. 05 all; compared with non-MH group, there were significant rise in serum levels of NGAL [(47. 50±3. 15) μg/L vs. (156. 87±18. 56) μg/L]and CysC [(0. 68±0. 16) mg/L vs. (1. 26±0. 86) mg/L]in MH group, P=0. 001 both. Conclusion: Serum levels of NGAL and CysC in MH patients are significantly higher than those of non-MH patients, which is of great significance for diagnosing early renal dysfunction in MH patients. Therefore, management of morning blood pressure should be strengthened in clinic.

Relationship between serum neutrophil gelatinase-associated lipocalin and kerbs von lungren 6 antigen expressions in early preterm after birth and the development of bronchopulmonary dysplasia / 中国新生儿科杂志

Objective To study the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL),kerbs von lungren 6 antigen (KL-6) and bronchopulmonary dysplasia (BPD) in preterm infants.Method From Jan.2015 to Dec.2015,preterm infants admitted to NICU of Guangzhou Women and Childrem's Medical Center with gestational age less than 32 weeks and birth weight less than 1 500 g were enrolled.The serum levels of procalcitonin (PCT),NGAL and KL-6 protein were detected at 24 h,7 d and 14 d after birth.At the 28 d after birth,according to the presence of BPD or not,the infants were assigned into BPD group and non-BPD group.The differences of the serum levels of PCT,NGAL and KL-6 between the two groups were compared.Result A total of 55 cases were included in the study (BPD group 20 cases,non-BPD group 35 cases).No significant differences existed in gender,birth weight and gestational age between the two groups (P ＞ 0.05).The incidence of respiratory distress syndrome were siginificantly higher in the BPD group (P ＜ 0.05) and the duration of mechanical ventilation and oxygen therapy were siginifantly longer in the BPD group (P ＜ 0.05).No significant difference between the two groups in the level of PCT at 24 h after birth (P ＞ 0.05).The levels of serum PCT at 7 d and 14 d after birth in BPD group were significantly higher than non-BPD group [7 d:(1.5 ± 1.7) ng/ml vs.(0.4 ± 0.2)ng/ml,14 d:(0.8 ± 0.7) ng/ml vs.(0.2 ± 0.1) ng/ml] (P ＜ 0.001).The levels of serum NGAL at 24 h,7 d and 14 d were significantly higher than non-BPD group [24 h:(1.6 ± 0.3) pg/ml vs.(0.8 ±0.2) pg/ml,7 d:(2.3 ±0.5) pg/ml vs.(0.7 ±0.2) pg/ml,14 d:(2.5 ±0.3) pg/ml vs.(0.8 ±0.2)pg/ml] (P ＜0.001).The levels of serum NGAL at 7 d and 14 d after birth in BPD group were significantly higher than 24 h in BPD group (P ＜ 0.05).No significant difference between KL-6 at 24 h after birth in BPD group and non-BPD group (P ＞0.05).The levels of serum KL-6 at 7 d and 14 d after birth in BPD group were significantly higher than non-BPD group [7 d:(1.2 ± 0.2) ng/ml vs.(0.8 ± 0.1) ng/ml,14 d:(1.3 ±0.2) ng/ml vs.(0.8 ±0.9) ng/ml] (P ＜0.001).The level of serum KL-6 at 7 d and 14 d after birth in BPD group were significantly higher than 24 h in BPD group (P ＜ 0.05).Conclusion Respiratory distress syndrome and prolonged mechanical ventilation were risk factors of BPD.The rising of serum NGAL and KL-6 early after birth might be involved in the development of BPD,which had predictive value of BPD.

Construction and identification of recombinant human neutrophil gelatinase-associated lipo1calinlinear multi-epitope peptide / 中华检验医学杂志

Objective The feasibility of predicting the B-cell epitopes of human Neutrophil Gelatinase-Associated Lipocalin (NGAL) was discussed by applicating bioinformatics technology.Linear epitope molecules that have diagnostic value were screened and these recombinant linear multi-epitope peptides were constructed,and expressed.The immunogenicity of the recombinant linear multi-epitope peptides were also identified.Methods NGAL amino acid sequence was got from GenBank in the Department of Clinical Laboratory of the Second Affiliated Hospital of Nanjing Medical University in July 2015,the Predicted,ABCpred,BepiPred,BcePred,and Lasergene softwares were used to predict the linear B cell epitope prediction.The predict epitopes were constructed and prokaryotic expressed,and then the single epitope antigens which could reacted with commercially available polyclonal NGAL antibody were screened out by Western blot.Finally,the multi-epitope peptide was constructed,expressed,and identified through immunoreactions.Results Eight possible epitopes were obtained after prediction.pET32a-N1-N8 prokaryotic expression vector were used to express the predict epitopes.After purification and Western blot analysis,three of the epitopes have strong antigenicity,and then a soluble fusion protein was expressed and obtained from the multi-epitope prokaryotic expression vector pET22b-Ngal_MEP1.The fusion protein was successfully purified by Ni2 + affinity column.Western blot analysis showed that the fusion protein had a strong antigenicity.Conclusions The constructed multi-epitope linear NGAL antigen peptides can obtain high soluble expression in prokaryotic expression system,and have a strong immunoreactivity,which can be used in subsequent antibody preparation.

The relationship between the apolipoprotein M-sphingosine-1-phosphate axis and atherosclerosis / 中华检验医学杂志

Apolipoprotein M-sphingosine-1-phosphate axis ( apoM-S1P axis ) signaling pathway consists of apolipoproteinM (apoM), sphingosine-1-phosphate (S1P) and sphingosine-1-phosphate receptor (S1PR).Plasma apoM belongs to lipocalinsuperfamily members , and is mainly associated to high density lipoprotein( HDL), whereas HDL-cholesterol correlates inversely with cardiovascular risk .The ability of apoM to bind S1P is due to a lipophilic binding pocket within the lipocalin structure of the apoM molecule . S1P, a bioactive mediator of phospholipid metabolism , predominantly abound in HDL among all lipoproteins.S1P can not only be used as intracellular second messengers , but also as intercellular signal molecules, activating of G protein-coupled receptors (S1PR) to mediate various physiological functions.It′s clear that apoM protects human beings from atherosclerosis .Furthermore, recent studies showed that S1P has a significant impact on atherosclerosis , and ApoM-S1P axis may play a important role in the pathogenesis or progression of atherosclerosis .

Clinical significance of plasma and urine neutrophil gelatinase-associated lipocalin levels in diagnosis of acute kindney injury in patients with cirrhosis / 临床肝胆病杂志

ObjectiveTo explore the significance of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) in the diagnosis of acute kidney injury (AKI) in patients with cirrhosis. MethodsA total of 78 patients with cirrhosis admitted to our hospital from January 2012 to December 2014 were selected and divided into group A of 38 patients with cirrhosis and AKI and group B of 40 patients with cirrhosis alone. The control group (group C) included 40 healthy people undergoing the routine physical examination. The NGAL concentrations in serum and urine were measured by enzyme-linked immunosorbent assay. The levels of pNGAL, uNGAL, and serum creatinine, as well as glomerular filtration rate (GFR), were compared between different groups. The comparison between different groups was made by one-way ANOVA and simple linear correlation analysis was used to investigate the relationship of GFR with pNGAL and uNGAL in group A. ResultsThe NGAL levels in serum and urine in group A were significantly higher than those in groups B and C (all P＜0.01). Staging of AKI was made according to the kidney injury criteria and the NGAL levels in serum and urine significantly increased with AKI stage (all P＜0.01). In group A, NGAL level was negatively correlated with GFR in both serum (r=-0.757, P＜0.05) and urine (r=-0.547, P＜0.05). ConclusionNGAL can be used as an indicator in the diagnosis of AKI in patients with cirrhosis. Early and continuous measurement of serum and urine NGAL levels in patients with cirrhosis and AKI has a great significance in monitoring the progression of renal damage in the patients and developing timely and appropriate intervention measures.

Early diagnosis value of plasma NGAL,CysC on detection of surgical critical illness patients with AKI / 重庆医学

Objective To assess and compare the roles of plasma concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis and treatment of septic acute kidney injury (AKI) in adult Surgical critically ill patient . Methods One hundred patients were divided into two groups ,the group of 63 cases of AKI and AKI group of 37 cases ,plasma NGAL and Cystatin C level of the 2 groups were determined by the method of enzyme‐linked immunosorbent (ELISA) ,latex en‐hanced immune turbidimetry (PETIA) respectively on arrival in the surgical intensive care unit(SICU) (T0 ) and 24 h after arrival in SICU(T1 ) .Results Compared with patients in non AKI group ,both plasma NGAL and Cystatin C level of patients in AKI group on T0 and T1 increased significantly ,the difference between the two groups had significant statistical difference (P<0 .01);Although ,plasma NGAL on T1 performed less well (AUC=0 .69) ,with a threshold value of 92 ng/mL(70 .3% sensitivity ,57%specificity) .Plasma NGAL showed significant discrimination for AKI diagnosis (AUC=0 .85) with a threshold value of 65 .95 ng/mL(81 .8% sensitivity ,76 .2% specificity) on T0 .Both plasma Cystatin C on T0 and T1 worked well for the diagnosis of AKI (AUC=0 .90 ,0 .88 ,thresholds 1 .49 and 1 .47 mg/L ,respectively) ,with diagnostic sensitivity of 89 .2% ,82 .5% respectively ,speci‐ficity of 83 .8% ,76 .2% respectively .Conclusion Plasma NGAL and Cystatin C are useful markers in predicting AKI in surgical critically ill patients ,the early diagnosis value of plasma Cystatin C for AKI is better than plasma NGAL on arrival in the surgical intensive care unit .

NGAL urinária em pacientes sem e com lesão renal aguda em unidade de terapia intensiva / Urinary NGAL in patients with and without acute kidney injury in a cardiology intensive care unit

Objetivo: Avaliar a eficácia diagnóstica e prognóstica da lipocalina associada à gelatinase neutrofílica urinária em pacientes de unidade de terapia intensiva. Métodos: Estudo do tipo coorte, prospectivo, longitudinal desenvolvido em uma unidade de terapia intensiva clínica especializada em cardiologia. Os pacientes foram estratificados segundo os grupos sem e com lesão renal aguda, acompanhados a partir das primeiras 24 horas de internação até a alta hospitalar ou óbito. A creatinina sérica, o fluxo urinário e a lipocalina associada à gelatinase neutrofílica urinária foram coletadas em dois períodos: 24 horas e 48 horas de admissão. Resultados: Foram avaliados 83 pacientes clínicos da unidade de terapia intensiva, com predomínio do gênero masculino (57,8%). Os pacientes foram agrupados em sem lesão renal aguda (N=18), com lesão renal aguda (N=28) ou com lesão renal aguda grave (N=37). Entre os pacientes com lesão renal aguda e lesão renal aguda grave, foram prevalentes os portadores de doenças crônicas, em uso de ventilação mecânica e em terapia de substituição renal, além daqueles com maiores taxas de permanência na unidade de terapia intensiva e hospitalar, e maior mortalidade. O grupo com lesão renal aguda não apresentou alteração significativa da creatinina sérica nas primeiras 24 horas na unidade de terapia intensiva, ...

Objective: To assess the diagnostic and prognostic efficacy of urine neutrophil gelatinase-associated lipocalin in patients admitted to an intensive care unit. Methods: Longitudinal, prospective cohort study conducted in a cardiology intensive care unit. The participants were divided into groups with and without acute kidney injury and were followed from admission to the intensive care unit until hospital discharge or death. Serum creatinine, urine output and urine neutrophil gelatinase-associated lipocalin were measured 24 and 48 hours after admission. Results: A total of 83 patients admitted to the intensive care unit for clinical reasons were assessed, most being male (57.8%). The participants were divided into groups without acute kidney injury (N=18), with acute kidney injury (N=28) and with severe acute kidney injury (N=37). Chronic diseases, mechanical ventilation and renal replacement therapy were more common in the groups with acute kidney injury and severe acute kidney injury, and those groups exhibited longer intensive care unit stay and hospital stay and higher mortality. Serum creatinine did not change significantly in the group with acute kidney injury within the first 24 hours of admission to the intensive care unit, although, urine neutrophil gelatinase-associated lipocalin was high in the groups with acute kidney injury and severe acute kidney injury (p<0.001). Increased urine neutrophil gelatinase-associated lipocalin was associated with death. ...

Papel da lipocalina associada à gelatinase neutrofílica (NGAL) urinária na nefrotoxicidade da cisplatina em pacientes com câncer de cabeça e pescoço / Evaluation of the cisplatin nephrotoxicity using the urinary neutrophil gelatinase-associated lipocalin (NGAL) in patients with head and neck cancer

Introdução: A injúria renal aguda (IRA) em pacientes que recebem a cisplatina é comum, portanto, a avaliação da função renal em pacientes utilizando drogas nefrotóxicas é fundamental. Objetivo: Avaliar a incidência da IRA e o papel da lipocalina associada à gelatinase neutrofílica (NGAL) na avaliação da função renal em pacientes com câncer de cabeça e pescoço (CCP) que receberam a cisplatina. Métodos: Foram avaliados prospectivamente 50 pacientes com CCP, tratados com três sessões de cisplatina. Foram coletados sangue e urina 24 horas antes da cisplatina, 24 horas após a infusão, 48 horas após cada aplicação e 35 dias após o término do tratamento (NGAL urinária, proteína C reativa, creatinina e taxa de filtração glomerular, desidrogenase lática e magnésio plasmáticos). Resultados: A IRA foi observada em 78% dos pacientes. Houve aumento na creatinina, ureia e queda na TFG após cada ciclo de cisplatina, e aumento da NGAL urinária. Foi observada associação positiva entre os níveis de NGAL e a creatinina e PCR. Evidenciou-se um aumento dos níveis de creatinina, NGAL, PCR e diminuição da TFG nos pacientes com IRA em relação aos pacientes sem IRA. Conclusão: Observamos IRA em 78% dos pacientes avaliados com CCP tratados com a cisplatina e correlação da NGAL com a creatinina e a TFG em demonstrar lesão renal. Os níveis de NGAL podem estar elevados em relação aos níveis basais, mesmo antes da utilização da cisplatina. .

Introduction: Acute kidney injury (AKI) in patients receiving cisplatin is common, therefore the evaluation of renal function in patients on use of nephrotoxic drugs is fundamental. Objective: To evaluate the incidence of AKI and the role of lipocalin associated to neutrophil gelatinase (NGAL) in the monitoring of renal function in patients with head and neck cancer (HNC) who received cisplatin. Methods: We prospectively studied 50 patients with HNC treated with three sessions of cisplatin. Blood and urine were collected 24 hours before cisplatin, 24 hours after infusion, 48 hours after each application and 35 days after the end of treatment (urine NGAL, C-reactive protein, creatinine, glomerular filtration rate, plasma lactate dehydrogenase and magnesium). Results: AKI was observed in 78% of patients. There was increase in creatinine, and decrease in GFR after each cycle of cisplatin, and increased urine NGAL. Positive association was observed between the levels of NGAL, creatinine and C-reactive protein. It was observed an increase in creatinine, NGAL, C-reactive protein and decreased GFR in AKI patients compared to patients without AKI. Conclusion: AKI was noted in 78% of patients with HNC treated with cisplatin and showed the correlation of NGAL with creatinine and GFR in demonstrating renal injury. NGAL levels may be elevated compared to baseline levels, even before the use of cisplatin. .

Value of urinary L-FABP and NGAL in the diagnosis of acute kidney injury caused by obstructive nephropathy and the prediction of renal outcome / 中华肾脏病杂志

Objective To evaluate the values of urinary liver-fatty acid binding protein (uL-FABP) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosis of acute kidney injury (AKI) caused by obstructive nephropathy and in the prediction of renal prognosis.Methods Clinical data of 30 patients with obstructive nephropathy were collected prospectively.uL-FABP and uNGAL were measured by ELISA at various time points.Risk factors of the renal outcome were evaluated.The patients were followed up for at least one year.Results Patients with AK1 had higher levels of uL-FABP and uNGAL compared to those without AKI [700.00(154.62-1216.14) μg/g· Cr vs 26.90 (16.77-41.38) μg/g·Cr; 1266.69 (671.57-3396.07) μg/g·Cr vs 179.12 (90.98-215.16) μg/g·Cr,all P ＜ 0.01].Positive correlations of uL-FABP and uNGAL with serum creatinine were found (r =0.552,0.553,all P ＜ 0.01).The AUCs of uL-FABP and uNGAL to detect AKI were 0.925 and 0.900.Patients with non complete renal recovery had higher levels of uL-FABP before operation and 72-hour after operation compared to those with complete renal recovery (all P ＜ 0.01).Before operation,the AUC of uL-FABP to detect renal prognosis was 0.948,sensitivity was 85.7％ and specificity was 90.9％.72-hour after operation,the AUC of uL-FABP to detect renal prognosis was 0.935,sensitivity was 85.7％ and specificity was 90.9％.Kaplan-Meier analysis revealed that uL-FABP before operation over 366.57 μg/g · Cr or uL-FABP 72-hour after operation over 223.60 μg/g · Cr were closely related to the poor progression of renal function.Conclusions uL-FABP and uL-NGAL have good accuracy in detecting AKI.The level of uL-FABP before operation and 72-hour after operation is helpful to predict the renal outcome of obstructive nephropathy.

Correlation of lipocalin-2 and its receptor expressions with preeclampsia / 中华妇产科杂志

Objective To research the correlation of the expressions of lipocalin-2 (LCN-2) and its receptor (NGALR) in serum and placenta with preeclampsia.Methods From Dec.2010 to Apr.2011,64 women with preeclampsia who delivered in Affiliated Hospital of Qingdao University Medical College were recruited in the study,including 26 women with moderate preeclampsia ( MPE group) and 38 women with severe preeclampsia (SPE group).Twenty-five healthy pregnant women were taken as control group.LCN-2 and NGALR mRNA and protein expression in placenta were measured by reverse transcription-PCR ( RTPCR) and western blot,respectively.Results ( 1 ) The serum levels of LCN-2 in MPE group and SPE group [ (58 ±20),(90 ± 18) μg/L] were significantly higher than that in control group [ ( 19 ±6) μg/L,P＜0.01] ; the serum LCN-2 level in SPE group was significantly higher than that in MPE group (P ＜0.01).(2) LCN-2 mRNA expression in placenta in MPE group and SPE group (0.55 ±0.14,0.61 ±0.14) were both significantly higher than that in control group (0.28 ±0.16,P ＜0.01 ) ; LCN-2 protein expression in placenta of MPE group and SPE group ( 2.2 ± 0.4,2.4 ± 0.5 ) were also significantly higher than that in control group (1.4 ±0.4,P ＜0,01 ),no significant difference was found between MPE group and SPE group ( P ＞ 0.05 ),(3) No significant difference was found in the expressions of NGALR mRNA in placenta among MPE group,SPE group and control group (0.46 ±0.1l,0.46 ±0.14,0.45 ±0.15,P ＞0.05 ).(4) NGALR protein expressions in MPE group,SPE group and control group were 2.7 ±0.8,3.0 ±0.9,and 2.7 ± 0.9,and there were no significant difference among these three groups ( P ＞ 0.05 ).(5) In preeclampsia,serum LCN-2 level significant associated with 24 hours total urinary protein and uric acid ( r =0.565,0.476,P＜0.01).LCN-2 serum level were not associated with systolic pressure and diastolic pressure (P ＞ 0.05 ) ; there were no association with the expressions LCN-2 mRNA aud protein in placenta ( P ＞ 0.05).Conclusions Serum LCN-2 level is closely related to the progress of preeclampsia.Increasing expression of LCN-2 in placenta may be a compensatory response to preeclampsia.

Value of urine L-FABP and its combination with urine NGAL in early diagnosis of acute kidney injury after cardiac surgery in adults / 中华肾脏病杂志

Objective To investigate the value of urinary liver-type fatty acid-binding protein (L-FABP),neutrophil gelatinase-associated lipocalin (NGAL) and their combination in predicting the development and the severity of acute kidney injury (AKI) following cardiac surgery in adults. Methods Scr,urinary L-FABP and NGAL corrected by urine creatinine at preoperation,0 h and 2 h postoperative time points were examined.The differences of above indexes between AKI and non-AKI groups were compared.Receiver operating characteristic (ROC)curves and area under curves (AUC) were used to evaluate the diagnostic value of urinary L-FABP,NGAL and their combination for AKI. Results The cohort consisted of 109 patients,26(23.9％) developed AKI,and AKIN stage Ⅰ, Ⅱ and Ⅲ was 46.2％,34.6％ and 19.2％ respectively.Levels of urinary L-FABP and NGAL were significantly higher in AKI patients at 0 h and 2 h postoperatively.AUC to predict AKI or AKI stage Ⅱ-Ⅲ was 0.81 to 0.87 using either of the biomarkers.The performance of combining two biomarkers was better with AUC of 0.911 to 0.927. Conclusions Urinary L-FABP and NGAL increase at the early stage after cardiac surgery.Combination of these two biomarkers enhances the accuracy of the early diagnosis of postoperative AKI after cardiac surgery before a rise of Scr.

Serum level of neutrophii gelatinase-associated lipocalin in preeclampsia with gestational diabetes mellitus / 中华围产医学杂志

Objective To investigate the relationship of serum neutrophil gelatinase associatedlipocalin (NGAL) levels among preeclamptic women with or without gestational diabetes mellitus (GDM),GDM and healthy pregnant controls. Methods This study included 263 singleton pregnant women who visited the antenatal chinics in Guangdong Women and Children's Hospital and Health Instutite Affiliated to Guangzhou Medical College from December 2009 to November 2010,77 healthy pregnant women,77 women with preeclampsia,77 women with GDM and 32 women complicated with both preeclampsia and GDM.Blood pressure,height and body weight of all subjects were measured.Peripheral blood samples were collected to detect serum NGAL,parameters of glycolipid metabolism,24-hour urine protein content,uric acid,creatinine and lactate dehydrogenase.Maternal levels of serum NGAL were quantified by enzyme-linked immunosorbent assay.Meanwhile,body mass index (BMI) and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated. Data under normal distribution were analyzed with one-way ANOVA and Student's t test,and those under abnormal distribution were compared with Kruskal-Wallis H or Mann-Whitney U test. Results The preeclampsia with GDM group had higher serum NGAL level [(70.82±20.02) ng/ml] as compared with preeclampsia group [(56.17 ±18.22) ng/ml],GDM group [(43.99 ± 14.82) ng/ml] and healthy pregnant control group [(17.80±5.78) ng/ml],t=3.65,5.97,14.76,P＜0.01,respectively.The NGAL levels in preeclampsia group without GDM were higher than in GDM group (t=5.90,P＜0.01).In both the preeclampsia with and without GDM groups,NGAL levels in patients with severe preeclampsia were higher than in the mild ones [(76.44±28.06) ng/ml or(60.15±25.86) ng/ml,t=2.82,P＜0.05; (61.61±37.14) ng/ml or (46.30±13.97) ng/ml,t=4.74,P＜0.01].After adjusted by gesrational weeks and maternal age,NGAL level was positively correlated with BMI before pregnancy (r=0.335,P＜0.01),BMI after pregnancy (r=0.427,P＜0.01),systolic blood pressure (r=0.648,P＜0.01),diastolic blood pressure (r=0.664,P＜0.01),fasting blood glucose (r=0.320,P＜0.01),fasting insulin level (r=0.381,P＜0.01),HOMA-IR (r=0.399,P＜0.01),triglyceride level (r=0.405,P＜0.01),total cholesterol (r=0.145,P＜0.05),free fatty acids (r=0.335,P＜0.01),uric acid (r =0.292,P＜0.01),creatinine (r =0.226,P ＜ 0.01),and 24-hour urine protein content (r =0.436,P＜0.01),and negatively correlated with high density lipoprotein-cholesterol (r=-0.189,P =0.008).Stepwise regression analysis showed that systolic blood pressure (β =0.251,P ＜ 0.01),diastolic blood pressure (β=0.351,P＜0.01),HOMA-IR (β=0.265,P＜0.01) and 24-hour urine protein content (β=0.140,P=0.011) were independent factors of NGAL. Conclusions Serum NGAL levels increase significantly in patients with preeclampsia or GDM,and are correlated with parameters of glycolipid metabolism end endothelial dysfunction,which might play a role in the pathogenesis of preeclampsia and GDM.

Neutrophil gelatinase- associated lipocalin for diagnosis of acute kidney injury after cardiopulmonary bypass / 中国医师杂志

Objective To evaluate the value of neutrophil gelatinase - associated lipocalin (NGAL) for diagnosis of acute kidney injury (AKI) after cardiopulmonary bypass established. Method 120 children undergoing cardiopulmonary bypass were enrolled in this prospectively study. Serial urine samples were analyzed by ELISA for NGAL expression. The primary outcome measure was AKI, which was defined as a 50% or greater increase in serum creatinine from baseline. Result 21 children ( 17.5% ) developed AKI. Urine concentrations of NGAL increased after cardiopulmonary bypass had been established for 2 hours. The concentration of NGAL in urine after cardiopulmonary bypass had been established for 2 hours was used to diagnose AKI. The area under the receiver-operating characteristic curve was 0. 96, the sensitivity was 92%, and the specificity was 91% for the cutoff value of 100ng/mg Cr. Conclusion Concentrations of NGAL in urine might be used as a sensitive and specific biomarker for early prediction of AKI after cardiopulmonary bypass had been established.

Prediction of acute kidney injury complicated by sepsis with neutronphil gelatinase-associated lipocalin as an early marker / 中华检验医学杂志

Objective To investigate the accuracy of NGAL in prediction of acute kidney injury (AKI) complicated by sepsis. Methods Blood and urine samples were collected at different time points in 74 sepsis patients, and 17 AKI patients were got from them.Cysteine Cys C levels were detected with Latex enhanced turbidimetric immunoassay (LETIA). Urine NGAL and Scr levels were detected with solid-phase sandwich enzyme-linked immunosorbent assay and creatinine enzymatic assay respectively. At the same time, 57 non-AKI patients were set as controls. Dynamic changes of urine NGAL and Scr were observed in sepsis patients in test and control group. ROC curve was used to evaluate the performance of AKI diagnosis by urinary NGAL.Results The Scr base line was (59. 38 ±16. 72) μmol/L.The median time of diagnose of AKI was 24 (12, 48) h past-sepsis diagnosis, while the Scr was(100. 35± 28. 26) μmol/L. Of the group, 17 cases of sepsis were diagnosed with AKI, accounting for 23% (17/74) prevalence. In sepsis group, base line value[(0. 61 ± 0. 15) mg/L] of serum Cys C was not upregulated at 2, 4 and 6 h, which was (0. 63 ± 0. 14) mg/L, (0. 68 ± 0. 16) mg/L and (0.65±0. 14) mg/L respectively. As to 8 h [(0. 85 ± 0. 22) mg/L], a slight upregulation was found with no significant difference (t = 1.63, P ＞ 0. 05).A trend of gradual increase of serum Cys C levels was found in sepsis AKI group at 12, 18, 24, 36, 48 and 72 h. A significant difference was found compared with base line (t = 2. 81, 2.98, 3.05, 3.11, 3. 38,3. 17,P ＜0.01). NGAL level[(96.21 ±45.32) μg/L] was significantly higher than base line value [(4. 98 ± 1.65) μg/L]. Subsequently, in each time point from the 2 h to 48 h, a trend of gradual increase in urinary NGAL levels was showed. The differences were significant compared with the baseline values (t =2. 74,2. 83,2. 91,3.04,3.15,3.22,3. 31,3.45,3.57 ,P ＜0. 01). Urinary NGAL levels of sepsis AKI group were significantly higher than those in non-AKI group at different time points with significant difference (t =2. 69,2. 73,2. 84,2. 96,3.02,3. 13,3.29,3.43,3.54,3.22,P ＜0. 01). ROC curve was selected to analyze diagnostic performance of urinary NGAL levels in AKI patients 2 h post-sepsis. Area under ROC curve was obtained as 0. 935, 95% confidence interval was 0. 683-0. 971. When cut-off value of urinary NGAL for patients 2 h post-sepsis was 50 μg/L, the sensitivity, specificity and accuracy were 94. 4%, 87. 5% and 96. 8% in AKI diagnosis respectively. Conclusions The occurrence of AKi can be accurately predicted by urinary NGAL levels 2 h post-sepsis , and its AKI diagnosis time is earlier than that of Scr. Urine NGAL can be used as early marker of AKI complicated by sepsis.