Using urinary neutrophile gelatinase-associated lipocalin for prognosticate renal dysfunction in children with familial Mediterranean fever the study design: a pilot study

Abstract Background: The most important finding that affects the prognosis in Familial Mediterranean Fever is renal amyloidosis. The aim of the present study was to analyze neutrophil gelatinase-associated lipocalin levels in the urine, and to investigate whether it may be used as an early marker for renal involvement. Methods: Forty attack-free children followed by diagnosis of Familial Mediterranean Fever with age range of 5 and 18 years, and 38 healthy children with similar ages and genders were enrolled into the study. Hemogram, sedimentation, C-reactive protein, urine analysis, creatinine in the spot urine, microalbumin and urinary neutrophil gelatinase-associated lipocalin levels were analyzed and evaluated statistically in the patients and controls. Results: There was not any statistically significant difference between the patient and control groups for age, gender, height and body weight. Although there was not any clinical sign of attack in the patient group, sedimentation, C-reactive protein and fibrinogen levels were significantly higher than the control group (p = 0.002, p = 0.023, and p = 0.006, respectively). Similarly, urinary neutrophil gelatinase-associated lipocalin level and urinary creatinine ratio were significantly higher in the patient group (p = 0.0001, p = 0.011, respectively). We found a positive correlation between uNGAL level and uNGAL/uCr ratio and number of attacks per year in FMF patients (r =0.743, p =0.001 and r =0.516, p =0.001; respectively). Conclusions: Detection of significantly higher levels of urinary neutrophil gelatinase-associated lipocalin level and urinary neutrophil gelatinase-associated lipocalin level to creatinine ratio were suggested as urinary neutrophil gelatinase-associated lipocalin level as a non-invasive marker for renal involvement better than microalbumin.

Urinary neutrophil gelatinase 3 associated lipocalin and nephrology in children / 中华实用儿科临床杂志

Urinary neutrophil gelatinase－associated lipocalin(uNGAL)characterizes With obvious indication of urinary epithelial injury. It is induced significantly and secreted predominantly by the injured epithelial cells of the kidney. Recent published reports have described additional utility of uNGAL in various pathologic conditions Within the pediatric urinary tract,including urinary tract infection,vesicoureteral reflux,renal scarring,and obstructive uropathy. And it Was recommended as a good biomarker for diagnosis and treatment monitoring of acute pyelonephritis in chil﹣dren. Furthermore,uNGAL is one of the earliest and most indicative biomarkers of acute kidney injury. Recent studies suggested that uNGAL excretion could be helpful in diagnosis and monitoring of treatment and progressing of various re﹣nal diseases,such as nephrotic syndrome,diabetes nephropathy,immunoglobulin A(IgA)vasculitis nephritis,lupus ne﹣phritis,et al. Additionally,the ability to assay the marker noninvasively in urine represents a significant advantage over current methods,especially for the pediatric population. These improvements Will increase the clinical utility of uNGAL and may lead to more effective and personalized treatments for children With uropoietic system diseases. The role of uNGAL in the diagnosis and treatment of children＇s kidney disease is systematically described in this article,so as to provide a reference for clinicians in their daily Work.

Clinical significance of early diagnostic value of urinary neutrophil gelatinase-associated lipocalin in acute kidney injury in sepsis patients / 中国中西医结合急救杂志

Objective To estimate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) level for early diagnosis of acute kidney injury (AKI) in patients with sepsis.Methods One hundred and twenty-six sepsis patients admitted to intensive care unit (ICU) in Baoshan Branch Hospital of Shuguang Hospital Affiliated to Shanghai University ofTraditional Chinese Medicine from June 2014 to December 2015 were enrolled, and they were divided into two groups according to whether complication of AKI was present. The levels of urinary NGAL in the two groups of septic patients were evaluated immediately and at 12, 24 and 48 hours after the definite diagnosis, and the levels were compared between the two groups; the receiver operating characteristic curve (ROC curve) was performed and the value of urinary NGAL level in early diagnosis of sepsis AKI was evaluated.Results There were 60 septic cases complicated with AKI (AKI group), with the prolongation of time after definite diagnosis, the urinary NGAL (g/L) levels were gradually increased at 12, 24 and 48 hours, the levels were significantly higher than those at the corresponding time points in the group without AKI [non AKI group (66 cases), 12 hours: 178.2±32.8 vs. 53.8±10.4, 24 hours: 228.4±24.6 vs. 54.1±9.0, 48 hours: 186.1±43.6 vs. 52.5±9.4, allP < 0.05]. The area under ROC curve (AUC) of urinary NGAL level at 24 hours after definite diagnosis and 95% confidence interval (CI) were 0.863 (0.766-0.929) and 0.686 (0.466-0.696), respectively, when the cutoff value of urinary NGAL was 65.9μg/L, the sensitivity was 81.9% and specificity 76.1%; when the cutoff value of urinary NGAL was 57.9μg/L, the sensitivity was 70.2% and the specificity 57.2%.Conclusion Urinary NGAL level can be used as a reference marker for the early diagnosis of sepsis concomitant AKI.

Urinary neutrophil gelatinase-associated lipocalin as an early predictor of prolonged intensive care unit stay after cardiac surgery.

Neutrophil gelatinase-associated lipocalin (NGAL) is a protein of lipocalin family highly expressed in various pathologic states and is an early biomarker of acute kidney injury in cardiac surgery. We performed an observational study to evaluate the role of NGAL in predicting postoperative intensive care stay in high-risk patients undergoing cardiac surgery. We enrolled 27 consecutive patients who underwent high-risk cardiac surgery with cardiopulmonary bypass. Urinary NGAL (uNGAL) was measured before surgery, at intensive care unit (ICU) arrival and 24 h later. Univariate and multivariate predictors of ICU stay were performed. uNGAL was 18.0 (8.7-28.1) ng/mL at baseline, 10.7 (4.35-36.0) ng/mL at ICU arrival and 29.6 (9.65-29.5) 24 h later. The predictors of prolonged ICU stay at the multivariate analysis were body mass index (BMI), uNGAL 24 h after surgery, and aortic cross-clamp time. The predictors of high uNGAL levels 24 h after at a multivariate analysis were preoperative uNGAL and logistic European System for Cardiac Operative Risk Evaluation. At a multivariate analysis the only independent predictors of prolonged ICU stay were BMI, uNGAL 24 h after surgery and aortic cross-clamp time.

Diagnostic value of joint marker detection in the early acute kidney injury after adult cardiac surgery / 中国综合临床

Objective To explore the sensitivity and clinical value of combined detection of urine NGAL,Urine Kim-1,Urine NAG,urine Cystatin C in early acute kidney injury after adult cardiac surgery.Methods A hundred-five patients who underwent cardiac surgery in the department of heart surgery in the People's Hospital of the Xinjiang Uygur Autonomous Region from January 2010 to June 2011 were collected as subjects.Blood and urine specimens before operation and 24,48 and 72 hours after the operation were collected,urine NGAL,Kim-1,NAG,Cyst C and serum SCr levels were determined.According to AKI standard,65 patients were recruited into AKI group( serum SCr value increased by 50％ ),and the rest 40 patients were in non-AKI group.The changes of the parameters were recorded and analyzed.Urine NGAL,Kim-1,Cyst C were respectively determined by enzyme linked immuno sorbent assay (ELISA).The urine NAG was determined by nitro phenol (PNP) colorimetric detection.The SCr were detected by turbidity method.The individual and combined diagnostic values of these parameters for AKI were assessed using receiver-operating characteristic (ROC) curve and the area under the curve (AUC).Results There was no significant difference on SCr,NGAL,KIM-1,NAG and CystC between wo groups before operation (P ＞ 0.05 ),The level of each biological marker was significantly increased in AKI group than that in none AKI group at different time points after operation( P＜0.001 ).The levels of NAG,CystC,NGAL and KIM-1 in the AKI group were significantly higher at 24,48,and 72 hours after surgery than those before surgery ( P＜0.001 ).Giving a comprehensive evaluation,the above four parameters were at their best sensitivity at 48 hours after surgery,with an AUC of 0.901 (95％ CI;0.769 ～ 0.938).Conclusion The biological markers of AKI in heart surgery patients are significantly increased after operation.Joint marker detection can be used in the early diagnosis of AKI after adult heart surgery.