Comparison of Neutrophil Gelatinase Associated Lipocalin with Serum Creatinine for Early Detection of Decrease in Estimated Glomerular Filtration Rate
Keywords:
Acute kidney injury, Biomarkers, Creatinine, Estimated Glomerular Filtration Rate, Neutrophil Gelatinase Associated Lipocalin, CT scan with contrast.Abstract
Objective: To determine the accuracy of Neutrophil Gelatinase Associated Lipocalin (NGAL) at 2 h compared to serum creatinine at 48 h after Computerized Tomography (CT) scan with contrast medium for early detection of decrease in estimated Glomerular Filtration Rate (eGFR).
Materials and Methods:This Cross Sectional Study was carried out in Departments of Chemical Pathology and Radiology PNS SHIFA Karachi from 1stFebruary 2014 to 31st Jan 2015. One hundred and ten patients undergoing CT scan with contrastwere included. Serum creatinine wasmeasured byJaffé assay using Alkaline Picrate reagent on Modular P800 (Roche) analyzer before and 48 h after CT scan. eGFR was calculated by Modification of Diet in Renal Disease (MDRD) formula. Patients were divided into AKI and non-AKI groups. NGAL was analyzed by NGAL Reagent Kit on Triage meter pro at 2 h after contrast. Results: Out of 110 patients, 5 (4.54%) developed Acute Kidney Injury (AKI) 2 h after CT scan with contrast in which eGFR was decreased more than 25%. NGAL level in AKI group was 161ng/ml (IQR: 98 to 196) at 2 h after CT contrast was significantly higher than non-AKI group of 63ng/ml (IQR: 42 to 75). Serum creatinine showed significant rise but with delay of 24 – 48h after CT contrast in AKI group. There was a positive correlation between 2 h plasma NGAL and eGFR at 48 h, which was statistically significant.
Conclusion: NGAL is a potential marker for early detection of decrease in eGFR and predictor of AKI
References
Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2008;73(5):538-46.
Uchino S, Bellomo R, Goldsmith D, Bates S,RoncoC.An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006;34(7):1913-21.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):31-41.
Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettila V. Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann ThoracSurg 2006;81(2):542-6.
Murray PT, Devarajan P, Levey AS, Eckardt KU, Bonv-entre JV, Lombardi R, et al. A framework and key research questions in AKI diagnosis and staging in different envir-onments.Clin J Am SocNephrol 2008;3(3):864-8.
Kim H, Hur M, Cruz DN, Moon HW, Yun YM: Plasma neutrophil gelatinase- associated lipocalin as a biomarker for acute kidney injury in criticallyill patients with suspected sepsis. ClinBiochem 2013, 46:1414–8.
Peacock WF, Maisel A, Kim J, Ronco C: Neutrophil gelatinase associated lipocalin in acute kidney injury. Postgrad Med 2013, 125:82–93.
Ronco: Biomarkers for acute kidney injury: is NGAL ready for clinical use? Critical Care. 2014;18:680-7.
Jaffé M. Über den nieder chlagwelchen Pikrinsaure in normal enharnerzeugt und übereineneue reaction des kreatinins. PhysiolChem 1886; 10: 391-400.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De BD, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10(3):73-9.
Ronco C, Kellum JA, Haase M: Subclinical AKI is still AKI. Crit Care 2012, 16:313.
Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling CR. Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant 2005;20(2):354-60.
Ronco C, Ricci Z: The concept of risk and the value of novel markers of acute kidney injury. Crit Care 2013; 17:117.
Munir MU, Khan DA, Khan FA, Naqvi SMS.Rapid dete-ction of acute kidney injury by urinary neutrophil gelat-inaseassociated lipocalin after cardiopulmonary bypass surgery. JCPSP 2013;23:103-6.
Mishra J, Dent C, Tarabishi R. Neutrophil gelatinaseass-ociated lipocalin as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231-8.
Siew ED, Lorraine BW, Tebeb G, Ayumi S, Karel GM, Nancy W, et al. Urine Neutrophil Gelatinase Associated Lipocalin Moderately Predicts Acute Kidney Injury in Critically ill Adults. J Am Soc Nephrol 2009;20(8):18 23–32.
Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A; NGAL Meta-analysis Investigator Group.Acc-uracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a sys-tematic review and meta-analysis. Am J Kidney Dis 200 9;54(6):1012-24.
Liangos O, Tighiouart H, Perianayagam MC, Kolyada A, Han WK, Wald R, et al. Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass. Biomar-kers. 2009;14(6):423-31.
Koyner JL, Garg AX, Coca SG, Sint K, ThiessenPhilbrook H, Patel UD, et al. Biomarkers predict progression of acute kidney injury after cardiac surgery. J Am SocNe-phrol 2012;23(5):905-14.
Ralib AM, Pickering JW, Shaw GM, Than MP, George PM, Endre ZH. The clinical utility window for acute kidney injury biomarkers in the critically ill.Crit Care 2014;18(6):601.
Ralib AM, Pickering JW, Shaw GM, Endre ZH. The urine output definition of acute kidney injury is too liberal. Crit Care. 2013;17:R112. doi:10.1186/cc12784.
Mehta RL. Acute kidney injury: Urine output in AKI-the canary in the coal mine? Nat Rev Nephrol. 2013;9:568– 570. doi: 10.1038/nrneph.2013.178.
Pickering JW, Endre ZH. Acute kidney injury urinary biomarker time-courses. PLoS One. 2014;9:e101288. doi: 10.1371/journal.pone.0101288.
Pickering JW, Endre ZH. The clinical utility of plasma neutrophil-gelatinase-associated-lipocalin in acute kidney injury. Blood Purif. 2013;35:295–302. doi: 10.1159/00 0351542.
Pickering JW, Endre ZH. linking injury to outcome in acute kidney injury: a matter of sensitivity. PLoS One. 2013;8:e62691. doi: 0.1371/journal.pone.0062691.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2015 Fawaad Sana, Syed Raza Jaffar, Dilshad Ahmed Khan, Najam uddin, Mohammad Anwar Magsi, Muhammad Tahir Khadim, Irfan Ali Mirza, Farhan Akhtar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0