Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) for Early Diagnosis of Acute Kidney Injury in Renal Transplant Recipients

Zohreh Rostami, Mohammad Nikpoor, Behzad Einollahi, Zohreh Rostami, Mohammad Nikpoor, Behzad Einollahi

Abstract

Background: Early predictive biomarkers for acute kidney injury (AKI) such as neutrophil elatinase-associated lipocalin (NGAL) could identify patients who may benefit from early initiation of treatment.

Objectives: We aimed to obtain a cut off point for AKI prediction by urine NGAL in kidney transplantation.

Patients and methods: In a prospective cohort study, 64 adult who underwent kidney transplantation from living or deceased donors at Baqiyatallah transplant center between April 2009 and January 2010 were included. Patients divided into two groups based on the presence or absence of graft dysfunction. In this study, early graft dysfunction (post transplantation AKI) was defined as Cr level more than 1.5 mg/dL on the second postoperative day.

Results: Post-transplant AKI was observed in 31 recipients. Mean urinary NGAL level was greater in recipients with AKI (P = 0.024). In linear regression model, AKI was only factor affected on urinary NGAL level (B = 299.8, P = 0.009). The best sensitivity and specificity for AKI detection by urinary NGAL observed at 2 hour after operation with cut-off point 204 ng/mL.

Conclusions: Our study showed in those who developed early post transplantation graft dysfunction the best AUC-ROC for urine NGAL observed at a cut-off value of 204 ng/mL after 2 hour post transplantation.

Keywords: Acute Kidney Injury; Kidney Transplantation; Neutrophil Gelatinase-associated Lipocalin Protein, Rat.

Figures

Figure 1. Urinary NGALComparison Between 2 Groups
Figure 1. Urinary NGALComparison Between 2 Groups
Figure 2. Sensitivity and Specificity of NGAL…
Figure 2. Sensitivity and Specificity of NGAL Based on the Time of Urinary NGAL Measurement

References

    1. Mishra J, Ma Q, Kelly C, Mitsnefes M, Mori K, Barasch J, et al. Kidney NGAL is a novel early marker of acute injury following transplantation. Pediatr Nephrol. 2006;21(6):856–63. doi: 10.1007/s00467-006-0055-0.
    1. Parikh CR, Jani A, Mishra J, Ma Q, Kelly C, Barasch J, et al. Urine NGAL and IL-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant. 2006;6(7):1639–45. doi: 10.1111/j.1600-6143.2006.01352.x.
    1. Nguyen MT, Devarajan P. Biomarkers for the early detection of acute kidney injury. Pediatr Nephrol. 2008;23(12):2151–7. doi: 10.1007/s00467-007-0470-x.
    1. Feldkamp T, Bienholz A, Kribben A. Urinary neutrophil gelatinase-associated lipocalin (NGAL) for the detection of acute kidney injury after orthotopic liver transplantation. Nephrol Dialysis Transplant. 2011;26(5):1456.
    1. Rostami Z, Lessan-Pezeshki M. Role of NGAL for the Early Detection of Acute Kidney Injury. Nephro-Urol Mon. 2010;2(3):387–389.
    1. Hall IE, Yarlagadda SG, Coca SG, Wang Z, Doshi M, Devarajan P, et al. IL-18 and urinary NGAL predict dialysis and graft recovery after kidney transplantation. J Am Soci Nephrol. 2010;21(1):189–7.
    1. Cullen MR, Murray PT, Fitzgibbon MC. Establishment of a reference interval for urinary neutrophil gelatinase-associated lipocalin. Annal Clin Biochem. 2012;49(Pt 2):190–3.
    1. Devarajan P. Review: Neutrophil gelatinase‐associated lipocalin: A troponin‐like biomarker for human acute kidney injury. Nephrology. 2010;15(4):419–28.
    1. Prabhu A, Sujatha DI, Ninan B, Vijayalakshmi MA. Neutrophil gelatinase associated lipocalin as a biomarker for acute kidney injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Annal Vasc Surg. 2010;24(4):525–31.
    1. Coca SG, Yalavarthy R, Concato J, Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int. 2007;73(9):1008–16.
    1. Coca SG, Parikh CR. Urinary biomarkers for acute kidney injury: perspectives on translation. Clin J Am Soci Nephrol. 2008;3(2):481–90.
    1. Shapiro NI, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, et al. The Diagnostic Accuracy of Plasma Neutrophil Gelatinase–Associated Lipocalin in the Prediction of Acute Kidney Injury in Emergency Department Patients With Suspected Sepsis. Annal Emerg Med. 2010;56(1):52–9.:e1
    1. Bataille A, Abbas S, Semoun O, Bourgeois É, Marie O, Bonnet F, et al. Plasma Neutrophil Gelatinase-Associated Lipocalin in Kidney Transplantation and Early Renal Function Prediction. Transplantation. 2011;92(9):1024.
    1. Kusaka M, Kuroyanagi Y, Mori T, Nagaoka K, Sasaki H, Maruyama T, et al. Serum neutrophil gelatinase-associated lipocalin as a predictor of organ recovery from delayed graft function after kidney transplantation from donors after cardiac death. Cell Transplant. 2008;1(2):129–34.
    1. Cruz DN, De Cal M, Garzotto F, Perazella MA, Lentini P, Corradi V, et al. Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population. Intens Care Med. 2010;36(3):444–51.
    1. Hollmen ME, Kyllönen LE, Inkinen KA, Lalla MLT, Salmela KT. Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation. Kidney Int. 2010;79(1):89–98.
    1. Devarajan P. NGAL in acute kidney injury: from serendipity to utility. Am J kidney Dis. 2008;52(3):395.
    1. Johnston O, O'Kelly P, Spencer S, Donohoe J, Walshe JJ, Little DM, et al. Reduced graft function (with or without dialysis) vs immediate graft function—a comparison of long-term renal allograft survival. Nephrol Dialys Transplant. 2006;21(8):2270.
    1. Humar A, Ramcharan T, Kandaswamy R, Gillingham K, Payne WD, Matas AJ. Risk factors for slow graft function after kidney transplants: a multivariate analysis. Clin Transplant. 2002;16(6):425–9.
    1. Koyner JL, Bennett MR, Worcester EM, Ma Q, Raman J, Jeevanandam V, et al. Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery. Kidney Int. 2008;74(8):1059–69.
    1. Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J kidney Dis. 2009;54(6):1012–24.
    1. Dent C, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Barasch J, et al. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Critical Care. 2007;11(6):R127.
    1. Bennett M, Dent CL, Ma Q, Dastrala S, Grenier F, Workman R, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J AM Soci Nephrol. 2008;3(3):665.
    1. Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Critical Care. 2007;11(4):R84.
    1. Mori K, Nakao K. Neutrophil gelatinase-associated lipocalin as the real-time indicator of active kidney damage. Kidney Int. 2007;71(10):967–70.

Source: PubMed

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