CLINICAL UTILITY OF URINE NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (UNGAL) AS A MARKER IN DISCRIMINATION OF SEPTIC VERSUS NON-SEPTIC ACUTE KIDNEY INJURY

Abstract

Background & Aim:This study was aimed to determine whether there are unique patterns to urine neutrophil gelatinase-associated lipocalin (uNGAL) in septic compared with non-septic acute kidney injury (AKI)and also to evaluate whether uNGAL could discriminate between septic and non-septic AKI. Materials& Methods:This prospective observational study screened critically ill AKI patientsand evaluated them for presenting complaints, and on evaluation, those who satisfied Systemic inflammatory response syndrome (SIRS) criteria were taken up for study. Those patients with evidence of infection and positive for at least two criteria for SIRS are taken up as cases (n=30) and the rest as controls (n=30). All the patients were serially monitored for urine output, renal parameters, urine NGAL, APACHE II score and SOFA score. Patient urine was collected immediately after admission, followed by 12h, 24 h & 48 h for measuring uNGAL. Results:Mean change in uNGAL(ng/ml) at 12h, 24h and 48h was 12.5±5, 20.5±6.7 and 29.3±10.2 respectively in septic AKI and was 0.9±6.1, 0.9±6.3 and 0.1±6.1 respectively in non-septic AKI. Within the group, the analysis showed statistically high significance (p-value<0.0001) in septic AKI but not in the non-septic AKI group (p-value=0.97). On evaluating between-group analyses, we found a significantly high difference of NGAL in septic AKI at 12h, 24h and 48h compared to non-septic AKI(p-value<0.0001). Conclusions:Septic AKI patients have higher detectable uNGAL than non-septic AKI patients. These differences in uNGAL values in septic AKI may have diagnostic and clinical relevance and pathogenetic implications.