Evaluation of Measurement of Urinary Neutrophil Gelatinase Associated Lipocalin for Diagnosis of Vesicoureteral Reflux in Children

Abstract

Background: One of the most common urological disorders in childhood is vesicoureteral reflux (VUR) that can lead to kidney injury, scarring and chronic kidney disease. VUR is diagnosed by radiological methods, which are often invasive. We evaluated the possibility of diagnosing VUR by measuring urinary NGAL (Neutrophil gelatinase-associated lipocalin) in this study. Materials and Methods: This prospective cohort study was done on children aged 1-5 years old with recurrent urinary tract infections in 2017- 2018 in Sannandaj, Iran. After ruling out other causes of recurrent urinary tract infections, urinary levels of NGAL and creatinine (Cr) were measured in random urine simultaneously with voiding cystourethrography (VCUG). Then the patients were divided into 2 groups with and without VUR based on VCUG and the collected data were statistically analyzed in 2 groups. Results: In this study, 71 children (12-60 months) with a mean age of 23±36.35 months were studied, of which 34 children had VUR and 37 children did not have VUR. The mean urinary NGAL/Cr ratio in the group with VUR (3.45 ± 3.8 ng/mg) was significantly higher than the group without VUR (1.18± 0.8 ng/mg) (P: 0.002). The best cut-off point for urinary NGAL/Cr ratio was 1.27 ng/mg, with a sensitivity of 76.5% and specificity of 73% (ROC area: 0.76, P <0.001). Conclusion: Urinary NGAL/Cr ratio is higher in children with VUR and may be used as a rapid and non-invasive method in the diagnosis of VUR.