Predictive Role Of Neutrophil Gelatinase-Associated Lipocaline As An Early Marker For Kidney Injury In Patients With Diabetes Mellitus

Abstract

Diabetic kidney disease (DKD) is a chronic complication of diabetes mellitus leading to increased cardiovascular morbidity and mortality, and a risk of developing an end-stage renal disease (ESRD). Diabetic nephropathy is a disease affecting mainly the glomerulus, however, a number of studies indicate the predictive role of tubulo-interstitial lesions in the development and the progression of diabetic nephropathy. Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising tubular biomarkers in the diagnosis of kidney disease. The data in the literature determine NGAL as a marker with a good diagnostic profile in the diagnosis of DKD. Neutrophil gelatinase-associated lipocalin values correlate with the progression of the albumin excretion, with the decrease in the glomerular filtration rate and with the severity of renal impairment. Neutrophil gelatinase-associated lipocalin is defined as an early marker of DKD, which establishes the development of renal dysfunction before the increase in albumin excretion. The evaluated cut-off values demonstrate good to high efficacy of NGAL in discriminating DKD patients with normal albumin excretion from healthy individuals. Several studies have indicated NGAL as an indicator of DKD progression, stratifying the risk of developing ESRD, patients with diabetes with higher NGAL levels have a faster and earlier decline in renal function. However, NGAL is a modulator of insulin signalling and its levels are elevated in patients with diabetes without DKD. Elevated levels of NGAL may be the result of common concomitant diseases of diabetes—cardiovascular disease and urinary tract infections. Additional studies are needed to assess the clinical applicability of NGAL in the diagnosis of DKD.