Renal resistance indices and neutrophil gelatinase-associated lipocalin for early prediction of acute kidney injury in patients with severe preeclampsia

Abstract

ABSTRACT Purpose To evaluate the efficacy of renal resistance indices (RRIs) and neutrophil gelatinase-associated lipocalin (NGAL) for early prediction of occurrence and severity of acute kidney injury in patients suffered from severe preeclampsia. Settings and Design This study was a prospective and observational study. Methods A total of 80 patients suffered from severe preeclampsia admitted to Obstetric ICU after cesarean delivery, the renal color duplex was carried out on all patients participated in the study on the 1st day of admission, intrarenal resistance indices were measured, serum NGAL was determined for all patients enrolled in the study and according to the existence of AKI as defined by Acute Kidney Injury Network (AKIN), patients were further classified into two groups AKI and non-AKI group. Results RRIs (RI, PI, and Ved) were higher in the AKI group with a significant difference than the non-AKI group, with a cut-off value of (0.665, 1.14, and 14.36) respectively. Resistive index of 0.665, pulsatile index of 1.14 and End diastolic flow velocity of 14.36 have a sensitivity and specificity of (92.9% and 84.6%), (92.86%, and 84.62%), and (89.29%, and 84.62%), respectively, according to serum NGAL, it was higher in AKI group than the non-AKI group, the optimal cut-off value of serum NGAL in AKI group at or was 27.03 ng/ml with sensitivity and specificity of (82.1% and 92.3%). Conclusion This study concluded that patients with severe preeclampsia, renal resistance indices (RRIs), and NGAL can predict early the occurrence and severity of acute kidney injury. Abbreviations: RRIs: Renal resistance indices; NGAL: Neutrophil gelatinase-associated lipocalin; AKIN: Acute kidney injury network; AKI: Acute kidney injury; RI: Resistive index; PI: Pulsatile index; Ved: End diastolic flow velocity; PE: Preeclampsia; GFR: Glomerular filtration rate; ATN: Acute tubular necrosis; RRT: Renal replacement therapy; BNP: Brain natriuretic peptide; IL: Interleukins; ICU: Intensive care unit; ELISA: Enzyme-linked immunosorbent assay; AUC: Area under the curve; ROC: Receiver operating characteristic; US: Ultrasound; CKD: Chronic kidney disease