Abstract
The present study was aimed at assessing the value of serum NGAL in identifying early acute kidney injury induced by HDMTX. Children aged 1-14years with newly diagnosed ALL receiving MTX over 3g/m2 were enrolled. Serum NGAL concentrations, serum creatinine (Scr) and MTX concentrations were measured. The area under the receiver-operating characteristic curve (ROC) was used for evaluating variables' ability of early diagnosis of AKI. A total of 196 courses of 62 patients were assessed, and 22 courses (11.2%) developed AKI. Twenty-four hours serum NGAL concentrations, 24h Scr ratio, 48h Scr ratio, CMTX24h, CMTX48h, CMTX72h were significantly higher in patients with AKI. The combination of 24h Scr ratio and 24h serum NGAL had higher value for detecting HDMTX induced AKI compared with the 24h Scr ratio. And the combination had similar value for detecting HDMTX induced AKI compared with the 48h Scr ratio. After 48h, CMTX48h had a satisfying accuracy in predicting AKI. The proportion of post-HDMTX sepsis in patients with AKI was significantly higher than that in patients without AKI. Serum NGAL levels could be used as a marker in identifying the direct kidney tubular damage induced by HDMTX. The combination of 24h Scr ratio and 24h serum NGAL had higher value for early diagnosis of HDMTX associated AKI compared with the 24h Scr ratio.
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