Abstract
Objective: Neutrophil gelatinase-associated lipocalin has emerged as a promising biomarker of kidney injury better than creatinine to early predict the acute kidney injury in both chronic kidney diseases and early diagnosis of kidney allograft dysfunction.Methods: Neutrophil gelatinase-associated lipocalin was evaluated as a new biomarker for acute renal injury in 69 patients were divided in two groups chronic kidney disease patients (stage5), (n=34), and renal transplant patients, (n=35) comparing with apparently healthy control (n= 35) of matching age and weight. Neutrophil gelatinase-associated lipocalin, hsCRP and Cystatin-C were measured by enzyme-linked immune sorbent assay which is included first incubating the test serum in an antigen-coated polystyrene plate, then enzyme labelled anti-immunoglobulin is added and the enzyme then remaining in plate after washing provides a measure of the amount of specific antibody in the serum and in the final step a substance is added that the enzyme can convert to some detectable signal, most commonly a color change in a chemical substrate.Results: There was a significant increase in serum NGAL of renal transplantation patients, and CKD patients (stage5) than in healthy control subjects (455±145 ng/ml vs. 296.4±83.5 ng/ml 486±153 ng/ml vs296. 4±83.5 ng/ml) respectively. A high serum Neutrophil gelatinase-associated lipocalin is noted in renal transplanted patients after one month, then after six months (480±188ng/ml vs. 409±78ng/ml). There was a significant negative correlation between serum Neutrophil gelatinase-associated lipocalin in renal transplanted patients, and chronic kidney disease patients (stage 5) with an estimated glomerular filtration rate (p<0.05).Conclusion: Serum neutrophil gelatinase-associated lipocalin seems to be an early predictor of kidney injury and post-transplantation management, including dialysis and grafting function of the kidney.
Highlights
Acute kidney injury (AKI) is a term that has largely replaced the older term acute renal failure, and is characterized by a rapid decline in the glomerular filtration rate (GFR) resulting in the retention of metabolic waste products, like urea and creatinine and big changes in fluid, electrolyte and acid-base homeostasis Staging of Chronic kidney disease (CKD) is important for proper evaluation and treatment and to consider the need for dialysis
There was a significant increase in serum neutrophil gelatinaseassociated lipocalin (NGAL) of renal transplantation patients, and CKD patients than in healthy control subjects included in this study as shown in table 1 and 2 respectively
Lebkowska U et al in their study showed, on 41 patients on hemodialysis prior to kidney transplantation NGAL level significantly decreased in one day after successful kidney transplantation, before a falling in the main renal biomarkers such as serum cystatin-c or creatinine [25]
Summary
Acute kidney injury (AKI) is a term that has largely replaced the older term acute renal failure, and is characterized by a rapid decline in the glomerular filtration rate (GFR) resulting in the retention of metabolic waste products, like urea and creatinine and big changes in fluid, electrolyte and acid-base homeostasis Staging of Chronic kidney disease (CKD) is important for proper evaluation and treatment and to consider the need for dialysis. Serum creatinine, glomerular filtration rate (GFR), proteinuria measurements, and biopsy remain the current gold standards for the evaluation of renal allografts, though these tests have significant limitations in predicting the immune tolerance or immune-mediated graft loss, and assisting in the management of long-term immunosuppression in renal transplantation patients [4]. One of the most promising novel biomarker, namely neutrophil gelatinaseassociated lipocalin (NGAL), which is the surrogate marker of renal allograft outcome and a biomarker of acute and chronic graft injury in addition to cystatin-c [5, 6]. Delayed graft function (DGF) is one of the most important complications of kidney transplantation which leads to AKI This results in increased the risk of acute rejection episodes and decreased long-term survival [12, 13]. NGAL incrementally adds value to the baseline clinical risk assessment, potentially enabling physicians to intervene early to limit the extent of renal injury [19]
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