The Use of Nuetrophil Gelatinase Associated Lipocalin (NGAL) as a Novel Marker in Early Diagnosis of Hepato Renal Syndrome in Advanced Cirrhotic Patients

Abstract

Abstract Background Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. Objective To predict value of serum and urinary NGAL as an early predictor of hepatorenal syndrome in cirrhotic patients. Patients and Methods The study was conducted on 60 participants with cirrhosis child C on Child-Pugh score, each one was investigated for both Urinary and Plasma NGAL level. Randomized controlled clinical trial. This study is a prospective, random, clinical trial conducted at Kafr El Sheikh Liver Institution Results Group I had Urinary NGAL ranged from 12 - 120, with a mean value of 61.45 ± 36.17. While group II A, ranged from 211-493 with a mean value of 379 ± 72.825. And in group II B, ranged from 306- 732 with a mean value of 438.05 ± 111.26. There was statistical difference between studied groups, p value <0.001. It was found that Urinary NGAL not only good predictor for early renal affection, but also it can differentiate between HRS and non HRS AKI due to the marked difference readings of its level in groups with renal impairment. Conclusion Both Plasma and urinary NGAL levels are markedly elevated in renal affection whatever the cause, so they are highly sensitive in detecting early renal impairment. However, the rate of elevation of plasma NGAL is so close in different types of AKI so it’s not advisable to use it alone to diagnose HRS. On the other hand, Urinary NGAL show noticeable differences between degree of elevation with different causes of AKI, so it’s somehow could be a trusted diagnostic tool to diagnose HRS.