Urinary Neutrophil Gelatinase Associated Lipocalcin—A Novel Diagnostic and Prognostic Biomarker of Hours in Acute Kidney Injury in Cirrhosis

Abstract

Background and Aim: Acute kidney injury (AKI) is prone to increase mortality in patients with cirrhosis. Identification of kidney failure etiology and recognition of those at the highest mortality risk remains a challenge. We aimed to determine an accuracy of uNGAL for diagnosing HRS in cirrhosis and association in predicting mortality at 30 days in AKI in cirrhosis. Methods: We Prospectively enrolled patients with cirrhosis at single institute from western India. Patients were investigated for uNGAL by CMIA method upon hospital admission (within 24 h or after development of AKI). FeNa calculated from urine and serum creatinine and urinary sodium values. Patients with urinary tract infection and anuria were excluded. Kidney failure type was determined blinded to NGAL measurements. Patients were followed for 30 days and 90 days. Results: We enrolled 45 patients of cirrhosis. Four (8.6%) patients had normal kidney function, 5 (12%) stable chronic kidney disease, 14 (33.33%) prerenal azotemia, 16(38.09%) HRS and 6 (14.2%) intrinsic acute kidney injury (iAKI). Patients with HRS had mean uNGAL levels of 432.45 ng/ml intermediate between prerenal azotemia mean 256 ng/ml, and iAKI [1389 ng/ml]. 12 patients died at 30 days. Patients with intrinsic AKI had highest uNGAl level. Level of uNGAL correlated with MELD levels. Eleven patients had hepatic encephalopathy and 6 had SBP. Patients with SBP had higher mean NGAL values (1234 ng/ml) than patients with hepatic encephalopathy (552 ng/ml).though serum creatine values were same in HRS or prerenal AKI, uNGAL can differentiate early between two conditions. FeNa levels does not differentiate between prerenal and HRS group. Conclusion: uNGAL level and Fe Na can serve as early marker in differentiating HRS and prerenal AKI early than serum creatinine. Patients with higher urinary NGAL level has higher transplant free mortality at 30 days. The authors have none to declare.