Urinary neutrophil gelatinase-associated lipocalin as a biomarker for the diagnosis of hepatorenal syndrome in cirrhotic patients

Abstract

PurposeThe aim of the study was to assess the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a biomarker for hepatorenal syndrome (HRS) in patients with cirrhosis.Patients and methodsEighty-two cirrhotic patients were enrolled in this study. Urinary levels of NGAL were measured using enzyme-linked immunosorbent assay. Ten normal healthy individuals were enrolled as a control group. Group I included 15 cirrhotic patients with normal kidney function. Group II included 52 cirrhotic patients with acute impaired kidney function: 21 with prerenal azotemia, 22 with HRS, and nine with intrinsic acute kidney injury (iAKI). Group III included 15 cirrhotic patients with chronic impaired kidney function. Group IV included 10 healthy normal individuals as control.ResultsIn HRS, uNGAL was significantly different from patients with either iAKI or prerenal azotemia. uNGAL levels in patients with prerenal azotemia were low and equivalent to levels in patients with normal kidney function and chronic kidney disease. uNGAL elevation was more prominent in type 1 than in type 2. Serum creatinine was significantly higher in patients with iAKI compared with those with normal kidney function and chronic kidney disease but was statistically similar to those with prerenal azotemia and HRS. Patients with HRS had a significantly higher level of serum creatinine than those with prerenal azotemia, but the level was similar to patients with iAKI. Fractional excretion of sodium was significantly higher in patients with iAKI than in patients with either HRS or prerenal azotemia.ConclusionuNGAL levels may be useful in the differential diagnosis of HRS from other causes of acute impairment of kidney function in cirrhosis.