Abstract
ObjectiveAvailable biomarkers for monitoring primary glomerulonephritides (GNs), often lack the ability to assess longitudinal changes and have great variability with poor sensitivity. Accruing evidence has demonstrated that Neutrophil Gelatinase-Associated Lipocalin (NGAL), holds promising capacities in predicting renal function worsening in various renal diseases. We aimed at analyzing urinary NGAL (uNGAL) levels in a cohort of individuals with biopsy-proven GNs in order to evaluate its ability to reflect the entity of renal damage and to predict disease evolution overtime.MethodsWe enrolled 61 consecutive GNs patients still naïve to pathogenic therapy. uNGAL levels were measured at baseline and patients prospectively followed until the manifestation of a combined outcome of doubling of baseline serum creatinine and/or end-stage kidney disease requiring permanent dialysis support.ResultsMedian uNGAL levels were 107[35–312] ng/mL. At univariate and multivariate analyses an inverse correlation was found between eGFR and uNGAL levels (p = 0.001). Progressor subjects showed exceedingly increased baseline uNGAL values as compared with non-progressors (p < 0.001). Twenty-one patients (34%) reached the composite renal endpoint. Subjects with uNGAL values above the optimal, ROC-derived, cut-off of 107 ng/mL experienced a more rapid progression to the renal endpoint (p < 0.001; HR: 5.47; 95% CI 2.31–12.95) with a mean follow-up time to progression of 73.4 vs 83.5 months.ConclusionIn patients affected by primary glomerulonephritides, uNGAL may represent a real-time indicator of renal damage and an independent predictor of renal disease progression. Further studies on larger populations are warranted to confirm these findings.
Highlights
The clinical management of primary glomerulonephritides (GNs) remains a major challenge for nephrologists. This concerns their early identification, and the choice of the optimal therapeutic pathway to procrastinate the evolution toward end-stage kidney disease (ESKD) (Floege and Amann, 2016)
Renal biopsy represents the key-approach for diagnosis, risk stratification and urinary NGAL (uNGAL) Predicts Renal Worsening therapeutic management of patients affected by GNs (Fuiano et al, 2000)
The main aim of our study was to test the ability of urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) to predict progression of renal disease over a long follow-up period in a selected cohort of patients affected by primitive glomerulonephritides
Summary
The clinical management of primary glomerulonephritides (GNs) remains a major challenge for nephrologists. This concerns their early identification, and the choice of the optimal therapeutic pathway to procrastinate the evolution toward end-stage kidney disease (ESKD) (Floege and Amann, 2016). The measurement of proteinuria has been proved to be a good marker in such regard It often lacks of sensitivity, even if stratified for glomerular filtration rate (Provenzano et al, 2020a), and it is far from being an early indicator of renal impairment, as it usually reflects an already evident damage of the glomerular barrier (Simeoni et al, 2016; Provenzano et al, 2020b)
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