Blood Neutrophil Gelatinase-associated Lipocalin Levels Research Articles

Evaluation of Lac and NGAL on the Condition and Prognosis of Patients with Diquat Poisoning.

This study aims to explore the evaluation of lactic acid (Lac) and neutrophil gelatinase-associated lipocalin (NGAL) on the condition and prognosis of patients with diquat (DQ) poisoning. A total of 79 cases of DQ poisoning treated in one hospital from January 2019 through February 2023 were included: 10 cases of mild poisoning, 49 cases of moderate to severe poisoning, and 20 cases of fulminant poisoning. According to the Kidney Disease: Improving Global Outcomes-acute kidney injury (KDIGO-AKI) criteria, the patients were divided into 60 cases in the AKI group and 19 cases in the non-acute kidney injury (NAKI) group. According to the AKI diagnostic indicators, AKI patients were divided into Grade I, Grade II, and Grade III. According to prognosis, the patients were divided into survivor group and non-survivor group. During the same period, 30 healthy subjects were selected as the healthy group. The changes of blood Lac, NGAL, cystatin C (CysC), and serum creatinine (Scr) levels of patients were detected, the 28-day survival of patients was recorded, and the correlation between blood Lac, NGAL levels, and renal injury grade in patients with AKI caused by DQ poisoning was analyzed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value and prognostic value of Lac, NGAL, and their combination in patients with AKI caused by DQ poisoning. There were significant differences in AKI grade, Lac, NGAL, CysC, and Scr levels among different degrees of poisoning groups (P < .05). There were significant differences in the levels of Lac, NGAL, CysC, and Scr among patients with different AKI grades (P < .05). The levels of Lac, NGAL, CysC, and Scr in the survivor group were significantly lower than those in the non-survivor group (P < .05). The blood Lac and NGAL levels were positively correlated with AKI grades in patients with DQ poisoning (r = 0.752, 0.836; P = .000, .000). The combined detection of blood Lac and NGAL had higher predictive value for AKI and assessed value for death in DQ poisoning than either of them alone. The combined detection of Lac and NGAL have a certain clinical value in AKI grading and evaluating AKI prognosis caused by DQ poisoning.

The Measurement of Neutrophil Gelatinase Associated Lipocalin in Umbilical Cord Blood and the Assessment of Its Relationship with Neonatal Results

Objectives: In this study, the relationship of cord blood Neutrophil Gelatinase-Associated Lipocalin (NGAL) with neonatal diseases was investigated.&#x0D; Methods: NGAL levels were measured in the cord blood of 180 babies born between 2015 and 2016. Patients were classified according to maternal diseases, neonatal diseases and demographic characteristics. Obtained data were compared with cord blood NGAL levels.&#x0D; Results: In our study, the mean NGAL levels were 1283.99 ng/mL in boys and 1306.52 ng/mL in girls. Umbilical cord blood NGAL levels of infants diagnosed with intrauterine growth retardation (1913.4±2833.5 ng/mL) and prolonged premature rupture of membranes (2594.2±2037.1 ng/mL) were found to be statistically high (p0.05).&#x0D; Conclusions: Neutrophil Gelatinase-Associated Lipocalin, may be useful as a diagnostic biomarker in the evaluation of maternal and neonatal diseases. However, studies on larger patient populations are needed.

Serum Neutrophil Gelatinase-associated Lipocalin (NGAL) Is Elevated in Patients with Asthma and Airway Obstruction.

Neutrophilic airway inflammation is one of the features of severe asthma. Neutrophil gelatinase-associated lipocalin (NGAL), or lipocalin-2, is a glycoprotein associated with neutrophilic inflammation and can be detected in blood. Recently, blood NGAL levels have been reported to be elevated in chronic obstructive pulmonary disease. However, the clinical significance of serum NGAL levels in patients with asthma has not been elucidated. The aim of this study was to explore the association between serum NGAL level and clinical parameters in patients with asthma. Sixty-one non-smoking people with stable asthma were enrolled in this study. All patients underwent blood collection and pulmonary function tests. The associations between serum NGAL levels and clinical parameters were analyzed retrospectively. Serum NGAL levels in patients with asthma and obstructive ventilatory defect were higher than those in patients with asthma without obstructive ventilatory defect (76.4±51.4 ng/mL vs. 39.3±27.4 ng/mL, P=0.0019). Serum NGAL levels were correlated with forced expired flow at 50% of vital capacity %predicted and forced expired flow at 75% of vital capacity %predicted (r=-0.3373, P=0.0078 and r=-0.2900, P=0.0234, respectively). Results of a multiple regression analysis demonstrated that serum NGAL level was independently associated with obstructive ventilatory defect. Serum NGAL levels were elevated in patients with asthma and obstructive ventilatory defect. NGAL may be involved in airway remodeling possibly mediated by neutrophilic inflammation in asthma.

The application of neutrophil gelatin-related lipid delivery protein in evaluation of renal function, nutrition, anemia and inflammation in patients with CKD

ObjectiveTo investigate the role of neutrophil gelatinase-associated lipocalin in the evaluation of renal function, nutrition, anemia and inflammation in patients with chronic kidney diseases. Materials and methodsA total of 302 patients with chronic kidney diseases were selected, and their clinical data, blood neutrophil gelatinase-associated lipocalin levels, renal function, nutrition, anemia, inflammation and calcium, and phosphorus metabolism were analyzed. ResultSerum neutrophil gelatinase-associated lipocalin level increased with the progression of chronic kidney diseases. Higher neutrophil gelatinase-associated lipocalin levels were observed in patients with chronic kidney diseases stage 3b compared with healthy individuals (P<0.05), while the patients with chronic kidney diseases stage 5 showed higher levels compared with other chronic kidney diseases stages (P<0.01). Moreover, the ROC curve showed that neutrophil gelatinase-associated lipocalin had a better diagnostic performance from the chronic kidney diseases stage 3b to 5 (P<0.05). In addition, the serum neutrophil gelatinase-associated lipocalin levels in patient with chronic kidney diseases were negatively correlated with body mass index, number of red blood cells, hemoglobin, transferrin, the estimatedglomerular filtration rate (eGFR), serum calcium (P<0.01); and were positively correlated with mean arterial blood pressure, blood BUN, SCr and alpha 1 microglobulin, beta 2 microglobulin, urinary inhibition C, homocysteine, PTH levels, neutrophils ratio, free serum ferritin and c-reactive protein (P<0.01); while no significant correlation was found with gender, and age (P>0.05). ConclusionSerum neutrophil gelatinase-associated lipocalin levels are closely related to renal function injury, inflammatory response and anemia-related indicators in patients with chronic kidney diseases, and thus could be used as a diagnostic biomarker for evaluating the degree of renal injury and related complications in patients with chronic kidney diseases.

Plasma neutrophil gelatinase-associated lipocalin levels and the hemogram levels and their relationship to disease severity in OCD

Objective: The release of neutrophil gelatinase-associated lipocalin (NGAL), involved with immunity regulation, is a neuromediators. The number of studies related to disease-hemogram in Obsessive Compulsive Disorder (OCD) is low. The aim of our study was to measure the blood NGAL levels and hemogram results in first diagnosis of OCD and to evaluate the relationship between the findings and disease severity. Methods: A total of 28,050 patients, who were presented to psychiatry outpatient clinic between January 2018 and January 2020 were evaluated. Thirty-two patients, for who were diagnosed first-episode OCD and agreed to participate the study were examined with using the Yale Brown Obsession Compulsion Scale (Y-BOCS), to measure the peripheral blood NGAL levels and hemogram results, and related to immune regulation the total leukocyte counts and neutrophil granulocyte percent-age (NEU%); and the C reactive protein (CRP) levels were recorded. Results: In the comparison of the first-episode OCD patients, a significant difference was found between the NEU% and CRP values while was not found between the blood NGAL levels. Although there was no significant difference between the Y-BOCS scores and blood NGAL levels, the Y-BOCS scores increased as the blood hemoglobin and hematocrit values decreased. Conclusion: This is the first study on this topic in the literature, indicated that although there was an increase in some inflammatory mediators in first-episode OCD patients, there was no significant increase between plasma NGAL levels and OCD severity; and that increasing OCD severity did have an effect on blood hemoglobin and hematocrit levels.

Physiologic risk factors for early acute kidney injury in severely injured patients.

The evaluation of the predictive value of the neutrophil gelatinase-associated lipocalin (NGAL) for an early acute kidney injury (AKI) development in severely injured patients. Determination of the time-dependent roles of trauma-related physiologic markers of tissue hypoxia, systemic inflammation and rhabdomyolysis in AKI development. 81 adult patients were screened for the presence of AKI for eight consecutive days following the injury. Arterial levels of plasma NGAL, lactate, interleukin-6, procalcitonin, and myoglobin were investigated at 24 hours (T1), 48 hours (T2), and 96 hours (T3) after the injury. The incidence of AKI was 32.1 %. Patients with AKI were older, but no significant difference in injury severity was observed. NGAL levels were significantly higher in the AKI group at T1, T2, and T3 when compared to the non-AKI group. Lactate levels were significantly higher in the AKI group at T2 only, and IL-6 levels were significantly higher in the AKI group at T2 and T3. Procalcitonin and myoglobin levels were significantly higher in the AKI group at T1, T2, and T3, when compared to the non-AKI group. Positive correlations were found between plasma NGAL and all screened physiological factors at all defined time points. Development of AKI after blunt trauma is very complex and multifactorial. Activation of the systemic inflammatory response and rhabdomyolysis (high concentration of myoglobin) were strongly involved in AKI development. Blood NGAL levels after injury were significantly higher in patients, who developed posttraumatic AKI. Plasma NGAL, lactate, procalcitonin, interleukin-6, and myoglobin had potential to be useful parameters for risk stratification and prediction of AKI after trauma (Tab. 6, Ref. 40).

Effect of Shenfu Injection on Porcine Renal Function after Cardiopulmonary Resuscitation.

Objective To comprehensively evaluate the protective effect of Shenfu injection (SFI) on renal ischaemia/reperfusion injury (IRI) after cardiopulmonary resuscitation (CPR) through neutrophil gelatinase-associated lipocalin (NGAL) and to explore effective monitoring of early renal injuries after CPR. Methods Thirty healthy minipigs were randomly divided into 3 groups: sham operation (SO) (n = 6), control (n = 12), and SFI (n = 12). The SO group underwent only catheterization, whereas the control and SFI groups were subjected to program-controlled electrical stimulation to establish a cardiac arrest (CA) model due to ventricular fibrillation. After CPR, the return of spontaneous circulation was achieved. Each animal in the SFI group was intravenously injected with SFI after resuscitation. Haemodynamic parameters were monitored at baseline and 2, 6, 12, and 24 hr after CPR. At each time point, venous blood samples were collected for NGAL, creatinine, and ATPase screening. Results After CA, the MAP, CPP, and CO of the animals in the control and SFI groups decreased significantly. However, at 6 hr after CPR, the MAP, CPP, and CO of the animals in the SFI group began to recover gradually; the differences between the control and SFI groups were significant (P < 0.005). The renal damage immediately after CPR appeared to be significant in the pathological examinations. However, the degree of renal injury in the SFI group improved significantly, and the apoptosis index was also notably reduced. The blood and urine NGAL levels were clearly elevated after CPR. The greatest increase in NGAL was found in the control group, which was significantly different from that of the SFI group (P < 0.001). SFI can significantly increase the ATPase activity of kidney tissues after CPR and improve abnormal caspase-3 protein expression. Conclusion SFI can effectively prevent acute kidney injuries caused by CPR through improving energy metabolism and inhibiting apoptosis.

Clinical significance of neutrophil gelatinase-associated lipocalin in evaluating residual renal function after living donor kidney resection

Objective To investigate the clinical significance of serum and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) for evaluating changes of residual renal function after living donor kidney resection under different operation model in young versus elderly patients. Methods The clinical data of renal transplants were retrospectively analyzed by successfully using 66 living-related donors at the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2017.According to the operation model and age, renal donors were divided into 4 groups: group A (young/open), group B (young/laparoscopic), group C (aged/open), and group D (aged/laparoscopic). Blood and urinary NGAL and serum levels of creatinine, cystatin C, and other indices of renal function were assayed and collected before and at 1, 3, 7 days after operation. Results Both blood NGAL levels and urinary NGAL levels showed no statistically significant difference (all P>0.05) among four groups both before and after operation, except that urinary NGAL was higher in group C (aged/open) than other groups, at 1 day after operation, (P=0.03). The post-vs.pre-operation level dynamic changes of renal function were four or three times higher in urine or serum NGAL level than in serum creatinine or cystatin C level at 1 day after operation, which showed an important role for predicting an early residual renal damage and relative treatment. Conclusions NGAL can be used as indices in evaluating changes of residual renal function after living donor kidney resection, especially in the elderly receiving open kidney resection. Key words: Living donors; Kidney transplantation; Gelatinases

Effects of remote ischemic preconditioning on contrast induced nephropathy after percutaneous coronary intervention in patients with acute coronary syndrome.

Objective:The aim of this study was to explore the clinical effects of remote ischemic preconditioning (RIPC) on contrast-induced nephropathy after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).Patients and Methods:The study was a single-center, prospective, randomized, controlled study. A total of 161 patients with ACS and the rate of estimate glomerular filtration (eGFR) 15 to 70 mL/min/1.73 m2 undergoing PCI were randomly assigned to RIPC group (induced by 4 times of 5-minute inflations of a blood pressure cuff to 200 mmHg around the upper arm, followed by 5-min intervals of reperfusion at 1 hour before PCI therapy) or control group (an uninflated cuff around the arm). Successful completion of the PCI eventually included 107 cases of patients, including 50 cases in the RIPC group and 57 cases in the control group. The level of serum creatinine (Scr), CystatinC (CysC), blood neutrophil gelatinase-associated lipocalin (NGAL), eGFR were measured in all patients at 6 am before the day of PCI, and 4-hour NGAL, 24-hour CysC, 72-hour Scr, and eGFR after PCI in the 2 groups. The incidence of major adverse events in the kidney (including the incidence of CIN, the need for dialysis, or renal replacement therapy after using contrast agent) and the composite endpoint of cardiovascular events were recorded at 6 months after PCI.Results:There were no statistically significant differences in baseline indicators between the 2 groups. Scr, CysC, and blood NGAL levels and the incidence of CIN in patients with RIPC group were significantly lower than those form the control group after PCI (P < .05), but there were no significant differences between the average value of eGFR and occurrence of Major cardiovascular events in the postoperative 6 months (P > .05).Conclusions:RIPC can reduce PCI-related CIN and protect renal function in patients with ACS. The benefits of these patients by RIPC may be related to the reduction of the NGAL and CysC.

Neutrophil gelatinase-associated lipocalin level is a prognostic factor for survival in rat and human chronic liver diseases.

Chronic liver disease patients often have complications, such as hepatocellular carcinoma (HCC) and acute bacterial infection. Model for end‐stage liver disease and Child‐Pugh scores are useful prognostic factors for chronic liver diseases but not for all chronic conditions, such as HCC. Our investigative aim targeted the prognostic abilities of neutrophil gelatinase‐associated lipocalin (NGAL) in rat and human chronic liver diseases. Blood NGAL levels were measured by enzyme‐linked immunosorbent assay in rats with cirrhosis and 96 patients with chronic liver disease and HCC. We examined the correlation between blood NGAL levels and liver functions as well as survival. In our rat model, liver NGAL expression was assessed by immunostaining, real‐time quantitative polymerase chain reaction, and immunoblot. In rats with cirrhosis, blood NGAL levels were continuously and significantly elevated in the deceased group and were significantly correlated with liver functions. Liver NGAL, toll‐like receptor 4, and interleukin‐6 levels were increased in the deceased group compared to the survival group. Blood NGAL levels were significantly correlated with liver NGAL levels, indicating blood NGAL was derived from the liver. In patients with chronic liver disease, blood NGAL levels were associated with liver function and renal function. Blood NGAL levels were significantly increased in patients with chronic liver disease with HCC compared to without HCC. For the survival group, 38 out of 96 patients were dead in the average follow‐up period of 9.9 months. The patients with blood NGAL ≤119 ng/mL had significantly longer rates of survival compared to patients with blood NGAL >119 ng/mL. Conclusion: Blood NGAL predicts the survival rate in rat and human chronic liver diseases. Our findings suggest blood NGAL may be prognostic of survival in chronic liver diseases complicated by HCC. (Hepatology Communications 2017;1:946–956)

OP21 - Urine partial oxygen pressure as early marker of acute kidney injury after paediatric cardiac surgery

Acute kidney injury (AKI) is the common and serious complication which occurs in open-heart surgery (HS) using cardiopulmonary bypass (CPB). The renal medulla is one the first affected tissues from decreased perfusion during the procedure of cardiopulmonary bypass. Partial pressure of the urine taken from the renal pelvis is related to the perfusion of renal medulla was shown. Neutrophil gelatinase-associated lipocalin (NGAL) is accepted as an early biomarker and a predictor of AKI in a variety of clinical settings. We sought to evaluate the relationship between urine pO2 and kidney function-injury biomarkers and contribution of glycocalyx derangement after paediatric cardiac surgery. Twenty paediatric patients with normal preoperative renal function as assessed by the creatinine level, undergoing HS with CPB were included in this prospective clinical observational study. Besides routine hemodynamics and cerebral tissue oxygen saturation monitoring, patients were assessed for the partial pressure of the bladder urine (PuO2) and renal tissue oxygen saturation monitoring by NIRS intraoperatively (after induction, before CPB, after CPB) and postoperative (admission of ICU, 3rd, 6th, 9th, 12th in ICU) periodically. Additionally, syndecan-1, hyaluronan, cystatin-c, and NGAL levels were measured in plasma and urine samples. PuO2 was found wavy throughout the operation (p>0.05) and increased at the 6th (p<0.05), 9th (p<0.001) and 12th (p<0.001) hours of ICU admission. Renal tissue oxygen saturation (rSO2) monitored by NIRS was found stable throughout the operation and postoperative 12 hours. Plasma NGAL and hyaluronan levels were significantly found to rise at the 12th hour of ICU admission compared to the anaesthesia induction (p<0.001); meanwhile syndecan and cystatin-c were remained constant (p>0.05). A significant correlation between PuO2 and other measurements as renal tissue oxygen saturation (rSO2), arterial blood lactate, NGAL and hyaluronan levels was not determined at any time points. Coexistence of urine pO2 fluctuations and increment of plasma NGAL-hyaluronan levels suggest that urine pO2 could be early marker of kidney injury in paediatric patients undergoing HS. Further investigation in the role of urine pO2 plays in ischemic organ injury and its potential diagnostic implications is needed. 1. Clin Exp Pharmacol Physiol. 2008 Sep;35(9):1109-12

Effect of perinatal risk factors on neutrophil gelatinase-associated lipocalin (NGAL) level in umbilical and peripheral blood in neonates.

IntroductionAcute kidney injury biomarkers are opening a new era in diagnosing kidney failure. The requirement for a specific and sensitive marker of kidney function is highly desirable in neonates because the diagnostic possibilities in this age group are not sufficient. Recent research show that neutrophil gelatinase-associated lipocalin (NGAL) can have a great potential but there is a wide range of medical conditions, that may influence their expression.The aim of the studywas to evaluate the impact of perinatal risk factors on NGAL level in neonates.Material and methodsNGAL was measured in umbilical cord blood and peripheral blood in full term neonates with perinatal risk factors during the first days of life.ResultsWe found significantly higher umbilical cord blood NGAL levels in neonates with perinatal risk factors (117.69 ng/ml) compared to the control group (64.37 ng/ml). No significant difference in peripheral blood NGAL level was shown between the two groups. Umbilical cord blood NGAL level correlated positively with peripheral blood NGAL level (r = 0.36, p < 0.01). Umbilical cord blood NGAL level was significantly higher in neonates with fetal distress and infection compared to neonates with other perinatal risk factors. Peripheral blood NGAL level was significantly higher in neonates with infection compared to neonates with other perinatal risk factors. Significantly higher umbilical cord blood NGAL levels were seen in neonates born by operative delivery compared to born by natural delivery.

Neutrophil gelatinase-associated lipocal in protein levels as an acute appendicitis biomarker in children.

ObjectiveAppendicitis is very commonly encountered in emergency clinics. There is an urgent need for early and accurate predictive biomarkers of appendicitis in order to save lives, because currently-available biomarkers are imprecise and their delayed response impairs the ability of emergency doctors and pediatric surgeons to provide timely and potentially effective therapies. This study was performed to determine whether changes in the blood levels of neutrophil gelatinase-associated lipocalin (NGAL) can help to diagnose acute appendicitis in children and distinguish acute appendicitis from abdominal pain.MethodsSixty children were enrolled and divided into three groups, with 20 patients per group: Group 1 (patients with appendicitis), Group 2 (patients with abdominal pain) and Group 3 (control). Blood NGAL levels were determined by ELISA.ResultsThe basal average serum NGAL levels were 8.2 ng/ml for Group 1, 3.9 ng/ml for Group 2, and 3.3 ng/ml for Group 3. Twenty-four and 72 h after surgery the levels were 5.1 and 2.8 ng/ml, respectively, in Group 1, 2.9 and 2.8 ng/ml in Group 2, and 2.6, 2.7 ng/ml in Group 3. Setting the cut-off point to 7 generated an area under the receiving operating curve (ROC) curve at 95 % confidence interval with 77.3 % sensitivity and 97.4 % specificity.ConclusionThese data indicate a significant difference in NGAL values between basal and postoperative measurements in appendicitis patients (p < 0.05). The ROC curve results showed that NGAL is a promising novel biomarker for the differential diagnosis of acute appendicitis from abdominal pain.

Effects of N-acetyl cysteine on renal functions evaluated by blood neutrophil gelatinase-associated lipocalin levels in geriatric patients undergoing coronary artery bypass grafting.

Objective:Recent conflicting studies on the renal effects of N-acetyl cysteine (NAC) after cardiac surgery have been published. The aim of this study was to evaluate the renal effects of NAC using neutrophil gelatinase-associated lipocalin (NGAL) blood levels in elderly patients undergoing coronary artery bypass grafting (CABG).Methods:This randomized, double-blinded, placebo-controlled study was conducted among geriatric patients (>65 years) scheduled to undergo CABG. A total of 60 consecutive patients were randomly assigned to 2 groups. The first group received I.V. NAC (n=30) and the second group received placebo (n=30) at induction of anesthesia and then for 20 h. NGAL values were determined and conventional renal function tests were performed. Statistical analysis was performed using SPSS 17.0 (IL, Chicago, USA). A p value of <0.05 was considered statistically significantResults:Plasma creatinine levels at 24 h postoperatively were significantly higher in the placebo group than in the NAC group (1.41±0.63 vs. 1.13±0.35; p<0.05). The mean serum NGAL levels at 3 h postoperatively were higher in the placebo group than in the NAC group (104.94±30.51 vs. 87.82±25.18; p<0.05). NGAL levels were similar between the groups at all other measurement time points. Plasma creatinine levels of ≥1.5 mg/dL or >25% of the baseline value at any time during the study period were observed in 27% of patients in the NAC group and 37% of patients in the placebo group; the difference was statistically significant (p<0.05).Conclusion:In the present study, we found that I.V. NAC infusion in elderly patients undergoing CABG reduced the incidence of acute kidney injury as determined by blood NGAL and creatinine levels.

Could Blood Neutrophil Gelatinase-Associated Lipocalin (NGAL) be a Diagnostic Marker for Acute Kidney Injury in Neonates? A Systemic Review and Meta-Analysis.

Blood neutrophil gelatinase-associated lipocalin (NGAL) has been shown to be helpful for acute kidney injury (AKI) in pediatric patients and adults. Whether this is true in neonates remains unclear. A systemic review and diagnostic meta-analysis was performed. Keywords included blood NGAL/serum NGAL, neonate/newborn, and AKI/acute kidney failure. Eligible studies measured blood or serum NGAL levels in neonates with AKI (first 30 days of life). Studies were excluded if they did not present sufficient data to extract or calculate true positives, false positives, false negatives, and true negatives, or were not available in English. Five of 50 studies were included with 159 critically ill neonates and 251 measurements of blood NGAL concentrations. The overall pooled positive and negative likelihood ratios were 5.84 (95% CI 2.68 - 12.75) and 0.23 (95% CI 0.14 - 0.38). The area under the receiver operating characteristic curve was 0.87 and the Q value was 0.823. The overall pooled sensitivity and specificity of all studies were 0.813 (95% CI: 0.697 - 0.891) and 0.859 (95% CI: 0.730 - 0.932). The pooled diagnostic odds ratio was 27.20 (95% CI 8.84 - 83.74), with Cochran's Q = 4.07 (p = 0.397). No publication bias was found. Blood NGAL could be used as diagnostic marker for AKI in neonates.