Urinary NGAL (neutrophil gelatinase-associated lipocalin) levels have been shown to predict renal damage in various medical conditions. The present study was conducted to study the role of urinary NGAL levels in children with bladder exstrophy-epispadias complex post single-stage total reconstruction (SSTR) as markers of early renal functionreduction. Urine samples were collected from children with bladder exstrophy before SSTR (Group A, n = 11), 5years post SSTR (Group B, n = 40) and controls (Group C, n = 41) and stored at - 20°C. NGAL levels were estimated using double antibody sandwich ELISA. Mean NGAL levels in Groups A, B and C were 1.39, 34.24 and 2.58ng/ml, respectively. Mean NGAL levels among Group B subjects with glomerular filtration rate (GFR) ≥ 80ml/min/1.73m2 body surface area (BSA) was 29.8ng/ml, while it was 31.74ng/ml in those with GFR < 80ml/min. Urine samples were also evaluated 6months post SSTR. Mean NGAL at 6months was 6.76ng/ml, while at 12months it was 30.3ng/ml, remaining > 30ng/ml at 18 and 24months. Dimercaptosuccinic acid (DMSA) scans did not show any scarring, and GFRon diethylenetriamine pentaacetate (DTPA) scans remained stable. Increasing levels of urinary NGAL following bladder-exstrophyandepispadias complex repair suggest that NGAL detects the earliest signs of renal damage even before any deterioration is observed in DMSA and/or DTPA-GFR scans. Further studies with an adequate sample size and periodic measurement of NGAL need to be performed before any definitive conclusion can be drawn.
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