Neutrophil Gelatinase-associated Lipocalin In Diagnosis Research Articles

The use of urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin for diagnosis of hepato-renal syndrome in advanced cirrhotic patients

Background Chronic liver disease is a common and important clinical problem.Hepatorenal syndrome (HRS) is a life threatening complication. Serum creatinine (Cr) remains the only conventional indicator of renal function. However, the interpretation of serum Cr level can be confounded by malnutrition and reduced muscle mass often observed in patients with severe liver disease. Here, we present a cross-sectional study to explore the sensitivity and specificity of other markers as urinary KIM-1 and NGAL for cases of HRS. Methods Cross-sectional study was conducted on 88 patients who were admitted to Alexandria main university hospital. Enrolled patients were divided in two groups; group 1: patients with advanced liver cirrhosis (child B and C) who have normal kidney functions while group 2: patients who developed HRS. Stata© version 14.2 software package was used for analysis. Results Group 1 included 18 males and 26 females compared to 25 males and 19 females in group 2 (p = 0.135). Only the urinary KIM-1 showed a statistically significant difference between both groups in the multivariate logistic regression analysis adjusted for gender, serum bilirubin, serum albumin, INR, serum K, AST and ALT levels. Conclusion In conclusion, our study aligns with prior research, as seen in the consistent findings regarding Urinary NGAL elevation in cirrhotic patients with AKI. Urinary KIM-1, independent of Urinary NGAL, may have a role in precisely distinguishing between advanced liver cirrhosis and HRS and merits further exploration.

Value of Plasma NGAL in the Diagnosis of Cardiorenal Syndrome Type 1

Background: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. This study was aimed to evaluate the diagnostic efficacy of plasma NGAL in diagnosis of CRS1. Methods: there were 139 patients with AHF or ADHF in the department of Cardiovascular resuscitation and Interventional cardiology Ho Chi Minh City 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study. Results: there were 48 cases (rate 34.5%) with CRS1, mean age 66.12 ± 15.77, men accounted for 50.4%. There were no significant differences of vital signs at admission, diagnosis, EF-based heart failure between CRS1 and Non-CRS1 groups. The urea, creatinin on first day (creatininD1) and third day (creatininD3), NT-proBNP, NGAL levels were higher in the CRS1group than Non-CRS1 group, p 353.23 ng/ml, Area Under Curve (AUC) 0.732 (95% CI 0.65-0.80, p < 0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, negative predictive value 84%. Building the optimal regression model by the BMA (Bayesian Model Average) method with two variables NGAL and CreatininD1: Odds Ratio= ey while y = - 2.39 + 0.0037 x NGAL + 0.17 x Creatinin D1. The nomogram was designed to predict the likelihood of CRS1 with AUC 0.79. Conclusions: Plasma NGAL is quite good value in diagnosing of CRS1 in patients with acute heart failure or ADHF. A predictive model based on NGAL may help diagnosing CRS1 in patients with acute heart failure or ADHF

Discriminatory Precision of Neutrophil Gelatinase-Associated Lipocalin in Detection of Urinary Tract Infection in Children: a Systematic Review and Meta-Analysis.

There is a significant discrepancy between studies on diagnostic precision of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis of urinary tract infection (UTI). Therefore, the present systematic review and meta-analysis was designed to assess the diagnostic value of NGAL in diagnosis of UTI in children and adolescents. An extensive search was performed on Medline, Embase, Scopus and Web of Science databases by the end of 2019. Two independent researchers screened and summarized the data. Discriminatory precision of urinary and serum NGAL was assessed by reporting area under the curve, sensitivity, specificity and diagnostic odds ratio with 95% confidence interval (95% CI). Data from 12 studies were included. The area under the curve of urinary and serum NGAL for diagnosis of UTI in children and adolescents at the best cut-off point (between 30-39.9 ng/ml) was 0.95 (95% CI: 0.93 to 0.97) and 0.83 (95% CI: 0.80 to 0.86), respectively. Sensitivity, specificity and diagnostic odds ratio on urinary NGAL at these cut-off points were 0.89 (95% CI: 0.64 to 0.97), 0.89 (95% CI: 0.71 to 0.97) and 67 (95% CI: 5 to 891), respectively. Sensitivity, specificity and diagnostic odds ratio of serum NGAL in UTI detection were 0.85 (95% CI: 0.70 to 0.90), 0.81 (95% CI: 0.69 to 0.88) and 9.53 (95% CI: 1.52 to 59.65), respectively. The present meta-analysis showed that urinary NGAL had a high diagnostic value in detection of UTI in children and adolescents with an optimum cut-off point in the range of 30-39.9 ng/ml.

Usefulness and limitations of neutrophil gelatinase-associated lipocalin in the assessment of kidney diseases

Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa glycoprotein expressed and secreted by renal tubular cells, immune cells and cancer cells under various pathologic states. NGAL plays important roles in renal tubular epithelial recovery, bacterial defense and inflammation. Currently, NGAL is considered as an accurate early biomarker for acute renal disease, and also shows great potential in improving the assessment of risk groups and the short-term and the long-term prognosis of chronic renal disease. Systemic reviews and meta-analysis illustrated that systemic and urinary NGAL have similar sensitivity and specificity for assessing renal damage, however, emerging studies found that they behaved dissimilar in certain patients, suggesting they may have different clinical significances. Moreover, plenty of studies have found that pathologic conditions, like inflammation, sepsis and cancer also upregulate NGAL protein, which caused the fluctuations of systemic and urinary NGAL concentrations and blurred the accuracy of NGAL as renal damage indicator. The purpose of this review article is to examine the different performances of systemic and urinary NGAL in diagnosis and prognosis of renal diseases and summarize the current knowledge on factors affecting NGAL as sensitive renal damage biomarker.

Urinary neutrophil gelatinase-associated lipocalin for diagnosis and estimating activity in lupus nephritis: a meta-analysis.

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is relatively specific in lupus nephritis (LN) patients. However, its diagnostic value has not been evaluated. The aim of this review was to determine the value of uNGAL for diagnosis and estimating activity in LN. A comprehensive search was performed on PubMed, EMBASE, Web of Knowledge, Cochrane electronic databases through December 2014. Meta-analysis of sensitivity and specificity was performed with a random-effects model. Additionally, summary receiver operating characteristic (SROC) curves and area under the curve (AUC) values were calculated. Fourteen studies were selected for this review. With respect to diagnosing LN, the pooled sensitivity and specificity were 73.6% (95% confidence interval (CI), 61.9-83.3) and 78.1% (95% CI, 69.0-85.6), respectively. The SROC-AUC value was 0.8632. Regarding estimating LN activity, the pooled sensitivity and specificity were 66.2% (95% CI, 60.4-71.7) and 62.1% (95% CI, 57.9-66.3), respectively. The SROC-AUC value was 0.7583. In predicting renal flares, the pooled sensitivity and specificity were 77.5% (95% CI, 68.1-85.1) and 65.3% (95% CI, 60.0-70.3), respectively. The SROC-AUC value was 0.7756. In conclusion, this meta-analysis indicates that uNGAL has relatively fair sensitivity and specificity in diagnosing LN, estimating LN activity and predicting renal flares, suggesting that uNGAL is a potential biomarker in diagnosing LN and monitoring LN activity.

Additive value to clinical judgement of blood neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury and prediction of mortality in patients hospitalized from the emergency department

Acute kidney injury (AKI) is a common and difficult to diagnose complication among hospitalized patients with increasing incidence.