Serum Neutrophil Gelatinase-associated Lipocalin Levels Research Articles

ADMISSION SERUM NGAL LEVELS, CLINICAL SEVERITY AND SHORT-TERM OUTCOME OF ACUTE STROKE AT UITH, ILORIN- A PILOT STUDY

<h3>Background and Aims</h3> There is a need to continuously search for potential biomarkers for early stroke diagnosis and prognostication, especially in low resource settings. This pilot study determined the relationship between admission serum NGAL, clinical severity and the short- term outcome of acute stroke. <h3>Methods</h3> The study was done at the University of Ilorin Teaching Hospital. Forty patients with clinical and radiological evidence of stroke were recruited between April and July 2021 and compared with equal number of apparently healthy stroke-free, age- and sex-matched controls. Blood sample collection for serum NGAL levels were taken within 72 hours of ictus. Stroke severity on admission was assessed using the National Institutes of Health Stroke Scale (NIHSS) while the functional outcome at one month was assessed using the Modified Rankin Scale (mRS). <h3>Results</h3> A total of 40 stroke subjects (23 males and 17 females) and 40 controls were enrolled into the study with mean age of 58.3 ± 13.5 and 58.3+ 11.3 years respectively. The mean values of NGAL for ischemic, hemorrhagic and controls were 22.8 ± 7.8, 18.9 ± 5.8 and 17.7 ± 7.5 (ng/ml) respectively, with a significant difference between ischaemic stroke subjects and controls (p =0.019). No correlation was found between NGAL levels and clinical severity at admission (r= -0.018, p=0.912), functional outcome (r 0.240, p=0.136) and mortality (r= 0.188, p=0.245). <h3>Conclusion</h3> NGAL levels are elevated in stroke patients but its role in diagnosis and prognostication needs further study.

Serum and Urinary Neutrophil Gelatinase-Associated Lipocalin Levels as Early Markers of the Renal Function in Patients With Urinary Stone-Induced Hydronephrosis.

IntroductionUrinary stones cause hydronephrosis, which leads to kidney function impairment. The serum creatinine level is frequently used as a marker of kidney function. However, in some patients with hydronephrosis, it does not reflect the kidney function changes in the early stages of kidney stone disease. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel indicator of the kidney function. Previous NGAL-related research has focused on its role in acute kidney injury. This study aimed to determine the usefulness of NGAL as an early marker of the kidney function in patients with urinary stones and hydronephrosis.MethodsEighty-five patients with urinary stones who were admitted to the Shanghai Tenth People's Hospital (USP group) and 65 healthy volunteers (NC group) were recruited. Blood and urine samples collected from the study participants were evaluated using an enzyme-linked immunosorbent assay to determine the NGAL concentration. Data on the height, weight, age, medical history, and blood and urine findings were collected. Computed tomography data were collected from the USP group.ResultsCompared to in the NC group, NGAL levels were significantly elevated in the USP group (P < 0.001). However, no significant differences in the NGAL levels were observed among the USP group members with different degrees of hydronephrosis. Furthermore, no significant between-group differences in the creatinine level or the estimated glomerular filtration rate were observed. The areas under the receiver operating characteristic curves for the serum and urinary NGAL levels with hydronephrosis were 92.03 and 99.54%, respectively. The areas under the receiver operating characteristic curves for the serum and urinary NGAL levels with kidney stones were 85.05 and 91.89%, respectively.ConclusionNGAL is a sensitive indicator of hydronephrosis secondary to urinary stones.

The Association between Serum Neutrophil Gelatinase-Associated Lipocalin and Depression in Patients with Type 2 Diabetes Mellitus

ABSTRACT Background Patients wtih type 2 diabetes mellitus (DM) have an increased risk of depressive symptoms. Whether serum neutrophil gelatinase-associated lipocalin (NGAL) is associated with depressive symptoms in old patients with type 2 DM is still uncertain. Objective We aim to investigate whether serum NGAL levels were associated with elevated risk of depressive symptoms in patients with type 2 DM in an old population. Methods Blood samples from 1012 hospitalized patients were measured for serum NGAL within the first 24 hours after admission. The Center for Epidemiological Studies Depression (CES-D) scale was performed to calculate depressive score. Cox analyses were used to examine the prognostic value of serum NGAL on detecting depressive symptoms during a median period of 5 years (range = 0.3–6.2 years). Results 136 (36.6)% of all subjects have depressive symptoms during the follow-up period. Linear analysis showed that serum NGAL levels at baseline were associated with CES-D score after adjusting for clinically relevant variables in type 2 DM patients (Sβ = 0.118, 95% CI 0.106–0.171, P < .001) but not in non-DM patients (Sβ = 0.025, 95% CI, −0.047–0.083; P = .205). Cox analysis revealed that serum NGAL did have an independent prognostic value on predicting depressive symptoms (HR = 2.247, 95% CI 1.415–3.811, P-trend<0.001, Model 2) in type 2 DM patients but not in non-DM patients (HR = 1.811, 95% CI 1.209–3.292, P-trend = 0.189, Model 2) during follow-up period. Conclusions We found the first evidence that serum NGAL were strongly associated with depressive symptoms in patients with type 2 DM but not in non-DM patients. Further studies are needed to prove the underlying mechanism for the impact of type 2 DM on the association.

Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Acute Brucellosis and Brucellar Spondylodiscitis

Brucellosis is a zoonotic infectious disease caused by Brucella spp., an intracellular bacterium. The complications of acute Brucellosis may affect all organs and systems. The most common complication of the disease is musculoskeletal system involvement. The neutrophil gelatinase-associated lipocalin (NGAL) is a marker of neutrophil formation and acts as a siderophore-binding protein to prevent bacterial iron uptake and its use as a marker in the diagnosis and follow-up of bacterial infections is being investigated. The aim of this study was to measure the serum levels of NGAL in patients with acute Brucellosis and Brucellar spondylodiscitis, and to determine whether there is a correlation between NGAL levels and the progression and complications of the disease. This prospective case control study was conducted with 240 patients and 120 healthy controls. The diagnosis of acute Brucellosis was established when a person was asked to take an STA test due to clinical symptoms within the past eight weeks, and the test result that exceeded 1/160, or a 4-fold titer increase was found in the STA test after an interval of two weeks, and/or there was Brucella spp. growth in the blood culture. A contrasted lumbar magnetic resonance (MR) scan was performed on patients diagnosed with acute Brucellosis who had lower back pain. Presence of spondylodiscitis was assessed radiologically with contrasted lumbar MR images. NGAL levels were determined with ELISA assay. The median NGAL value was found to be 456.67 ng/L (101.41-5804.41 ng/L) in patients with acute Brucellosis and 113.84 ng/L (58.29-542.34 ng/L) in the control group. The median NGAL value was statistically higher in the patients than the control group (p= 0.001). Brucellar spondylodiscitis was detected in 57 (23.7%) of 240 patients diagnosed with acute Brucellosis. The median NGAL value was 1885.62 ng/L (143.21-5804.41 ng/L) in patients with Brucellar spondylodiscitis, and 356.87 ng/L (101.41-1874.07 ng/L) in those who did not have Brucellar spondylodiscitis. This difference was statistically significant (p= 0.001). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values were found to be higher in patients who had Brucellar spondylodiscitis. Blood cultures were drawn from 186 (77.5%) of the 240 patients diagnosed with acute Brucellosis. The blood culture positivity rate was 36.02%. Patients whose blood cultures were positive had higher NGAL levels (p= 0.001). The blood culture positivity rate was higher in patients who were diagnosed with Brucellar spondylodiscitis (p= 0.001). A regression analysis showed that female gender and high levels of NGAL, ESR, and alanine aminotransferase (ALT) could be used as predictors of Brucellar spondylodiscitis. The explanatoriness of the model was 82.3%. Although determination of NGAL levels is seen as a useful marker in the diagnosis of acute Brucellosis and predicting the presence of Brucellar spondylodiscitis, more comprehensive studies are required to be used in clinical practice in regions where Brucellosis is endemic.

The Utility of Neutrophil Gelatinase-Associated Lipocalin in the Detection of Emerging Lung Injury due to Mechanical Ventilation in Children: A Preliminary Study

Objective:Lung injuries are mostly ignored in patients supported by mechanical ventilation. Neutrophil gelatinase-associated lipocalin has come into prominence as an early sensitive and highly predictive biomarker of inflammation. The purpose of the study was to assess the capability of neutrophil gelatinase-associated lipocalin in recognizing lung injuries in children requiring mechanical ventilation.Materials and Methods:This prospective case-controlled study was carried out in a tertiary pediatric intensive care unit. The entire study group consisted of a total of 45 patients, 15 in the patient group (supported by invasive mechanical ventilation) and 30 in the control group (self-breathing). Whether lung injuries developed or not was investigated by measuring serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin levels in the course of ventilation support.Results:In the patient group supported by mechanical ventilation, mean levels of serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin were measured as 192 ± 136.7 ng/mL and 43.7 ± 57.5 ng/mL, respectively. In the control group (self-breathing patients), mean levels of serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin were found as 144.8 ± 95 ng/mL and 39.3 ± 85 ng/mL, respectively. The levels of serum-neutrophil gelatinase-associated lipocalin were higher in those ventilated mechanically, compared to self-breathing patients. Although urine-neutrophil gelatinase-associated lipocalin levels were higher among mechanically ventilated patients than the controls, the difference was not statistically significant.Conclusion:Based on our study findings, we consider that neutrophil gelatinase-associated lipocalin may be a useful biomarker for emerging lung injuries due to mechanical ventilation in critically ill children and deserves to be investigated.

THE RISK OF ACUTE KIDNEY INJURY AFTER ELECTIVE VERSUS EMERGENCY CORONARY INTERVENTION.

The aim: A serious and common complication after percutaneous coronary intervention is acute kidney injury, which is associated with an increased risk of renal, cardiovascular and even mortality; therefore, early prognosis and identification of patients at higher risk are essential for early initiation of preventive measures. The aim of this study is to predict and compare the risk for the development of CI-AKI in patient with ACS who undergo emergency PCI or elective (i.e. after medical stabilization) PCI by utilizing the sensitivity of serum NGAL as an early and reliable predictor for CI-AK. Materials and methods: The study include 37 patients with acute coronary syndrome, baseline serum creatinine, complete blood count and pre and two hours post operative serum neutrophil gelatinase-associated lipocalin were measured and all patients underwent percutaneous coronary intervention according to the standard protocol used in Al Najaf Cardiac Center. Results: This is a Two-Arm study that included a total of 37 patients with acute coronary syndrome aged 38-83 years. Eighteen of them had emergency percutaneous coronary intervention while the remaining 19 had elective percutaneous coronary intervention (after medical stabilization). Elevation of serum neutrophil gelatinase-associated lipocalin level two hours after percutaneous coronary intervention was found to be significantly higher among emergency percutaneous coronary intervention group compared to elective group. Conclusions: Acute coronary syndrome patients are undergoing emergency percutaneous coronary intervention are at an increasing risk for the development of contrast induced acute kidney injury than those undergoing elective percutaneous coronary intervention.

Role Portrayed by Serum NGAL and Vitamin D in Patients with Bone Tumors

Bone tumors are responsible for considerable morbidity and mortality at an early age. Malignant bone tumors are quite aggressive in nature. Thus, an accurate and timely diagnosis is essential for bone tumors. Neutrophil gelatinase associated lipocalin (NGAL) and vitamin D have been found to be associated with cancer and may have potential to act as biomarkers for bone tumors also. Serum levels of NGAL and 25-OH vitamin D were estimated in 14 patients with benign and 14 with malignant bone tumors and compared with 14 apparently healthy controls. The data collected was compared among different groups using appropriate statistical analysis. NGAL was estimated by enzyme linked immunosorbent as-say (ELISA) and 25-OH vitamin D by radioimmunoassay (RIA) in the serum samples. Serum NGAL levels were found to be increased significantly and 25-OH vitamin D levels decreased significantly in patients with malignant bone tumors as compared to healthy controls (p < 0.001) while this difference was not statistically significant in patients with benign bone tumors (p = 0.05). The difference in serum levels of NGAL and 25-OH vitamin D in patients with malignant bone tumors was found to be statistically significant as compared to patients with benign bone tumors (p < 0.05). The correlation was not statistically significant between the levels of 25-OH vitamin D and NGAL in group I (r = 0.067, p = 0.819), group II (r = 0.204, p = 0.483), and group III (r = -0.086, p = 0.772). Serum NGAL and 25-OH vitamin D may be used as important serological biomarkers in patients with bone tumors along with other standard investigative modalities.

The Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a Biomarker for Monitoring Renal Function in Patients with Solitary Kidney Stones: A Single-Center, Retrospective Analysis of 23 Cases.

To assess the efficacy of flexible ureteroscopy (F-URS) in treating single kidney stones and the role of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in detecting early renal function abnormalities in patients with solitary kidney stones. We retrospectively analyzed 23 patients with solitary kidney nephrolithiasis who underwent F-URS at the Sichuan Science City Hospital between January 2017 and November 2020. We collected data on the following variables: Age, gender, stone size, surgery time, perioperative outcomes, and complications; Stone-free rates (SFRs) were calculated using computed tomography (CT). Serum creatinine (SCr) and NGAL levels were tested before surgery and at one-day and one-month postoperatively. The average size of the stones was 1.53 ± 0.57 cm. The average operating time was 59.28 ± 21.25 minutes. For urethral stricture, three patients (13.0%) required second-stage F-URS. The SFRs were 91.3% following the first and second treatments. The mean NGAL levels were significantly increased at one-day postoperatively compared to baseline (768.91 ± 514.50 ng/mL vs. 173.39 ± 147.94 ng/mL, respectively, p < 0.001). Minor complications, including gross hematuria (n = 5) and mild fever (n = 3), occurred in 34.8% of cases (n = 8), who recovered quickly. F-URS is a safe and efficient therapeutic approach for patients with solitary kidney nephrolithiasis, and NGAL has huge prospects as an indicator of early-stage renal injury in this patient population.

The Utility of Neutrophil Gelatinase-Associated Lipocalin in the Detection of Emerging Lung Injury due to Mechanical Ventilation in Children: A Preliminary Study.

Lung injuries are mostly ignored in patients supported by mechanical ventilation. Neutrophil gelatinase-associated lipocalin has come into prominence as an early sensitive and highly predictive biomarker of inflammation. The purpose of the study was to assess the capability of neutrophil gelatinase-associated lipocalin in recognizing lung injuries in children requiring mechanical ventilation. This prospective case-controlled study was carried out in a tertiary pediatric intensive care unit. The entire study group consisted of a total of 45 patients, 15 in the patient group (supported by invasive mechanical ventilation) and 30 in the control group (self-breathing). Whether lung injuries developed or not was investigated by measuring serumneutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin levels in the course of ventilation support. In the patient group supported by mechanical ventilation, mean levels of serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin were measured as 192 ± 136.7 ng/mL and 43.7 ± 57.5 ng/mL, respectively. In the control group (self-breathing patients), mean levels of serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin were found as 144.8 ± 95 ng/mL and 39.3 ± 85 ng/mL, respectively. The levels of serum-neutrophil gelatinase-associated lipocalin were higher in those ventilated mechanically, compared to self-breathing patients. Although urineneutrophil gelatinase-associated lipocalin levels were higher among mechanically ventilated patients than the controls, the difference was not statistically significant. Based on our study findings, we consider that neutrophil gelatinase-associated lipocalin may be a useful biomarker for emerging lung injuries due to mechanical ventilation in critically ill children and deserves to be investigated.

Profiling Biomarkers in HIV Glomerular Disease - Potential for the Non-Invasive Diagnosis of HIVAN?

BackgroundThere is a wide spectrum of kidney pathology in human immunodeficiency virus (HIV) infection, affecting all structures of the kidney. The histology of HIV chronic kidney disease (CKD) is diverse, ranging from HIV-associated nephropathy (HIVAN) to focal glomerulosclerosis (FSGS), HIV-immune complex disease (HIV-ICD), other glomerulopathies and tubulo-interstitial nephritis. Definitive diagnosis is by kidney biopsy, an invasive procedure. However, serum and urinary biomarkers may be useful in predicting the histological diagnosis of HIVAN.PurposeWe wished to determine the utility of serum and urinary biomarkers in predicting the histological diagnosis of HIVAN.Patients and MethodsWe measured neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, transforming growth factor (TGF)-β isoforms and bone morphogenetic protein (BMP)-7 in the serum and urine in patients with different histological forms of HIV glomerular disease.ResultsIn HIVAN, we demonstrated increased levels of serum cystatin C and increased levels of serum and urinary NGAL. Urinary TGF-β1 and TGF-β2 levels were elevated in HIV-positive patients with CKD but were not significantly different in the different HIV histologies, while urinary BMP-7 levels were elevated in minimal change disease.ConclusionThis study confirmed the presence of increased serum and urinary biomarkers of tubular injury in patients with HIVAN, and increased urinary biomarkers of fibrosis in HIV CKD, and may indicate their value as a non-invasive diagnostic tool for the diagnosis of HIVAN.

Relation of Baseline Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels and Contrast-Induced Nephropathy following Percutaneous Coronary Intervention among Chronic Kidney Disease Patients.

Background: The risk of contrast-induced acute kidney injury (CI-AKI) following coronary intervention is particularly high among patients with chronic kidney disease (CKD). Among these patients, baseline neutrophil gelatinase-associated lipocalin (NGAL), a marker of tubular damage, reflects the severity of renal impairment. We evaluated whether the baseline serum NGAL level may be a marker for the development of CI-AKI following percutaneous coronary intervention (PCI). Methods: Eighty-eight CKD patients treated with PCI were included. Serum NGAL levels were drawn upon hospital admission. Receiver operator characteristic (ROC) methods were used to identify the optimal sensitivity and specificity for the observed NGAL level compared with the estimated glomerular filtration rate (eGFR) calculated for patients with CI-AKI. Results: Overall CI-AKI incidence was 43%. Baseline serum NGAL levels were significantly higher in patients with CI-AKI than in patients without CI-AKI (150 vs. 103 ng/mL, p < 0.001). According to the ROC curve, baseline NGAL levels performed better than eGFR to predict CI-AKI (AUC 0.753 vs. 0.604), with the optimal cutoff value for baseline NGAL to predict CI-AKI being 127 ng/mL (sensitivity of 68% and specificity of 68%, p < 0.001). In a multivariate logistic regression model, the NGAL level >127 ng/mL ng/mL was independently associated with CI-AKI (HR 9.84, 95% CI: 1.96–40.3; p = 0.01). Conclusion: Baseline serum NGAL levels in CKD patients may identify a high-risk population for CI-AKI following PCI. Further studies on larger populations are required to validate the potential utility of NGAL measurements in monitoring specific CKD-associated conditions.

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) Could Provide Better Accuracy Than Creatinine in Predicting Acute Kidney Injury Development in Critically Ill Patients.

Acute kidney injury (AKI) is one of the most common complications in critically ill patients. In recent years, studies have focused on exploring new biomarkers for the early diagnosis and prognosis of AKI. The aim of this study was to investigate serum prognostic biomarkers (neutrophil gelatinase-associated lipocalin, NGAL, and creatinine) of AKI in critically ill patients. The study included 266 critically ill, initially nonseptic, patients admitted to a multidisciplinary ICU. Serum levels of NGAL and creatinine were measured at ICU admission. ROC curves were generated to estimate the prognostic value of the biomarkers, while a logistic regression analysis was performed to assess their association with an increased AKI risk. Patients were divided in two groups based on the development (n = 98) or not (n = 168) of AKI during their ICU stay. Serum NGAL levels at ICU admission were significantly higher in those who subsequently developed AKI compared to those who did not (p < 0.0001). NGAL was shown to be more accurate in predicting AKI development than creatinine; furthermore, NGAL levels were associated with an increased risk of AKI development (1.005 (1.002–1.008), p < 0.0001). In the present study, we were able to demonstrate that increased serum NGAL levels at ICU admission might be predictive of AKI development during ICU hospitalization. Further studies are needed to support NGAL as a prognostic marker of acute kidney injury.

Protective effects of p-coumaric acid against gentamicin-induced nephrotoxicity in rats

The most important side effect of gentamicin (GM) is nephrotoxicity. p-Coumaric acid (PCA) is a phenolic compound that scavenges free radicals, reduces fibrosis, and tissue damage. This study investigates the protective effect of PCA on tissue damage and kidney function in gentamicin-induced nephrotoxicity (GIN). Thirty-five rats were separated into five groups and each group contained seven animals: control group, ethanol group, GM group, PCA group, and GM + PCA group. At the end of the seven-day treatment, the rats were sacrificed after blood and kidney tissue samples were taken. While serum urea, creatinine, and neutrophil gelatinase-associated lipocalin (NGAL) levels increased significantly in the GM group compared to the control, they showed a significant decrease in the GM + PCA group compared to the GM. Serum tumor necrosis factor-α (TNF-α) and tissue malondialdehyde (MDA) levels were significantly increased in the GM group compared to the control. While the tissue total oxidant status (TOS) and oxidative stress index (OSI) values of the GM group were significantly higher than the control, they showed a significant decrease in the GM + PCA group compared to the GM. In the histopathological examination, significant tubular necrosis and tubulointerstitial inflammation were detected in the proximal tubules in the GM group compared to the control, while a significant decrease was observed in the severity of these findings in the GM + PCA group compared to the GM. This study shows that PCA has biochemical and histopathological ameliorating effects on GIN in the rat model.

Effect of Mild Hypothermia after Craniotomy on the Function of Related Organs in Patients with Traumatic Brain Injury.

Objective To investigate the effect of mild hypothermia after craniotomy on the function of related organs in patients with traumatic brain injury. Method A total of 240 patients with craniocerebral injury from January 2017 to December 2020 were retrospectively analyzed. Patients were randomly divided into a control group and an experimental group, with 120 cases in each group. The control group was treated with craniotomy decompression, and the experimental group was treated with early mild hypothermia based on craniotomy decompression. Patients' venous blood was collected before operation (T0), at the end of operation (T1), 24 h after operation (T2), and 2 weeks after operation (T3) to detect the serum levels of the beta-subunit of S100 protein (S100-β); soluble growth stimulation expressed gene 2 (sST2), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin 6 (IL-6). The prognostic effect was evaluated after 2 weeks of treatment. Results After mild hypothermia treatment after craniotomy and decompression, the patients' serum S100-β, sST2, NGAL, and IL-6 levels at different time points were significantly lower than the control group, and the total effective rate was higher than that of the control group. Conclusion The treatment of mild hypothermia after craniotomy can reduce the related organs function damage indicators and inflammatory stress response, thus improving clinical efficacy and prognosis.

Role of microRNA as a marker in detection of diabetic nephropathy in type-2 diabetic Egyptian patients

Background Diabetic kidney disease (DKD) represents the major cause of chronic kidney disease. New biomarkers for early diagnosis of DKD are of interest. Our objective is to elucidate the significance of microRNA-192 (miRNA-192) and neutrophil gelatinase-associated lipocalin (NGAL) as early predictors of diabetic nephropathy in comparison with albuminuria in type-2 diabetic patients. Patients and methods A number of 45 persons in three groups, group 1: 15 healthy persons with no diabetes mellitus (DM). Group 2: 15 patients diagnosed with type-2 diabetes mellitus (T2DM) without albuminuria. Group 3: 15 patients diagnosed with T2DM with albuminuria. Estimation of serum miRNA, NGAL, urine albumin/creatinine ratio, serum creatinine, urea, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin. Results The study showed that the serum miRNA-192 and NGAL levels were significantly higher in patients diagnosed with T2DM with albuminuria in comparison with patients diagnosed with T2DM without albuminuria. There was a significant positive correlation between miRNA-192 and NGAL and urine albumin/creatinine ratio. Conclusion Serum NGAL and miRNA-192 may serve as tools to follow up the development and progression of DKD.

Serum neutrophil-gelatinase associated lipocalin as a predictor of post-contrast acute kidney injury in children

Abstract Background Diagnosis of post-contrast acute kidney injury (PC-AKI) by serum creatinine can be delayed because of various factors. A new biomarker neutrophilgelatinase associated lipocalin (NGAL) is postulated to be more sensitive for recognizing patients prone to PC-AKI. Objective To assess serum NGAL changes as an early biomarker of PC-AKI in children with congenital heart disease undergoing cardiac catheterization. Methods This observational study included 30 children with congenital heart disease who underwent cardiac catheterization at the Pediatric Cardiac Catheterization Unit, New Children’s Hospital, Ain Shams University. They had a median age of 30 months and 63% were females. Serum NGAL was measured just before the catheterization, 6hrs and 24hrs after contrast media administration while serum creatinine was measured before and after 24hrs of contrast media administration. Results Significant rise of serum NGAL was noted within 24hrs after contrast administration (p &amp;lt; 0.05) while serum creatinine showed a non-significant rise (p &amp;gt; 0.05). Serum NGAL was positively correlated with age, weight, height, body surface area and rate of contrast injection (p &amp;lt; 0.01). Higher levels of serum NGAL were found among patients who underwent diagnostic cardiac catheterization and those who received Midazolam for initial sedation during induction of anesthesia (p &amp;lt; 0.05). Conclusions Serum NGAL was elevated as early as 6 hours post contrast injection, however its serum level is affected by many factors. It’s important to be aware of other possible risk factors of PC-AKI rather than contrast media as type of cardiac catheterization and the anaesthetic Midazolam.

Hydroxyl Ethyl Starch (HES) Preserves Intrarenal Microcirculatory Perfusion Shown by Contrast-Enhanced Ultrasound (Ceus), and Renal Function in a Severe Hemodilution Model in Pigs.

Acute normovolemic hemodilution (ANH) is associated with low oxygen carrying capacity of blood and purposed to cause renal injury in perioperative setting. It is best accomplished in a perioperative setting by a colloid such as hydroxyl ethyl starch (HES) due its capacity to fill the vascular compartment and maintain colloidal pressure. However, alterations of intra renal microvascular perfusion, flow and its effects on renal function and damage during ANH has not been sufficiently clarified. Based on the extensive use of HES in the perioperative setting we tested the hypothesis that the use of HES during ANH is able to perfuse the kidney microcirculation adequately without causing renal dysfunction and injury in pigs. Hemodilution (n = 8) was performed by stepwise replacing blood with HES to hematocrit (Hct) levels of 20% (T1), 15% (T2), and 10% (T3). Seven control animals were investigated. Systemic and renal hemodynamics were monitored. Renal microcirculatory perfusion was visualized and quantified using contrast-enhanced ultrasound (CEUS) and laser speckle imaging (LSI). In addition, sublingual microcirculation was measured by handheld vital microscopy (HVM). Intrarenal mean transit time of ultrasound contrast agent (IRMTT-CEUS) was reduced in the renal cortex at Hct 10% in comparison to control at T3 (1.4 ± 0.6 vs. 2.2 ± 0.7 seconds, respectively, P < 0.05). Although renal function was preserved, the serum neutrophil gelatinase-associated lipocalin (NGAL) levels was higher at Hct 10% (0.033 ± 0.004 pg/μg protein) in comparison to control at T3 (0.021 ± 0.002 pg/μg protein. A mild correlation between CO and IRMTT (renal RBC velocity) (r -0.53; P = 0.001) and CO and NGAL levels (r 0.66; P = 0.001) was also found. Our results show that HES induced ANH is associated with a preserved intra renal blood volume, perfusion, and function in the clinical range of Hct (<15%). However, at severely low Hct (10%) ANH was associated with renal injury as indicated by increased NGAL levels. Changes in renal microcirculatory flow (CEUS and LSI) followed those seen in the sublingual microcirculation measured with HVM.

Serum KIM-1, NGAL, and NAG Levels and Correlation with the Diagnostic Value in Patients with Fracture Traumatic Shock.

Traumatic shock is the most common cause of serious adverse outcomes in patients with severe traumatic diseases such as fractures, and some studies here have shown that the main cause of death from traumatic shock is the impairment of organ function that occurs after shock. In this study, we explored the role of serum kidney injury molecule-1 (KIM-1), neutrophil gelatin-related lipid transporter protein (NGAL), and N-acetyl-β-D-glucosidase (NAG) levels in evaluating and diagnosing the condition of patients with fracture traumatic shock based on the goal of contributing to the clinical diagnosis of the patient's condition as soon as possible and taking measures to alleviate its progress. 96 patients with fracture traumatic shock were included in the study as the observation group and 58 healthy examiners as the control group, and the observation group was divided into 69 cases in the mild-moderate group and 27 cases in the severe group according to the Acute Physiology and Chronic Health Status Scale (APACHE-II). In this study, we detected and analyzed the differences in serum KIM-1, NGAL, and NAG levels between the observation group and the control group and the observation group with different disease levels. We found that the observation group was significantly higher than the control group, and the severe patients were higher than the mild to moderate patients, and we observed that serum KIM-1, NGAL, and NAG are significantly correlated with the condition of patients with fracture traumatic shock after further analysis using the Pearson model. In addition, the diagnostic value of receiver operating characteristic curve analysis showed that the AUC of serum KIM-1 for the diagnosis of fracture traumatic shock was 0.755, the AUC of serum NGAL was 0.750, the AUC of serum NAG was 0.772, and the AUC of the combination of the three indicators was 0.915. The results of this study thus suggest the possibility of serum KIM-1, NGAL, and NAG as clinical indicators for evaluating the condition of patients with fracture traumatic shock and the possibility of a combined test of serum KIM-1, NGAL, and NAG for diagnosing the condition.

Evaluating Neutrophil Gelatinase-Associated Lipocalin as an Early Marker of Acute Kidney Injury in Critically Ill Patients

Background: Detecting significant renal injury in an accurate and timely manner in acute kidney injury (AKI) patients who are critically ill remains controversial. Serum creatinine (Cr) is an important marker of kidney function in clinical practice, and its limitations are well known. Objectives: This study aimed to evaluate neutrophil gelatinase-associated lipocalin (NGAL) as a marker of the early development of AKI in critically ill AKI patients. Methods: This prospective study was carried out at JSS Hospital, Mysuru, India. The diagnosis and staging of AKI was done according to the RIFLE criteria. Results: A total of 53 critically ill patients were enrolled in this study. During Intensive Care Unit (ICU) stay, 34 (64.2%) patients developed AKI according to RIFLE criteria. Serum NGAL levels assessed on admission were an appropriate predictor of AKI com-pared to serum Cr. Serum NGAL levels also showed a significant elevation among AKI patients than non-AKI cases. The mean levels for AKI patients at 0, 4, and 8 hours were 870.53, 1074.9, and 1090, respectively. Meanwhile, the mean levels for non-AKI patients at 0, 4, and 8 hours were 337, 307, and 292. Conclusions: Measuring serum NGAL on admission is useful in the early diagnosis of AKI com-pared to serum Cr.

Effects of Dexmedetomidine on Patients Undergoing Laparoscopic Surgery for Colorectal Cancer

BackgroundPneumoperitoneum during laparoscopic surgery has a systemic impact on the renal system and might contribute to acute kidney injury or postoperative renal dysfunction. However, effective preventive strategies are still lacking. We aimed to explore the effects of dexmedetomidine (DEX) on kidney and other organ function in patients undergoing elective laparoscopic surgery for colorectal cancer. Materials and methodsFifty-six patients were randomly enrolled into the Control or DEX group. The DEX group received 1 µg kg−1 DEX intravenously within 10 min followed by a maintenance dose of 0.5 µg kg−1 h−1 infused until 30 min before closing the peritoneum. In the Control group, 0.9% sodium chloride was administered as a placebo. The primary outcome was serum neutrophil gelatinase-associated lipocalin (NGAL) levels reflecting kidney injury. Secondary outcomes included variables reflecting the kidney, intestinal injury and systemic inflammatory response. ResultsNGAL levels were significantly lower in the DEX group than in the Control group at 1 d and 5 d postoperatively (107.5 ± 55.6 ng mL−1versus 179.5 ± 78.2 ng mL−1; 70.3 ± 45.8 ng mL−1versus 135.2 ± 59.6 ng mL−1, P < 0.001), while the BUN and Cr levels showed no differences between the groups. Serum DAO activity was significantly lower in the DEX group patients 24 h after surgery. Moreover, I-FABP levels were markedly lower at 2 h and 24 h postoperatively in the DEX group than in the Control group (P < 0.001). ConclusionsPerioperative DEX administration may potentially confer kidney and intestinal protection during laparoscopic surgery for colorectal cancer patients.