Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients

Lee, Jong Ho; Yoon, Eileen L.; Park, Seong Eun; Park, Ji Young; Choi, Jeong Min; Jeon, Tae Joo; Shin, Won Chang; Choi, Won Choong

doi:10.4166/kjg.2019.74.4.212

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…35 (ii) Few studies published recently also had higher uNGAL levels that were comparable to our results where uNGAL levels were high in the iAKI group, 2625 ng/mL. 36 In a small cross-sectional study, Gerbes et al 20 evaluated the relationship between measured glomerular filtration rate (via 51Cr-EDTA technique) with plasma and uNGAL in patients with decompensated cirrhosis and variable kidney function; this showed that a cut-off of plasma NGAL>100 ng/mL was superior to creatinine in predicting patients with measured glomerular filtration rate (GFR) < 50 mL/min.…”

Section: Discussionsupporting

confidence: 90%

“…One of the studies comparing uNGAL levels used two measurement methods enzyme linked immnunosorbent assay (ELISA) and CMIA, in healthy volunteers and showed higher values by CMIA methods, hence explaining the high values in our studies 35 . (ii) Few studies published recently also had higher uNGAL levels that were comparable to our results where uNGAL levels were high in the iAKI group, 2625 ng/mL 36 …”

Section: Discussionsupporting

confidence: 86%

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Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

et al. 2020

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Background and Aim: Acute kidney injury increases mortality in cirrhotic patients by four fold. This study aimed to determine the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for differential diagnosis for acute kidney injury and for predicting short-term mortality in cirrhotic patients. Methods: We enrolled 94 patients of decompensated cirrhosis. uNGAL was measured upon hospital admission in all patients. Patients with urinary tract infection and anuria were excluded. Patients were followed for 30 days or until death. Results: Ten (9%) patients had normal kidney function, 9 (11.37%) stable chronic kidney disease, 32 (29.50%) prerenal azotemia, 33 (36.37%) hepatorenal syndrome (HRS), and 10 (13.64%) intrinsic acute kidney injury (iAKI). Prerenal azotemia had lower median uNGAL values compared to HRS and iAKI (95.50 vs 465.00 vs 1217.50, P < 0.001). uNGAL levels were significantly higher in patients who died within 30 days (717.17 ± 494.26 vs 331.65 ± 313.65 ng/mL, P −0.0017). On univariate analysis, serum creatinine (sCr), uNGAL, Model for End-Stage Liver Disease (MELD) score on admission, and length of stay were significant, and on multivariate analysis, uNGAL and hepatic encephalopathy (HE) were significant in predicting mortality. Conclusions: uNGAL at baseline serves as an early marker in differentiating HRS, prerenal AKI, and iAKI in cirrhotic patients, where sCr values are not useful. Patients with higher uNGAL levels had higher transplant-free mortality at 30 days.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

et al. 2020

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“…The study published by Huelin et al (16) goes with our results, as they performed their study on 320 cases, 153 were hypovolemia-induced AKI (48%), 93 were HRS-AKI (29%), 39 were ATN (12%), and 35 were due to miscellaneous causes, and revealed that "The results show that urinary NGAL has high accuracy in the differential diagnosis between ATN and other types of AKI, including HRS-AKI and hypovolemia-induced AKI". Furthermore Lee et al (17) also had near results and thoughts regarding the study performed on 55 patients, with Liver cell failure who exhibited acute kidney injury upon admission. Their result showed that urinary NGAL has emerged as a potential diagnostic biomarker for AKI.…”

Section: Starting With Plasma Ngalmentioning

confidence: 97%

The Use of Neutrophil Gelatinase Associated Lipocalin (NGAL) As A Novel Marker in Early Diagnosis of Hepatorenal Syndrome in Advanced Cirrhotic Patients

Musa¹,

Okasha²,

Allam³

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. Objective: To predict value of serum and urinary NGAL as an early predictor of hepatorenal syndrome in cirrhotic patients.Patients and Methods: This study was a prospective clinical trial conducted at Kafr El Sheikh Liver Institution. The study included 60 participants with cirrhosis Child C on Child-Pugh score, each one was investigated for both Urinary and Plasma NGAL level. Results: Group I had urinary NGAL ranged from 12 -120, with a mean value of 61.45 ± 36.17. While group II A, ranged from 211-493 with a mean value of 379 ± 72.825 and in group II B, ranged from 306-732 with a mean value of 438.05 ± 111.26. There was statistical difference between studied groups, p value <0.001. It was found that urinary NGAL is not only good predictor for early renal affection, but also it can differentiate between HRS and non HRS AKI due to the marked difference readings of its level in groups with renal impairment. Conclusion: Urinary NGAL shows noticeable differences between degree of elevation with different causes of AKI, so it somehow could be a trusted diagnostic tool to diagnose HRS.

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“…The authors found that among patients with persistent AKI, HRS-AKI could be accurately predicted with urinary NGAL values lower than 86 μg/g creatinine in 88% of patients[ 74 ]. In a study with 55 patients, Lee et al [ 77 ] found that urinary NGAL levels were significantly higher in ATN than HRS and PRA. Also, median urinary NGAL levels in HRS were markedly different from PRA levels, and the authors found that NGAL was an independent risk factor for mortality with AKI[ 77 ].…”

Section: Novel Biomarkersmentioning

confidence: 99%

“…In a study with 55 patients, Lee et al [ 77 ] found that urinary NGAL levels were significantly higher in ATN than HRS and PRA. Also, median urinary NGAL levels in HRS were markedly different from PRA levels, and the authors found that NGAL was an independent risk factor for mortality with AKI[ 77 ]. Jaques et al [ 67 ] studied multiple biomarkers in AKI in 55 decompensated cirrhosis patients.…”

Section: Novel Biomarkersmentioning

confidence: 99%

Acute kidney injury and hepatorenal syndrome in cirrhosis

Gupta¹,

Bhurwal²,

Law³

et al. 2021

WJG

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Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. AKI is separated into two categories, non-HRS AKI and HRS-AKI. The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease. The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation. The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients; novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models. The overall management of non-HRS AKI and HRS-AKI requires a systematic approach. Although pharmacological treatments have shown mortality benefit, the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation. Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment. This article reviews the current guidelines and recommendations of AKI in cirrhosis.

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Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients

Cited by 8 publications

References 26 publications

Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

The Use of Neutrophil Gelatinase Associated Lipocalin (NGAL) As A Novel Marker in Early Diagnosis of Hepatorenal Syndrome in Advanced Cirrhotic Patients

Acute kidney injury and hepatorenal syndrome in cirrhosis

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