Comparison of Serum Neutrophil Gelatinase - Associated Lipocalin(NGAL) with Serum Creatinine in Prediction of Kidney Recovery after Kidney Transplantion

Abstract

Background: Because of some insult to kidney during transplantation, assessment of kidney function after the procedure is essential. It would be ideal to find a marker better than creatinine to early predict the acute kidney injury. Objective: To compare with creatinine the predictive value of serum neutrophil gelatinase-associated lipocalin (NGAL) in detecting kidney recovery after renal transplantation. Methods: We studied 33 patients who received kidney transplantation (deceased [n=20] and live [n=13]) during a 6-month period in 2010. Serum NGAL and creatinine, hemoglobin, and blood glucose were measured at 0, 12, 24, 48, and 72 hours after transplantation. The need for dialysis and kidney function in one week were studied. Results: There were 16 men and 17 women with the mean±SD age of 36.3±12.2 (range: 14–58) years. Of the studied patients, 6 had delayed graft function (DGF; hemodialysis within the first week of transplant); 9 had slow graft function (SGF; serum creatinine reduction from transplantation to day 7 <70%), and 23 had immediate graft function (IGF; reduction in serum creatinine ≥70%). At any time, serum NGAL, and creatinine levels were significantly higher among patients with DGF (p=0.024) and SGF (p=0.026) compared with those with IGF. However, in those who got IGF vs non-IGF, serum creatinine levels were not significantly different (p=0.59) but serum NGAL levels differed significantly(p=0.020). Receiver-operating characteristic (ROC) curve and area under curves (AUCs) of serum NGAL and serum creatinine levels on the first post-transplantation day had similar significance in predicting the patient’s need to dialysis in the first week. However, using AUC of serum creatinine was not helpful in predicting non-IGF, compared to serum NGAL. The AUCs of the serum NGAL were 0.70 (95% CI: 0.52–0.89) and 0.76 (95% CI: 0.59–0.93) after 12 and 24 hours, respectively (p<0.05). The highest AUC (0.82) was attributed to serum NGAL of 24 hour (p=0.002). Conclusion: Serum NGAL level especially 24 hours post-transplantation, seems to be an early accurate predictor of both the need to dialysis and slow graft function within the first week of kidney transplantation.

Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis

“…Of the studies conducted in ICUs, 30 were conducted in patients with mixed etiologies for AKI [ 27 – 56 ]. Ten trials included patients after cardiac surgery [ 57 – 66 ], three studies investigated patients after major non-cardiac surgery [ 67 – 69 ], two studies included patients after kidney transplantation [ 70 , 71 ], and three studies included only patients with sepsis [ 72 – 74 ] while another two studies only comprised patients with malaria [ 75 , 76 ]. Other etiologies of AKI investigated only by a single trial were contrast-associated AKI [ 77 ], Shiga toxin-mediated hemolytic uremic syndrome [ 78 ], burns [ 79 ], and crush syndrome [ 80 ].…”

“…2). While sample collection and biomarker analysis were quite similar throughout all studies, only 15 studies [ 18 , 27 , 32 , 37 , 41 , 50 , 52 , 56 , 57 , 61 , 64 , 68 , 71 , 75 , 76 ] specified the clinical indications for initiation of RRT. Of these studies, seven [ 19 , 27 , 50 , 56 , 61 , 64 , 76 ] were rated as having set predefined criteria for RRT initiation.…”

Role of plasma neutrophil gelatinase-associated lipocalin as an emerging biomarker of acute renal failure following kidney transplantation and its correlation with plasma creatinine

“…In another study by Mahdavi-Mazdeh et al ( 26 ) the serum NGAL and creatinine levels were measured to predict post-graft renal recovery. It was found out that the serum creatinine and NGAL levels were higher in patients with delayed graft function (6 patients) and slow graft function (9 patients) as compared to patients with immediate graft function.…”

SERUM NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A PREDICTIVE BIOMARKER OF KIDNEY INJURY IN RENAL TRANSPLANTED PATIENTS and CHRONIC KIDNEY DISEASE

“…Previously creatinine was of one the most commonly used in laboratory parameter for CKD diagnosis in addition to others. However the creatinine level is affected by several factors such as gender and age, and it shows an elevation only after the 50 % loss of renal function so the creatinine value is considered a poor, indicative for AKI and it is unable to reflect acute renal injury as early as desired [27,28]. A previous report considered NGAL as a marker for both acute kidney disease and the severity of CKD [29].…”