Cystatin C and neutrophil gelatinase‐associated lipocalin as markers of renal function in pediatric heart transplant recipients

Abstract

We hypothesized that use of Schwartz formula underestimates the prevalence of CKD in PHT recipients. This study determined the prevalence and risk factors for CKD in PHT using novel methods-serum cystatin C, CKiD formula, Revised Schwartz formula, s- and u-NGAL. Serum BUN, creatinine, cystatin C and s- and u-NGAL were measured after prospective enrollment. Schwartz formula GFR was compared with novel methods. CKD was defined as CKiD GFR < 90 mL/min/1.73 m(2) . The s- and u-NGAL were compared between those with and without CKD. Potential risk factors for CKD were analyzed. Seventy-nine patients (46 male children or boys), mean age 9.9 ± 5.8 yr formed the study cohort. The prevalence of mild and moderate CKD was 2- to 3-fold higher using novel methods compared to Schwartz formula. u-NGAL and u-NGAL/Cr were significantly higher in patients with CKD. u- and s-NGAL had negative correlation with estimates of GFR. Women were at a higher risk for CKD (odds ratio 8.7) as was longer duration since transplant (p = 0.009). In conclusion, use of novel methods of GFR estimation unmasked 2- to 3-fold increased prevalence of CKD in PHT. Women and those with longer duration since transplant are at higher risk for CKD.

Usefulness of urinary NGAL levels during an operation in a patient with septic shock and acute kidney injury for determining postoperative initiation of renal replacement therapy: a case study

“…In current clinical practice, AKI is diagnosed by measuring Cre and/or blood urea nitrogen levels, but these markers are insensitive and late indicators of AKI [2]. Previous studies demonstrated that uNGAL levels for AKI were increased within 2 h, and a diagnosis using Cre levels was delayed by 1 to 3 days [3,4], which may be consistent with our case.…”

Effect of glomerular filtration rate impairment on diagnostic performance of neutrophil gelatinase-associated lipocalin and B-type natriuretic peptide as markers of acute cardiac and renal failure in chronic kidney disease patients

“…After heart and lung transplantation, plasma NGAL was also not correlated with cystatin C and estimated GFR [35]. Finally, only urine NGAL was found to be correlated with CKD in type 2 diabetics with nephropathy and in pediatric heart transplant recipients [36,37]. These literature data indicate the need for a study involving CKD patients at various functional stages with stable renal function, to evaluate the relationship of plasma and urine concentrations of NGAL with measured GFR.…”

Urine neutrophil gelatinase-associated lipocalin in septic patients with and without acute kidney injury

“…In current clinical practice, AKI is typically diagnosed by measuring blood urea nitrogen (BUN) and serum creatinine (SCr), but it is well recognized that BUN and SCr are insensitive and late indicators of AKI. 10 More recently, urine neutrophil gelatinase-associated lipocalin (uNGAL) has been considered more sensitive and specific test to detect AKI. 11 However, uNGAL is also a marker of systemic inflammation since it is typically released by neutrophils upon activation.…”