Increased NGAL level associated with iron store in chronic kidney disease with anemia

Abstract

An iron scarcity often occurs in chronic kidney disease (CKD). Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker of acute kidney injury, is associated with iron metabolism. The present study determined the association between serum NGAL and iron status in chronic kidney disease with anemia. A total of 154 adult CKD patients were divided into anemia and without anemia groups. The anemia groups were further subdivided into two groups based on the presence or absence of iron deficiency, defined as a transferrin saturation (TSAT) < 20%. The NGAL was measured for all the 154 patients, and the possible relationships with iron status were analyzed. 27.7% patients with TSAT < 20% presented lower hemoglobin, serum iron, serum ferritin, and higher NGAL values than those without iron deficiency. NGAL was inversely correlated with hemoglobin, hematocrit, MCV, MCH, serum iron, and TSAT. NGAL adequately diagnosed the status of iron deficiency among CKD patients by ROC analysis. The optimal NGAL cutoff value able to identify iron deficiency was found to be > 244.8 ng/mL, with 73.01% sensitivity and 68.29% specificity. CKD patients with anemia presented altered NGAL values as this protein is involved in the maintenance of iron balance. Thus, NGAL might be proposed as a new tool for assessing the iron deficiency and in the management of iron therapy for CKD patients.

Serum Neutrophil Gelatinase-Associated Lipocalin and Iron Status in Predialysis Chronic Kidney Disease at Zagazig University

“…The best cut-off value for serum ferritin was ≤ 181 ng/ml with an associated sensitivity of 50.9% and specificity of 66.7%. In the study done by Xiang et al (9) they reported that the optimal NGAL cutoff value able to identify iron deficiency was found to be > 244.8 ng/mL, with a 73.01% sensitivity and 68.29% specificity.…”

“…It is produced by injured nephron epithelia. Circulating NGAL is normally reabsorbed at the level of the proximal tubule, and after ischemia, NGAL is secreted in the thick ascending limb and found in the urine (9) . So, NGAL is considered as a novel biomarker of acute kidney injury (AKI) and a predictor of the progression of CKD (10) .…”

Clinical application value of serum neutrophil gelatinase-associated lipocalin in neonatal sepsis

“…The NGAL is a lipocalin superfamily member, which was first discovered and named by Lars Kjeldsen in 1993 (12). Normally, NGAL is released from a small amount of neutrophils in bone marrow while under pathological conditions, and it is also upregulated and released by a variety of other cells, such as activated neutrophils, macrophages, and non-hematopoietic epithelial cells (13,14). Meanwhile NGAL is a novel marker of AKI (15,16), and it has been identified as a highly sensitive and nonspecific predictor of AKI injury in pediatric septic shock (17).…”

Lipocalin-2: a novel link between the injured kidney and the bone

“…Subsequent studies have shown the existence of mammalian siderophores that LCN2 also binds, suggesting that LCN2 might be involved in the regulation of systemic and local iron metabolism. Consequently, several studies have shown strong association between iron metabolism, hematological indices, and LCN2 concentration [91 ▪ ,92,93]. LCN2 appears to regulate tissue-specific iron balance [94–96], and might play a pivotal role in the protection of tissue against high free iron levels.…”

“…LCN2 appears to regulate tissue-specific iron balance [94][95][96], and might play a pivotal role in the protection of tissue against high free iron levels. Finally, given the relationship between inflammation and LCN2, elevated serum LCN2 appear to strongly correlate with prevalent anemia in patients with chronic inflammatory conditions, such as CKD [93].…”