Is urinary neutrophil gelatinase-associated lipocalin able to predict acute kidney injury episodes in very low birth weight infants in clinical settings?

Abstract

Although UNGAL elevation > 50 ng/ml discriminates between pre-AKI and non-AKI days, high false positive and false negative rates limit utility as a screening test in VLBW newborns.

Patterns of Urinary Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury in Neonates Receiving Cardiopulmonary Bypass

“…Figure 2 shows a plot of log(uNGAL) vs. the time interval of post-operative urine collection in hours. Individual uNGAL trajectories by subject, shown in light gray, demonstrate wide uNGAL variability even at baseline, where one-third of uNGAL values exceeded 50 ng/mL, the predictive cut off for AKI noted for older children and very low birthweight infants [14,[18][19][20][21] (Table 1, Figure 2). Mean trajectories for those with and without AKI are derived from a single, mixed-effects hierarchical model regressing log(uNGAL) on the interaction of time interval and AKI status.…”

“…Our previous analysis exploring the relationship between uNGAL values and AKI in very low birthweight infants demonstrated that uNGAL >50 ng/mL had a sensitivity of 66% and a specificity of 66% to predict AKI [14]. Using this data in combination with our institutional prevalence rate of 25% for post-operative AKI in neonates undergoing cardiac surgery with CPB, we performed a power analysis to determine the number of neonates required to discriminate sensitivity and 1-specificity.…”

“…In these older children and adults, uNGAL is well correlated with and is an early predictor of AKI in a variety of clinical settings such as after exposure to cardiopulmonary bypass (CPB) during cardiac surgery. However, despite the high rate of post-operative AKI in neonates undergoing cardiac surgery, there remains limited information about the correlation between uNGAL and AKI in these neonates [12][13][14][15]. Given their elevated risk for AKI and the unique neonatal confounders of current AKI definitions, an accurate biomarker for neonatal AKI could substantially change our ability to identify and, therefore, support vulnerable neonates.…”

Niveles normales del marcador lipocalina asociada con gelatinasa de neutrófilo (NGAL) en orina en recién nacidos pretérmino y de término a las 24 y 72 horas de vida

“…Otros pacientes iniciarán con hipertensión arterial. 1,5 Un indicador de IRA es la elevación de la creatinina sérica; sin embargo, en las primeras 72 horas de vida ésta podría reflejar los niveles maternos. 4 Además, los niveles se modifican por el sexo, la masa muscular, el metabolismo, el uso de drogas y otros componentes endógenos.…”