Neutrophil gelatinase-associated lipocalin: primary care diagnostic technology update

Abstract

BACKGROUNDIn current clinical practice, the consensus diagnosis of acute kidney injury (AKI) depends on the detection of an acute rise in serum creatinine and/or oliguria.1 Recognition of AKI in the community is important, as it is relatively common and associated with excess mortality and morbidity.1 In a primarycare-based cohort of around 61 000 patients, 7% had an episode of AKI over a 6-month period.2 However, detection is difficult on clinical grounds alone. In a populationbased study among patients retrospectively diagnosed with AKI from laboratory samples using the NHS England AKI algorithm, those who were managed at home by GPs had a higher risk of death than those admitted to hospital.3 Improving the recognition of AKI in the community is a national priority, but the optimal strategy to achieve this is unclear. This horizon scanning article explores the potential for neutrophil gelatinase-associated lipocalin (NGAL) to detect AKI and how this could translate to community settings.

Neutrophil Gelatinase-Associated Lipocalin (Ngal): Biomarker Urin Potensial Dalam Diagnosis Penyakit Ginjal Kronis

“…[14] Oleh karena itu, NGAL pada urin diperkirakan memiliki kemampuan diagnosis yang kuat sehingga penulis bertujuan untuk mencari potensi penggunaan NGAL dalam diagnosis PGK. [9,10,15]…”

“…Bentukan monomer dan beberapa heterodimer banyak dihasilkan oleh sel-sel epitel tubulus, sedangkan bentuk dimer hanya diproduksi oleh neutrofil. [15,16] NGAL mengandung 20 asam amino signal peptide di ujung N-terminal protein dan sebuah domain lipocalin. Domain ini berupa lipocalin fold yang tampak seperti sebuah tong yang memiliki 8 beta sheets antiparalel yang akan melipat membentuk suatu rongga hidrofobik (Gambar 1).…”