NGAL: a biomarker of acute kidney injury and other systemic conditions

Abstract

Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa protein belonging to the lipocalin superfamily. It was initially found in activated neutrophils, however, many other cells, like kidney tubular cells, may produce NGAL in response to various insults. Recently, it has been found to have a role in iron metabolism by virtue of its binding with siderophores. It has also been found to have a role in kidney development and tubular regeneration after injury. In experimental studies, it was found to be highly expressed in response to tubular injury. In subsequent clinical studies, urine NGAL has been found to be an early predictor for acute kidney injury (AKI). Newer devices for early bedside detection of NGAL are now available. Since serum creatinine is known to be an inadequate and late marker of AKI, NGAL might soon emerge as a troponin-like early marker for AKI. Recent evidence also suggests its role as a biomarker in a variety of other renal and non-renal conditions.

Creatine pretreatment prevents birth asphyxia–induced injury of the newborn spiny mouse kidney

“…Birth asphyxia induced a twofold increase in the expression of Ngal at 24 h. It is widely accepted that the renal tubules are highly susceptible to damage in a low-oxygen environment, due to a high energy demand and low capacity for glycolytic metabolism (19). Although no direct signs of tubular apoptosis/necrosis were observed at 24 h after insult in this study, it is likely that the oxygen deprivation and ischemia within the tubules of the kidney was responsible for the increased expression of Ngal (20).…”

Urine neutrophil gelatinase associated lipocalin as an early marker of acute kidney injury in hematopoietic stem cell transplantation patients

“…In addition to early diagnosis of kidney injury, NGAL might be useful for differential diagnosis or the AKI prognosis, when compared with creatinine. 9,[14][15][16] Novel AKI biomarkers could be utilized in clinical settings whenever the sensitivity and specificity of appropriate cut-off thresholds have been determined. Moreover, their association with the currently recommended diagnostic criteria including of ''AKI, Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE)'' and ''Acute Kidney Injury Network (AKIN)'' should be elaborated.…”

Urinary neutrophil gelatinase-associated lipocalin is a biomarker of delayed graft function after kidney transplantation

“…12 Both urinary NGAL and plasma NGAL have been extensively investigated as reliable biomarkers in several clinical conditions, including cardiac surgery-related AKI, poor renal function in very low birth weight infants, critically ill patients, and DGF in kidney transplantation. [13][14][15][16] In addition, we have recently described the ability of NGAL to induce immune tolerance by upregulating human leukocyte antigen (HLA-G) expression and expansion of T-regulatory cells in healthy donors, providing the basis for further studies to evaluate its possible role in immunomodulation and tolerance induction in transplant recipients. 17 This mounting evidence led to evaluate the role of NGAL after kidney transplant.…”