Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: A prospective study

Constantin, Jean-Michel; Futier, Emmanuel; Parratte, Sébastien; Roszyk, Laurence; Lautrette, Alexandre; Gillart, Thierry; Guerin, R; Jabaudon, Matthieu; Souweine, Bertrand; Bazin, Jean-Étienne; Sapin, Vincent

doi:10.1016/j.jcrc.2009.05.010

Cited by 133 publications

(99 citation statements)

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“…Critically ill adult patients also showed a similar cut-off value of plasma NGAL for the prediction of AKI (35,36). Therefore, these findings suggest that, in some cases, the optimal cut-off value of plasma NGAL for predicting APN can be comparable to that determined for AKI.…”

Section: Discussionmentioning

confidence: 52%

“…In critically ill children with septic shock, an optimal cut-off value for the prediction of AKI was 139 ng/ml (sensitivity 86%, specificity 39%, positive predictive value 39%, negative predictive value 94%) (33). For the 2-h plasma NGAL measurement after pediatric cardiopulmonary bypass surgery, the AUC was 0.96, sensitivity was 84%, and specificity was 94% for prediction of AKI using a cut-off value of 150 ng/ml (34).Critically ill adult patients also showed a similar cut-off value of plasma NGAL for the prediction of AKI (35,36). Therefore, these findings suggest that, in some cases, the optimal cut-off value of plasma NGAL for predicting APN can be comparable to that determined for AKI.…”

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confidence: 99%

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Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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Background:The identification of acute pyelonephritis (APN) is still a challenge. Methods: Patients admitted for their first urinary tract infection (UTI) were enrolled. Plasma neutrophil gelatinaseassociated lipocalin (NGAL) levels were measured at admittance and after treatment. Laboratory, clinical, and imaging results were compared between children with and without APN. results: A total of 123 patients were enrolled (53 APN and 70 lower UTI). After adjusting for age and gender, plasma NGAL levels were higher in the APN group than in the lower UTI group (233 (129-496) ng/ml vs. 71 (50.8-110) ng/ml, P < 0.001). NGAL levels were correlated with the serum levels of leukocytes, C-reactive protein, and creatinine, as well as fever duration (P < 0.05). Multivariable analysis revealed that logtransformed plasma NGAL was an independent predictor of APN (P < 0.05). Receiver operating curve analysis showed a good diagnostic profile of NGAL for identifying APN (area under the curve 0.864) with a best cut-off value of 102.5 ng/ml. The NGAL levels in both two groups decreased after treatment compared to levels before treatment (P < 0.001). conclusion: Plasma NGAL can be a sensitive predictor for identifying APN and monitoring the treatment response of pediatric UTI. u rinary tract infections (UTIs) are among the most common bacterial infections in children (1). Early detection and proper management of UTIs is important since UTIs involving the kidney may cause permanent renal scarring and be a risk factor for future development of renal insufficiency (2). Establishing the diagnosis of acute pyelonephritis (APN) requires imaging with 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy to view renal parenchymal involvement (3). Although a DMSA scan is considered to be very sensitive in the assessment of renal damage, it is expensive, not readily available in all centers, and exposes the patients to radiation (4). Therefore, a more practical and accessible tool to determine the presence of renal parenchymal involvement could be helpful for the timely management of UTIs.Neutrophil gelatinase-associated lipocalin (NGAL), as a member of the lipocalin superfamily, is produced from the nephron in response to tubular epithelial damage (5). It has been identified as one of the earliest and potentially one of the most indicative biomarkers of acute kidney injury (AKI) from a diverse array of conditions and can differentiate between prerenal and intrinsic causes (6,7). Urinary NGAL (uNGAL) levels increase in patients with different causes of nephropathies (8,9) and might be a valuable tool in monitoring the treatment response of various renal diseases (10,11).As an iron-carrier protein derived from human neutrophils, NGAL also plays an important role in the innate immune response to bacterial infection (12). Experimentally, NGAL was capable of blocking Escherichia coli growth under ironpoor conditions, but NGAL with siderophore iron was not (13). NGAL-knockout mice demonstrated substantially increased mortality after intraperitoneal i...

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Section: Discussionmentioning

confidence: 52%

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confidence: 99%

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

et al. 2015

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“…It was shown previously in many clinical studies and has been accepted that NGAL and Cystatin C levels increase in different clinical settings leading to AKI development [10][11][12][13][14][15][16][17][18][19][20][21][22]. Since the aim of this study is to define the roles of Cystatin C and NGAL in predicting septic AKI development, the patients who had other risk factors, rather than sepsis, that would lead to AKI and increase the Cystatin C and NGAL levels (i.e., nonseptic-AKI patients) were excluded from the study.…”

Section: Exclusion Criteriamentioning

confidence: 98%

“…They are investigated in different clinical settings including cardiac surgery [10], contrast agent use [11], critically ill patients [12][13][14][15][16][17][18][19][20][21] and in emergency department [22].…”

Section: Introductionmentioning

confidence: 99%

The Use of Plasma and Urine Neutrophil Gelatinase Associated Lipocalin (NGAL) and Cystatin C in Early Diagnosis of Septic Acute Kidney Injury in Critically Ill Patients

et al. 2013

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Abstract. AIM:To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients. METHODS: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge. RESULTS: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively). CONCLUSION: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.

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“…Consequently, they recommended that an estimated baseline creatinine be calculated using the Modification of Diet in Renal Disease (MDRD) formula (11) with an assumed GFR for all patients between 75 and 100 ml/min. As a tool for post hoc analysis in research studies, this back-calculation method has become widespread, with most studies adopting 75 ml/min (5,8,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). A few epidemiologic studies have used an estimated baseline for all of their patients (e.g., those using the Australian and New Zealand Intensive Care Society database (5,(12)(13)(14)), whereas in other studies the proportion of patients for whom a baseline is estimated by back-calculation is as low as 7% (19).…”

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confidence: 99%

Back-Calculating Baseline Creatinine with MDRD Misclassifies Acute Kidney Injury in the Intensive Care Unit

Pickering

Endre

2010

Clinical Journal of the American Society of Nephrology

139

120

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Background and objectives: The purpose of this study was to assess the viability of back-calculation with the Modification of Diet in Renal Disease (MDRD) formula to determine baseline creatinine on the basis of acute kidney injury (AKI) metrics, RIFLE criteria, and Acute Kidney Injury Network (AKIN) criteria for the purpose of clinical trial outcomes or epidemiology.Design, setting, participants, & measurements: This study was a retrospective analysis of prospectively collected data from patients with measured baseline creatinines before entry to the intensive care unit (ICU). The AKI status was determined using five different baseline creatinines: the measured creatinine (the standard) and an estimated creatinine determined by back-calculation using MDRD assuming a GFR of 75 ml/min (epCr 75 ), 100 ml/min (epCr 100 ), randomly generating a value on a lognormal curve (epCr Rnd ), and choosing the lowest creatinine value within the first week in the ICU (epCr low ). A subgroup of patients without chronic kidney disease (CKD) was similarly analyzed.Results: Of 224 patients, 70 (31%) had AKI according to RIFLE and 93 (42%) according to AKIN. The epCr 75 and epCr 100 distributions greatly overestimated the proportion with AKI. The epCr low overestimated AKI according to AKIN but correctly estimated AKI according to RIFLE. The mean of 1000 epCr Rnd distributions correctly estimated AKI according to RIFLE and AKIN. Each estimated distribution performed better in the non-CKD population with the exception of epCr Rnd . However, only the epCr low distribution accurately determined the proportion with AKI.Conclusions: A measured rather than estimated value should be used for baseline creatinine in trials or epidemiologic studies of AKI.

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Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: A prospective study

Cited by 133 publications

References 20 publications

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

Plasma neutrophil gelatinase-associated lipocalin predicts acute pyelonephritis in children with urinary tract infections

The Use of Plasma and Urine Neutrophil Gelatinase Associated Lipocalin (NGAL) and Cystatin C in Early Diagnosis of Septic Acute Kidney Injury in Critically Ill Patients

Back-Calculating Baseline Creatinine with MDRD Misclassifies Acute Kidney Injury in the Intensive Care Unit

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