Sensitivity and Specificity of a Single Emergency Department Measurement of Urinary Neutrophil Gelatinase–Associated Lipocalin for Diagnosing Acute Kidney Injury

Nickolas, Thomas L.; O'Rourke, Matthew; Yang, Jun; Sise, Meghan E.; Canetta, Pietro A.; Barasch, Nicholas; Buchen, Charles; Khan, Faris; Mori, Kiyoshi; Giglio, James; Devarajan, Prasad; Barasch, Jonathan

doi:10.7326/0003-4819-148-11-200806030-00003

Cited by 622 publications

(540 citation statements)

References 50 publications

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“…This protein is an acute-phase glycoprotein produced primarily in the liver. An increase in AGP relates to several physiological states, for example; age, and pathological conditions including liver cirrhosis, nephritic disease and acute inflammation (Bachtiar et al, 2009;Devarajan et al, 2010;Nickolas et al, 2008;Williams et al, 1997). Thus, in the present study APG elevation may not specifically indicate acute kidney damage.…”

Section: Discussionmentioning

confidence: 66%

Kidney biomarkers in MCPA-induced acute kidney injury in rats: Reduced clearance enhances early biomarker performance

Wunnapuk¹,

Liu²,

Gobé³

et al. 2014

Toxicology Letters

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Accidental or intentional ingestion of glyphosate surfactant-based herbicides, like Roundup, leads to nephrotoxicity as well as death. In this study, a panel of kidney injury biomarkers was evaluated in terms of suitability to detect acute kidney injury and dysfunction. The Roundup intoxication model involved oral administration of glyphosate to rats at dose levels of 250, 500, 1200 and 2500 mg/kg. Urinary and plasma biomarker patterns were investigated at 8, 24 and 48 hours after dosing.Biomarkers were quantified by absolute concentration; by normalising to urine creatinine; and by calculating the excretion rate. The diagnostic performances of each method in predicting of acute kidney injury were compared. By Receiver Operating Characteristic (ROC) analysis of the selected biomarkers, only urinary kidney injury molecule-1 (KIM-1) best predicted histological changes at 8 h (best cut-off point > 0.00029 µg/ml). Plasma creatinine performed better than other biomarkers at 24 h (best cut-off point > 0.21 mg/dl). Urinary KIM-1 was the best early biomarker of kidney injury in this glyphosate-induced nephrotoxicity model.

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Section: Discussionmentioning

confidence: 66%

Kidney biomarkers in MCPA-induced acute kidney injury in rats: Reduced clearance enhances early biomarker performance

Wunnapuk¹,

Liu²,

Gobé³

et al. 2014

Toxicology Letters

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“…[20][21][22][23] Recently, in a prospective study of 635 adults presenting to the emergency department, a single elevated urinary NGAL was shown to predict a composite of development of AKI and the need for RRT, nephrology consultation, and/or ICU admission. 24 Similarly, serum NGAL and cystatin C have been found to be promising diagnostic biomarkers for early detection of AKI in a range of clinical settings, including cardiac surgery, contrast-induced nephropathy, and sepsis. [25][26][27][28][29] Acute kidney injury prognosis…”

Section: Acute Kidney Injury Predictionmentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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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: 99%

“…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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Sensitivity and Specificity of a Single Emergency Department Measurement of Urinary Neutrophil Gelatinase–Associated Lipocalin for Diagnosing Acute Kidney Injury

Abstract: A single measurement of urinary NGAL helps to distinguish acute injury from normal function, prerenal azotemia, and chronic kidney disease and predicts poor inpatient outcomes.

Cited by 622 publications

References 50 publications

Kidney biomarkers in MCPA-induced acute kidney injury in rats: Reduced clearance enhances early biomarker performance

Kidney biomarkers in MCPA-induced acute kidney injury in rats: Reduced clearance enhances early biomarker performance

Review article: Acute kidney injury in critical illness

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

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