Urinary neutrophil gelatinase-associated lipocalin as a biomarker for the diagnosis of hepatorenal syndrome in cirrhotic patients

El-Bassat, Hanan; Ziada, Dina Hazem; Taha, Atef; Alm-Eldin, Rasha

doi:10.4103/1110-1415.126207

Cited by 6 publications

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“…In this study it was found that the uNGAL level in type 1 HRS was significantly higher than type 2 HRS. These results are consistent with the research conducted by El-Bassat et al and Fagundez et al, but differ from the results obtained by Gungor et al [10,11,13] More severe and profound renal vasoconstriction in type 1 HRS may be the cause of higher uNGAL values in type 1 HRS compared to type 2 HRS. [12] The results of this study are in line with those reported El-Bassat and Gungor that there is a positive correlation between uNGAL and serum creatinine and negative correlation with GFR.…”

Section: Discussionsupporting

confidence: 84%

“…This is because in HRS there is an increase in urinary NGAL level in the intermediate range, which is significantly different from pre-renal azotemia and acute tubular necrosis (ATN). [10][11][12][13][14] The mechanism of increased NGAL in HRS patients is still unclear, it was previously known that HRS is a functional renal impairment, not a structural one. [15] However pathological investigations have reported minor tubular and glomerular damage in the kidneys of HRS patients, some seen only with electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Research conducted by El-Bassat et al concluded that there was a significant difference in uNGAL values between type 1 and type 2 HRS. [13] Meanwhile, other studies reported no significant difference between uNGAL levels for the two types of HRS. 10 For this reason, this study was conducted to see how the difference in uNGAL levels between types 1 and type 2 HRS and to see the correlation between uNGAL and kidney function and the degree of liver disease severity in liver cirrhosis patients with HRS.…”

Section: Introductionmentioning

confidence: 95%

“…[9] Previous studies have reported that uNGAL can be useful in differentiating between HRS and other AKI that occur in HRS, this is because the level is significantly different from other AKI. [10][11][12][13][14] Meanwhile, studies comparing uNGAL levels between type 1 and type 2 HRS are still rare. There are still differences in several previous studies regarding the uNGAL levesl for each type of HRS.…”

Section: Introductionmentioning

confidence: 99%

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Urinary Neutrophil Gelatinase-Associated Lipocalin in Type 1 and Type 2 Hepatorenal Syndrome and Its Correlation with Kidney Function

2021

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Objective: To determine the difference in urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) levels in type 1 and type 2 Hepatorenal Syndrome (HRS) and determine the correlation between urinary NGAL and kidney function and the degree of liver disease severity in HRS patients. Methods: A total of 26 patients consisting of 13 patients in each group, both in type 1 and type 2 HRS at Adam Malik Hospital, Medan City, Indonesia. Urine samples were taken for NGAL examination using the ELISA method. A blood sample is used to assess kidney function. Liver disease severity was measured using the Child-pugh score. Data were analyzed using statistical t-test independent and Pearson correlation test. A p value less than 0.05 was applied to each statistical test as significant. Result: Total subjects consisted of 18 men and 8 women, with a mean age 57.5±8.91 years old. Hepatitis B virus was the most common etiology of liver cirrhosis in this study (53.8%) and the most degree of liver disease severity was Child-pugh C (65.4%). Urinary NGAL levels in type 1 HRS is significantly higher than type 2 (155.71±43.04 vs 105.85±32.32 ng/ml, p = 0.003). There was a positive correlation between uNGAL and serum creatinine (r = 0.488, P = 0.006). There was a positive correlation between uNGAL and Child-pugh score (r = 0.466, P = 0.008). Conclusion: Urinary NGAL level in type 1 HRS is higher than type 2, there is a positive correlation between uNGAL and serum creatinine and Child-pugh score in HRS patients. Keywords: Hepatorenal syndrome, urinary NGAL, Liver cirrhosis, kidney function.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Urinary Neutrophil Gelatinase-Associated Lipocalin in Type 1 and Type 2 Hepatorenal Syndrome and Its Correlation with Kidney Function

2021

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Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

et al. 2020

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Background and Aim: Acute kidney injury increases mortality in cirrhotic patients by four fold. This study aimed to determine the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for differential diagnosis for acute kidney injury and for predicting short-term mortality in cirrhotic patients. Methods: We enrolled 94 patients of decompensated cirrhosis. uNGAL was measured upon hospital admission in all patients. Patients with urinary tract infection and anuria were excluded. Patients were followed for 30 days or until death. Results: Ten (9%) patients had normal kidney function, 9 (11.37%) stable chronic kidney disease, 32 (29.50%) prerenal azotemia, 33 (36.37%) hepatorenal syndrome (HRS), and 10 (13.64%) intrinsic acute kidney injury (iAKI). Prerenal azotemia had lower median uNGAL values compared to HRS and iAKI (95.50 vs 465.00 vs 1217.50, P < 0.001). uNGAL levels were significantly higher in patients who died within 30 days (717.17 ± 494.26 vs 331.65 ± 313.65 ng/mL, P −0.0017). On univariate analysis, serum creatinine (sCr), uNGAL, Model for End-Stage Liver Disease (MELD) score on admission, and length of stay were significant, and on multivariate analysis, uNGAL and hepatic encephalopathy (HE) were significant in predicting mortality. Conclusions: uNGAL at baseline serves as an early marker in differentiating HRS, prerenal AKI, and iAKI in cirrhotic patients, where sCr values are not useful. Patients with higher uNGAL levels had higher transplant-free mortality at 30 days.

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Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction: a challenge in the diagnosis of hepatorenal syndrome

Gomaa¹,

Madkour

2019

European Journal of Gastroenterology &Amp; Hepatology

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Objectives This study aimed to assess urinary neutrophil gelatinase-associated lipocalin (uNGAL) and serum cystatin C (sCys C) in liver cirrhosis patients with renal dysfunction and to evaluate their role in the diagnosis of the hepatorenal syndrome (HRS). Patients and methods Forty-five liver cirrhosis patients were enrolled in the study and they were divided into three groups; the first group included 15 patients with normal renal function, the second group included 15 patients with HRS; and the third group included 15 patients with chronic kidney disease (CKD). There was a fourth group, which included 15 healthy controls. Liver and renal function tests, as well as the estimated glomerular filtration rate were determined. uNGAL was measured using the enzyme-linked immunosorbent assay, and the uNGAL/urinary creatinine concentration (UCC) ratio was calculated. sCys C was measured using the particle-enhanced immunoturbidimetric assay. Results The ratios of uNGAL and uNGAL/UCC were the highest among HRS patients. The combined uNGAL/UCC ratio and sCys C improved the sensitivity of diagnosis to 93.33% and specificity to 76.67%, with the highest area under the curve of 0.944, 95% confidence interval of 0.879–1.0 (P<0.001). The three biomarkers could successfully identify HRS at the following cutoffs: 84.94 ng/ml, 0.6 ng/mg, and 1.6 mg/l, respectively. Significant positive correlations were found between uNGAL, uNGAL/UCC ratios as well as sCys C and KDIGO stage in liver cirrhosis patients with CKD. Conclusion uNGAL and a better uNGAL/UCC ratio can be used alone or together with serum cystatin C as early biomarkers for HRS among patients with decompensated liver cirrhosis. Moreover, uNGAL, uNGAL/UCC as well as serum cystatin C could aid the prognostic assessment of cirrhotic patients with CKD.

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Urinary neutrophil gelatinase-associated lipocalin as a biomarker for the diagnosis of hepatorenal syndrome in cirrhotic patients

Cited by 6 publications

References 0 publications

Urinary Neutrophil Gelatinase-Associated Lipocalin in Type 1 and Type 2 Hepatorenal Syndrome and Its Correlation with Kidney Function

Urinary Neutrophil Gelatinase-Associated Lipocalin in Type 1 and Type 2 Hepatorenal Syndrome and Its Correlation with Kidney Function

Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction: a challenge in the diagnosis of hepatorenal syndrome

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