Urinary neutrophil gelatinase-associated lipocalin rules out nephrotoxic acute kidney injury in children

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

“…Urine NGAL also performed well in the pediatric population. It could predict 30-day and 3-month mortality in children with AKI [ 17 ], and its concentration could distinguish between patients at risk of developing AKI as a consequence of nephrotoxicity [ 18 ]. Most recently, uNGAL has shown its usefulness, together with CT-scan, in the assessment of AKI in patients suffering from SARS-CoV 2 infection [ 19 ].…”

Improving acute kidney injury diagnostic precision using biomarkers

“…One of the limitations of this program is daily measurement of serum creatinine which requires a blood draw. Goldstein and colleagues recently reported on the utility of daily urine NGAL monitoring in nephrotoxin-exposed children [ 87 ]. In this 2-center study, the authors hypothesized that daily urine NGAL could be used to screen for AKI in patients exposed to nephrotoxins and that previous cutoffs predictive of AKI in other populations would be highly specific to detect severe, persistent AKI (stage 2/3 AKI that lasts more than 2 days).…”

Urine Sediment Exam Provides More Diagnostic Information in AKI than Novel Urinary Biomarkers: CON

“…Unlike microscopic urinalysis, many novel urinary biomarkers have been shown to identify patients prior to the presence of clinical AKI, but perhaps more importantly they have been consistently linked with adverse patient outcomes and have been shown to help improve outcomes when acted on. [7][8][9][10] For example, in the Schinstock ER study, a urine neutrophil gelatinase associated lipocalin (uNGAL) ≥42.7 ng/ml provided a higher sensitivity (64.5%) and a PPV on par with that of RTEs and granular casts. 6 Improved sensitivity for detecting AKI allows clinicians to implement renal-protective measures prior to the development of advanced renal damage and can prevent severe AKI and its complications.…”

“…Recently, Goldstein and colleagues prospectively enrolled hospitalized children at high risk for nephrotoxinassociated AKI, and they demonstrated that uNGAL thresholds of 150 and 300 ng/ml can effectively rule out the future development of Stage 2 or 3 AKI and can potentially be used as a surrogate to replace daily blood draws. 8 uNGAL is not the only biomarker that has been shown to be elevated earlier than SCr and demonstrated the ability to impact/improve AKI care. There have been several studies which randomized patients at risk for AKI to receive kidney-focused care bundles using urinary Tissue inhibitor metalloprotease-2 and insulin-like growth factor binding protein 7 (TIMP-2 and IGFBP-7) ≥0.3 as part of the enrollment criteria.…”