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

Abstract

(2015) Urine neutrophil gelatinase associated lipocalin as an early marker of acute kidney injury in hematopoietic stem cell transplantation patients, Renal Failure, 37:6,[994][995][996][997][998] DOI: 10.3109 AbstractAcute kidney injury (AKI) is common in hematopoietic stem cell transplantation (HSCT) patients with an incidence of 21-73%. Prevention and early diagnosis reduces the frequency and severity of this complication. Predictive biomarkers are of major importance to timely diagnosis. Neutrophil gelatinase associated lipocalin (NGAL) is a widely investigated novel biomarker for early diagnosis of AKI. However, no study assessed NGAL for AKI diagnosis in HSCT patients. We performed further analyses on gathered data from our recent trial to evaluate the performance of urine NGAL (uNGAL) as an indicator of AKI in 72 allogeneic HSCT patients. AKI diagnosis and severity were assessed using Risk-Injury-Failure-Loss-End-stage renal disease and AKI Network criteria. We assessed uNGAL on days À6, À3, +3, +9 and +15. Time-dependant Cox regression analysis revealed a statistically significant relationship between uNGAL and AKI occurrence.(HR ¼ 1.04 (1.008-1.07), p ¼ 0.01). There was a relation between uNGAL day + 9 to baseline ratio and incidence of AKI (unadjusted HR ¼ 1.047 (1.012-1.083), p50.01). The area under the receiver-operating characteristic curve for day + 9 to baseline ratio was 0.86 (0.74-0.99, p50.01) and a cut-off value of 2.62 was 85% sensitive and 83% specific in predicting AKI. Our results indicated that increase in uNGAL augmented the risk of AKI and the changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients. Additionally uNGAL changes preceded serum Cr raises by nearly 2 days.

Early Diagnostic Markers for Detection of Acute Kidney Injury in Allogeneic Hematopoietic Stem Cell Transplant Recipients

“…Although there were positive correlations between urine NGAL levels and serum creatinine and negative correlations with creatinine clearances, none of these reached statistically significance. We were also unable to find significant associations in our regression model, in contrast to that conducted by Taghizadeh-Ghehi et al 26 The relatively small sample size may have masked the possible value of urine NGAL levels in predicting AKI in our study. In addition, more frequent measurements of urine NGAL levels could be more effective for documenting renal function decline, since urine NGAL levels might change more rapidly due to the possible effects of various factors, such as direct drug toxicity, portal hypertension due to sinusoidal obstruction syndrome, renal hypoperfusion, and renal hemodynamic changes due to infections and sepsis after AHSCT.…”

Early Predictors of Acute Kidney Injury: A Narrative Review

“…NGAL demonstrated a sensitivity of 85% and specificity of 83% for predicting AKI after hematopoietic stem cell transplantation (HSCT). The changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients [64]. NGAL levels can be used as an AKI biomarker after extracorporeal circulation cardiac surgery and aortic valve replacement; after aortic valve replacement, NGAL levels more than 136 ng/ml show an obvious correlation with early treatment intervention.…”

Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation

“…28 The role of urinary NGAL in predicting AKI has been demonstrated in adults who have undergone HSCT for oncological reasons: as markers of AKI, elevated urinary NGAL preceded increased serum creatinine by 2 days. 31 No such investigation has been performed in children who have undergone HSCT.…”