Urine neutrophil gelatinase-associated lipocalin identifies unilateral and bilateral urinary tract obstruction

Sise, Meghan E.; Forster, Catherine S.; Singer, Eugenia; Valle, David Solá-Del; Hahn, Barry; Schmidt‐Ott, Kai M.; Barasch, Jonathan; Nickolas, Thomas L.

doi:10.1093/ndt/gfr569

Cited by 18 publications

(19 citation statements)

References 12 publications

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“…However, our analysis shows that there are minimal differences in the predictive accuracy of uNGAL for UTI when patients with augmented bladders are included and excluded for the cohort, suggesting that the gastrointestinal epithelium is not a large contributor of uNGAL in this clinical setting. Other potential confounders include the possibility of obstruction, as uNGAL concentrations are elevated in the setting of acute urinary tract obstruction [27]. However, the increase in uNGAL concentrations in acute obstruction is likely due to acute kidney injury, which is not present in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Forster

Jackson

et al. 2018

Pediatr Nephrol

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Background Distinguishing between urinary tract infection (UTI) and colonization (UTC) in patients with neurogenic bladders who require clean intermittent catheterization (CIC) is difficult. Urinary neutrophil gelatinase-associated lipocalin concentrations (uNGAL) are increased in UTIs. Our objective was to determine the predictive accuracy of uNGAL for UTI in CIC-dependent children. Methods Cross-sectional study of CIC-dependent patients from August, 2015 to November, 2016. UTI was defined as (1) growth of ≥ 50,000 cfu/mL of a uropathogen, (2) > 10 urinary white blood cells/hpf, and (3) ≥ 2 of the following: temperature > 38 °C, abdominal pain, back pain, worsened incontinence, pain with catheterization, or malodorous/cloudy urine. Positive urine cultures that did not meet these criteria were grouped as UTC, and negative cultures were grouped as no growth. Results Two hundred one patients were included (no growth = 100, UTC = 77, UTI = 24). Median (interquartile range) uNGAL was higher in the UTI group (UTI 1361 (931, 2516) μg/g creatinine, UTC 246 (106, 548) μg/g creatinine, no growth 36 (11, 179) μg/g creatinine, p < 0.01 for all comparisons). The area under the ROC curve for uNGAL for UTI versus no UTI was 0.89, 95% CI (0.80–0.98). Conclusion uNGAL is elevated in CIC-dependent children with UTI compared to those with negative cultures and those with UTC.

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Section: Discussionmentioning

confidence: 99%

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Forster

Jackson

et al. 2018

Pediatr Nephrol

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“…Gene expression analysis has shown differences in the genes expressed in acute kidney injury due to different processes, even if the magnitude of rise in creatinine is the same. Conversely, serum creatinine concentration can be normal with documented tubular injury due to the delayed achievement of detectable changes of this analyte (74). Generally, hemodynamically driven increases in serum creatinine resolve with treatment in 24 to 72 h, whereas the cellular derangements due to acute tubular damage, or even necrosis, may last for weeks (75).…”

Section: Knowledge Gaps In the Use Of Extracorporeal Uf In Heart Failurementioning

confidence: 99%

“…A systematic study of thousands of genes encoding for several biomarkers including NGAL, kidney injury molecule-1, tissue inhibitor of metalloproteinase-1, and clusterin, found that these molecules were detectable after a brief dose of ischemia, yet none of these genes were expressed after near-fatal volume depletion, despite the rise in serum creatinine in both models (80). Although this method is not yet widely available, in the setting of any method of fluid removal, the levels of urine NGAL and other biomarkers of tubular injury could potentially help distinguish a rise in serum creatinine due to a hemodynamically mediated decrease in glomerular filtration rate or actual tubular injury (74). Numerous genes are differentially expressed depending upon the presence and type of acute kidney injury.…”

Section: Knowledge Gaps In the Use Of Extracorporeal Uf In Heart Failurementioning

confidence: 99%

Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure

Costanzo

Ronco

Abraham

et al. 2017

Journal of the American College of Cardiology

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More than 1 million heart failure hospitalizations occur annually, and congestion is the predominant cause. Rehospitalizations for recurrent congestion portend poor outcomes independently of age and renal function. Persistent congestion trumps serum creatinine increases in predicting adverse heart failure outcomes. No decongestive pharmacological therapy has reduced these harmful consequences. Simplified ultrafiltration devices permit fluid removal in lower-acuity hospital settings, but with conflicting results regarding safety and efficacy. Ultrafiltration performed at fixed rates after onset of therapy-induced increased serum creatinine was not superior to standard care and resulted in more complications. In contrast, compared with diuretic agents, some data suggest that adjustment of ultrafiltration rates to patients’ vital signs and renal function may be associated with more effective decongestion and fewer heart failure events. Essential aspects of ultrafiltration remain poorly defined. Further research is urgently needed, given the burden of congestion and data suggesting sustained benefits of early and adjustable ultrafiltration.

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“…As NGAL is a marker of tubular injury, it may have clinical use as a marker of renal damage due to a variety of obstructive conditions. Early work in adults suggests that uNGAL is superior to serum creatinine in identifying both bilateral and unilateral obstruction [21]. Subsequently, in children, uNGAL has shown promise as a marker of ureteropelvic junction obstruction [22], and in patients with renal dysfunction due to hydronephrosis [23].…”

Section: Ngal and Urinary Tract Obstructionmentioning

confidence: 99%

Neutrophil gelatinase-associated lipocalin: utility in urologic conditions

Forster

Devarajan

2016

Pediatr Nephrol

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Neutrophil gelatinase-associated lipocalin (NGAL) is best known as a non-invasive early marker of acute kidney injury (AKI). However, recent reports in the literature have described additional utility of both plasma NGAL (pNGAL) and urine NGAL (uNGAL) in various pathologic conditions within the pediatric urinary tract, including urinary tract infection (UTI), vesicoureteral reflux (VUR), renal scarring, and obstructive uropathy. These two forms of NGAL have different applications related to their mechanisms of upregulation: pNGAL can serve as a marker of systemic inflammatory conditions, whereas uNGAL is specific for insults to the renal epithelium. Therefore, pNGAL has good predictive accuracy in systemic inflammation associated with pyelonephritis and renal damage, while uNGAL is effective in identifying infection with the genitourinary environment as well as subclinical renal damage as a result of scarring or obstruction. Continued work should focus on the effect of trending NGAL values in patients with pyelonephritis, VUR, and hydronephrosis, to determine if longitudinal NGAL patterns have value in predicting adverse outcomes.

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Urine neutrophil gelatinase-associated lipocalin identifies unilateral and bilateral urinary tract obstruction

Abstract: uNGAL identifies kidney injury in unilateral and bilateral UTO even in the absence of an elevated sCr.

Cited by 18 publications

References 12 publications

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure

Neutrophil gelatinase-associated lipocalin: utility in urologic conditions

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