Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation

Hollmén, Maria; Kyllönen, L.; Inkinen, Kaija; Lalla, M.; Salmela, K.

doi:10.1038/ki.2010.351

Cited by 102 publications

(106 citation statements)

References 36 publications

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“…There is a limited literature investigating the utility of NGAL for the diagnostic and prognostic evaluation of AKI in kidney transplantation. Hollmen and colleagues [7], also the authors of the paper commented on here, previously found that urine NGAL from the recipient on the first post-transplant day was of moderate utility to predict DGF, particularly prolonged DGF that correlated with worse 1-year graft survival. Similarly, others have shown that a variety of biomarkers of renal tubular injury/damage [8-12] or serum cystatin C (a marker of kidney function/glomerular filtration rate (GFR)) [11,13] can similarly diagnose AKI secondary to DGF in the early post-transplant period better than a combination of the usual clinical parameters of kidney function (serial monitoring of serum creatinine and urine output) with known DGF risk factors (ischemia times, and so on).…”

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Diagnosis of kidney damage using novel acute kidney injury biomarkers: assessment of kidney function alone is insufficient

Murray

2011

Critical Care

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Acute kidney injury (AKI) is a syndrome that is associated with a major burden of morbidity and mortality in a variety of high risk patient populations, many of them cared for by intensivists. Following renal transplantation, delayed graft function (DGF) caused by severe acute tubular necrosis (ATN), defined by a requirement for dialysis during the initial post-transplant week, complicates postoperative management, and if prolonged (>14 days), adversely affects allograft survival. Neutrophil gelatinase-associated lipocalin (NGAL) and other novel biomarkers can detect AKI earlier than serum creatinine, and can predict AKI severity in high risk patient populations, including kidney transplant recipients. Hollmen and colleagues now demonstrate that elevated urine NGAL in deceased kidney donors is a significant risk factor for prolonged post-transplant DGF in recipients. These findings have clear implications with regard to potentially improved assessment of deceased donor suitability for potential renal allograft donation. These findings are also consistent with the growing evidence that severe ATN diagnosed by markedly elevated levels of AKI biomarkers is a useful predictor of the requirement for acute renal replacement therapy in AKI patients.

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Diagnosis of kidney damage using novel acute kidney injury biomarkers: assessment of kidney function alone is insufficient

Murray

2011

Critical Care

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“…Se le considera una lesión por isquemia y reperfusión (5) cuyos mecanismos fisiopatológicos involucran el estrés oxidativo, la disfunción mitocondrial y la activación inmunológica (7), lo que no permite la recuperación completa de las células renales, predispone a la atrofia y la muerte celular (8), aumenta el riesgo de rechazo agudo y crónico (3) y la estancia hospitalaria, y reduce la supervivencia del injerto renal (3,6,(9)(10)(11)(12).…”

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“…Aunque en la actualidad se sabe mucho sobre la fisiopatología de la función retardada del injerto, son pocas las estrategias de tratamiento conocidas (6); algunos tratamientos exitosos de la lesión por reperfusión en modelos animales no han sido efectivos en humanos (5,12), lo cual se explicaría por la detección tardía de la función retardada del injerto (8), ya que los biomarcadores actuales, que incluyen la creatinina sérica y la diuresis, son poco sensibles para predecirla (11,13). El hallazgo de nuevos biomarcadores que detecten en forma no invasiva y temprana la función retardada del injerto, permitiría la implementación de tratamientos para limitar el daño (3,6,14,15) y mejorar el resultado a largo plazo del injerto renal (8,16).…”

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“…El hallazgo de nuevos biomarcadores que detecten en forma no invasiva y temprana la función retardada del injerto, permitiría la implementación de tratamientos para limitar el daño (3,6,14,15) y mejorar el resultado a largo plazo del injerto renal (8,16).…”

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“…En algunos estudios en pacientes con trasplante de riñón se ha sugerido que la LAGN urinaria podría ser superior a la creatinina para la detección temprana de la función retardada del injerto, ya que su elevación puede registrarse dos horas después del trasplante renal (3,5,6,8,14,19,20).…”

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La lipocalina asociada con la gelatinasa de neutrófilos como factor temprano de predicción de la función retardada del injerto renal

et al. 2016

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Introducción. La función retardada del injerto renal se presenta en 20 a 50 % de los trasplantes renales. Objetivo. Describir el comportamiento de la lipocalina urinaria asociada a la gelatinasa de neutrófilos en receptores de trasplante renal de donante fallecido y compararlo con el porcentaje de descenso de la creatinina sérica para detectar tempranamente la función retardada del injerto renal. Materiales y métodos. Se evaluaron los niveles de lipocalina urinaria asociada a la gelatinasa de neutrófilos en una cohorte prospectiva 1, 12, 24 y 48 horas después del trasplante renal, y se compararon diariamente con los de la creatinina sérica hasta el quinto día del trasplante. Resultados. Se incluyeron en el estudio 79 pacientes con trasplante renal de donante fallecido. La función retardada del injerto renal se presentó en 13 pacientes (16,5 %) y cinco de ellos (6,3 %) necesitaron diálisis en la primera semana. Los valores de lipocalina urinaria asociada a la gelatinasa de neutrófilos en todos los puntos de corte fueron mayores en los pacientes con función retardada del injerto renal (p=0,526, p=0,049, p=0,032 y p=0,001, respectivamente). Se estableció un valor de más de 120 ng/ml a las 48 horas como factor de predicción de la función retardada del injerto, con una sensibilidad de 75 % y una especificidad de 71 %; el valor de creatinina sérica que mejor discriminó la función retardada se presentó a las 48 horas (59,5 %), con una sensibilidad de 92 % y una especificidad de 83 %. En la regresión logística los únicos valores significativos para predecir la función retardada del injerto renal fueron los de la creatinina serica. Conclusión. Los niveles de lipocalina urinaria asociada a la gelatinasa de neutrófilos a las 48 horas del trasplante renal predijeron la función retardada, incluida la necesidad de diálisis, pero no fueron superiores a los de la creatinina sérica para la detección temprana.

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Surface‐enhanced Raman scattering analysis of urine from deceased donors as a prognostic tool for kidney transplant outcome

Chi

Weng

et al. 2017

Journal of Biophotonics

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We report the utility of surface-enhanced Raman scattering (SERS) analysis of urine from deceased donors for prognosis of kidney transplant outcomes. Iodide-modified silver nanoparticles were used as the enabler for sensitive measurements of urine proteins. Principal component analysis (PCA) and linear discriminant analysis (LDA) were employed for the statistical analysis of the SERS data. Thirty urine samples in three classes were analysed. The ATN class consists of donors whose kidneys had acute tubular necrosis (ATN), the most common type of acute kidney injury (AKI) with high risk of poor graft performance in recipients, yet yielded acceptable transplant outcome. The DGF class is comprised of donors whose kidney had delayed graft function (DGF) in recipients. The control class includes donors whose kidneys did not have donor ATN or recipient DGF. We show a sensitivity of more than 90% in differentiating the ATN class from the DGF and control classes. Our methodology can thus help clinicians choose kidneys in the high-risk ATN category for transplant which would otherwise be discarded. Our research is impactful in that it could serve as a valuable guidance to expand the deceased donor pool to include those perceived as high-risk AKI type based on common urinary biomarkers.

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Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation

Cited by 102 publications

References 36 publications

Diagnosis of kidney damage using novel acute kidney injury biomarkers: assessment of kidney function alone is insufficient

Diagnosis of kidney damage using novel acute kidney injury biomarkers: assessment of kidney function alone is insufficient

La lipocalina asociada con la gelatinasa de neutrófilos como factor temprano de predicción de la función retardada del injerto renal

Surface‐enhanced Raman scattering analysis of urine from deceased donors as a prognostic tool for kidney transplant outcome

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