Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study

Zappitelli, Michael; Washburn, Kimberly K.; Arıkan, Ayşe; Loftis, Laura; Ma, Qing; Devarajan, Prasad; Parikh, Chirag R.; Goldstein, Stuart L.

doi:10.1186/cc6089

Cited by 374 publications

(309 citation statements)

References 31 publications

(42 reference statements)

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“…In this case-control study of AKI in preterm infants, we found that urinary biomarkers were associated with AKI, defined Urine NGAL has been recently reported to be a useful early AKI marker that predicted development of severe AKI in a heterogeneous group of pediatric patients admitted to the PICU with unknown timing of kidney injury (15). A multicenter pooled analysis of prospective studies shows that NGAL can predict mortality even in the absence of diagnostic increases in serum creatinine (16).…”

Section: Discussionmentioning

confidence: 67%

Early urinary biomarkers of acute kidney injury in preterm infants

et al. 2016

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Background: Acute kidney injury (AKI) in the neonatal intensive care setting is multifactorial and is associated with significant morbidity and mortality. This study evaluates the utility of novel urinary biomarkers to predict the development and/or severity AKI in preterm infants. Methods: We performed a case-control study on a prospective cohort of preterm infants (<32 wk), to compare seven urine biomarkers between 25 infants with AKI and 20 infants without AKI. results: Infants with AKI had significantly higher neutrophil gelatinase-associated lipocalin (NGAL) (median, control (CTRL) vs. AKI; 0.598 vs. 4.24 µg/ml; P < 0.0001). In contrast, urinary epidermal growth factor (EGF) levels were significantly lower in infants who developed AKI compared to controls (median, CTRL vs. AKI; 0.016 vs. 0.006 µg/ml; P < 0.001). The area under the curve (AUC) for NGAL for prediction of stage I AKI on the day prior to AKI diagnosis (day-1) was 0.91, and for the prediction of stage II/III, AKI was 0.92. Similarly, urine EGF was a predictor of renal injury on day -1 (AUC: 0.97 for stage I and 0.86 for stage II/III AKI). conclusion: Urinary biomarkers may be useful to predict AKI development prior to changes in serum creatinine (SCr) in preterm infants.

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Section: Discussionmentioning

confidence: 67%

Early urinary biomarkers of acute kidney injury in preterm infants

et al. 2016

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“…It was shown previously in many clinical studies and has been accepted that NGAL and Cystatin C levels increase in different clinical settings leading to AKI development [10][11][12][13][14][15][16][17][18][19][20][21][22]. Since the aim of this study is to define the roles of Cystatin C and NGAL in predicting septic AKI development, the patients who had other risk factors, rather than sepsis, that would lead to AKI and increase the Cystatin C and NGAL levels (i.e., nonseptic-AKI patients) were excluded from the study.…”

Section: Exclusion Criteriamentioning

confidence: 98%

“…They concluded that urine NGAL is probably a more robust marker of AKI than plasma NGAL in patients with septic shock since urine NGAL levels remain within normal limits even when plasma levels are high and signs of AKI are absent. Previous studies on pediatric ICU patients have also shown that serum NGAL is a nonspecific predictor [19] and urine NGAL is a good predictor of AKI [13]. Bagshaw et al, also studied plasma and urine NGAL levels in early diagnosis of AKI in septic patients [15].…”

Section: Parametermentioning

confidence: 99%

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The Use of Plasma and Urine Neutrophil Gelatinase Associated Lipocalin (NGAL) and Cystatin C in Early Diagnosis of Septic Acute Kidney Injury in Critically Ill Patients

et al. 2013

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Abstract. AIM:To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients. METHODS: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge. RESULTS: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively). CONCLUSION: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.

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“…19 In adult cardiac surgery and critically ill children, the predictive ability of these urinary biomarkers for early diagnosis of AKI have been modest, largely reflecting the greater complexity of these populations. [20][21][22][23] Recently, in a prospective study of 635 adults presenting to the emergency department, a single elevated urinary NGAL was shown to predict a composite of development of AKI and the need for RRT, nephrology consultation, and/or ICU admission. 24 Similarly, serum NGAL and cystatin C have been found to be promising diagnostic biomarkers for early detection of AKI in a range of clinical settings, including cardiac surgery, contrast-induced nephropathy, and sepsis.…”

Section: Acute Kidney Injury Predictionmentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study

Cited by 374 publications

References 31 publications

Early urinary biomarkers of acute kidney injury in preterm infants

Early urinary biomarkers of acute kidney injury in preterm infants

The Use of Plasma and Urine Neutrophil Gelatinase Associated Lipocalin (NGAL) and Cystatin C in Early Diagnosis of Septic Acute Kidney Injury in Critically Ill Patients

Review article: Acute kidney injury in critical illness

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