Plasma neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis

Objectives

The aim of this study was to investigate the diagnostic utility of plasma neutrophil gelatinase-associated lipocalin (NGAL) as an early objective biomarker to predict acute kidney injury (AKI) in critically ill patients with suspected sepsis, for whom procalcitonin (PCT) was used for the diagnosis and staging of sepsis.

Design and methods

Plasma NGAL was measured using the Triage NGAL Test (Alere, Inc., San Diego, CA, USA) in 231 samples obtained from patients with suspected sepsis. The results of NGAL were compared with those of Elecsys BRAHMS PCT (Roche Diagnostics, Basel, Switzerland). Renal failure was assessed using the renal subscore of Sepsis-related Organ Failure Assessment (SOFA) score. AKI was defined according to the Acute Kidney Injury Network criteria.

Results

The concentrations of plasma NGAL were significantly different according to the five groups of PCT concentration (P < 0.0001) and the renal subscore of SOFA score (P < 0.0001). Plasma NGAL was significantly increased in the patients with AKI compared with those without AKI (416.5 ng/mL vs. 181.0 ng/mL, P = 0.0223).

Conclusion

Plasma NGAL seems to be a highly sensitive and objective predictor of AKI in patients with sepsis. Plasma NGAL can be added for the diagnosis and staging of renal failure in sepsis.     

急性肾损伤早期的分子标志物——NGAL

急性肾损伤(AKI)是由各种原因引起的肾功能在短时间(几小时至几天)内突然下降而出现的临床综合症。由于早期缺乏特异性的生物指标,给该病的早期治疗带来障碍。中性粒细胞明胶酶相关脂质运载蛋白(NGAL)是lipocalin家族的新成员,其结构与功能研究进展为人瞩目,众多研究表明NGAL基因可能是人类的一种重要的癌基因和一种重要的细菌抑制剂;NGAL还参与肾小管上皮细胞的发生及功能调控,对肾脏功能的诊断价值比传统的急性肾衰竭(ARF)实验室指标血肌酐更为快速和准确,是AKI最强有力的预测因子。     

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

Introduction  

Serum creatinine is a late marker of acute kidney injury (AKI). Urine neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of AKI, where the timing of kidney injury is known. It is unknown whether uNGAL predicts AKI in the general critical care setting. We assessed the ability of uNGAL to predict AKI development and severity in critically ill children.     

Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for early acute kidney injury

Based on information to date, although limitations in the accuracy of NGAL in predicting AKI persist, the preponderance of published studies demonstrate that NGAL, when measured in the plasma and in the urine, is?a reliable biomarker for the subsequent development of clinically apparent AKI. If very early detection of AKI, via the measurement of plasma or urinary NGAL, can be followed by effective treatment to abort the development or limit the severity of AKI, and therefore decrease the rate of RRT, length of hospitalization stay, and/or mortality risk, NGAL measurement will become a critically important diagnostic tool in critical care medicine, pediatrics, and surgery.     

Plasma neutrophil gelatinase-associated lipocalin as a predictive biomarker for the detection of acute kidney injury in adult poisoning

Context: Acute kidney injury (AKI) is a serious complication in intoxicated patients. Recently, a new biomarker - neutrophil gelatinase-associated lipocalin (NGAL) - was used to predict AKI in patients who were critically ill or had sepsis. Objective: To evaluate the utility of plasma NGAL as an early predictor of AKI in adults with acute poisoning. Materials and methods: This retrospective, observational, cohort study was conducted between December 2013 and November 2014. A total of 157 consecutive adult patients who presented to the emergency department (Level 1 regional center) of Kyungpook National University Hospital, a tertiary teaching hospital in Daegu, Korea, within 24 h of poisoning were included. Initial plasma NGAL levels and laboratory parameters were concurrently measured upon hospital arrival. AKI was defined according to Acute Kidney Injury Network criteria. Development of AKI was predicted using plasma NGAL levels and by analyzing the area under the receiver operating characteristic curve (AUC). Results: The overall rate of AKI was 14.6% (n?=?23). Plasma NGAL levels in the AKI group were higher than those in the non-AKI group (median, 310 vs. 86 ng/mL; p?<0.001). Additionally, baseline NGAL levels allowed for better prediction of AKI than initial creatinine levels. The AUC of plasma NGAL was 0.895 (95% confidence interval [CI]: 0.832–0.941), with a cut-off value of 227 ng/mL (sensitivity, 76.2%; specificity, 95.8%). Plasma NGAL had a higher predictive capacity for AKI than serum creatinine (AUC 0.741, 95% CI: 0.662–0.810), base deficit (AUC 0.795, 95% CI: 0.701–0.870), lactate (AUC 0.781, 95% CI: 0.690–0.856), and anion gap (AUC 0.636, 95% CI: 0.535–0.730). Conclusion: Plasma NGAL may serve as a good predictor of AKI in cases of adult poisoning.     

中性粒细胞明胶酶相关脂质运载蛋白在急性肾损伤中的保护作用

急性肾损伤(AKI)在临床上较为常见,且预后较差,需及早干预,但是目前临床上常用的诊断方法主要依赖于功能性指标,如血清肌酐(SCr)检测。然而由于检测技术的局限,SCr异常出现较晚,且其检测结果亦有可能出现一定的偏差,这对于临床上及时诊断及干预AKI非常不利。因此迫切需要一种能明确早期肾脏损伤的生物标志物。近年来,许多学者在寻找早期AKI的生物学标记物方面做了一定的探索,逐渐发现一些有潜在应用价值的指标,如中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)、白细胞介素-18(IL-18)、半胱氨酸蛋白酶抑制剂C(Cys C)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、肝脏脂肪酸结合蛋白(L-FABP)等,其中NGAL作为早期AKI生物标志物的研究倍受关注。一些研究显示NGAL在肾脏保护、炎症反应、肿瘤发生等方面亦发挥重要作用,但其具体作用机制目前尚未完全阐明。文章仅就NGAL在AKI发生过程中所发挥的保护作用及其参与机制做相关综述。     

NGAL在成人心脏术后急性肾损伤中的早期应用价值探讨

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在成人心脏术后急性肾损伤(AKI)早期诊断中的应用价值。方法收集成人心脏手术患者62例,分别在其术前及术后6、24、48 h采集血液标本。采用酶法检测血清肌酐(SCr),并以48 h内SCr上升至≥26.5μmol/L作为AKI的诊断标准,其中23例发生AKI(AKI组)、39例未发生AKI(无AKI组)。应用乳胶增强免疫透射比浊法分别检测2组患者的血清NGAL和半胱氨酸蛋白酶抑制剂C(Cys C)水平。结果与术前比较,AKI组术后6、24、48 h血清NGAL水平均明显上升(P0.01);血清Cys C水平在术后24、48 h明显上升(P0.01)。无AKI组术后6、24、48 h血清NGAL水平差异均无统计学意义(P0.05);血清Cys C水平术后6、24 h差异无统计学意义(P0.05),术后48 h升高(P0.05)。结论血清NGAL水平在成人心脏术后发生AKI 6 h即明显上升,明显早于Cys C和SCr。血清NGAL可以作为早期诊断成人心脏术后AKI的标志物。     

Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population

Purpose  

Neutrophil gelatinase-associated lipocalin (NGAL) is a useful marker for acute kidney injury (AKI), particularly when the timing of renal insult is known. However, its performance in an adult critical care setting has not been well described. We performed this study to estimate the diagnostic accuracy of plasma NGAL for early detection of AKI and need for renal replacement therapy (RRT) in an adult intensive care unit (ICU).     

Acute kidney injury in critically ill patients with pandemic influenza A pneumonia 2009 in Korea: a multicenter study

Objectives

We assessed the incidence and clinical characteristics of acute kidney injury (AKI) in critically ill patients infected with pandemic influenza A (H1N1) and its effect on clinical outcomes.

Methods

We conducted a multicenter, retrospective, observational study of patients with pandemic H1N1-related critical illness admitted to intensive care units (ICUs) of 28 tertiary or referral hospitals in South Korea between September 1, 2009, and February 28, 2010. Outcomes were AKI within 72 hours after ICU admission and 30-day mortality. Acute kidney injury was defined according to the Risk, Injury, Failure, Loss, and End-stage renal failure criteria.

Results

Of the 221 patients, 50 (22.6%) developed AKI within 72 hours after ICU admission. Independent risk factors for AKI were age (odds ratio [OR], 1.05; P = .003), chronic kidney disease (OR, 14.82; P = .004), and Sequential Organ Failure Assessment score (OR, 1.45; P < .001). Age (OR, 1.04; P = .003), Sequential Organ Failure Assessment score (OR, 1.28; P = .012), state of immune suppression (OR, 4.09; P = .01), mechanical ventilation (OR, 18.24; P = .001), corticosteroid use (OR, 3.09; P = .007), and AKI (OR, 2.86; P = .035) were significantly associated with 30-day mortality.

Conclusions

A significant number of patients with H1N1-related critical illness developed AKI within 72 hours of ICU admission, and this early development of AKI was associated with 30-day mortality.     

Neutrophil gelatinase-associated lipocalin does not predict acute kidney injury in heart failure

BACKGROUND Acute cardiorenal syndrome type 1(CRS-1)is defined by a rapid cardiac dysfunction leading to acute kidney injury(AKI).Neutrophil gelatinaseassociated lipocalin(NGAL)is expressed on the surface of human neutrophils and epithelial cells,such as renal tubule cells,and its serum(sNGAL)and urinary have been used to predict AKI in different clinical settings.AIM To characterize CRS-1 in a cohort of patients with acute heart diseases,evaluating the potentiality of sNGAL as an early marker of CRS-1.METHODS We performed a retrospective cohort,multi-centre study.From January 2010 to December 2011,we recruited 202 adult patients admitted to the coronary intensive care unit(CICU)with a diagnosis of acute heart failure or acute coronary syndrome.We monitored the renal function to evaluate CRS-1 development and measured sNGAL levels within 24 h and after 72 h of CICU admission.RESULTS Overall,enrolled patients were hemodynamically stable with a mean arterial pressure of 92(82-107)mmHg,55/202(27.2%)of the patients developed CRS-1,but none of them required dialysis.Neither the NGAL delta value(AUC 0.40,95%CI:0.25-0.55)nor the NGAL peak(AUC 0.45,95%CI:0.36-0.54)or NGAL cutoff(≥140 ng/mL)values were statistically significant between the two groups(CRS-1 vs no-CRS1 patients).The area under the ROC curve for the prediction of CRS-1 was 0.40(95%CI:0.25-0.55)for the delta NGAL value and 0.45(95%CI:0.36-0.54)for the NGAL peak value.Finally,in multivariate analysis,the risk of developing CRS-1 was correlated with age>60 years,urea nitrogen at admission and 24 h-urine output(AUC 0.83,SE=60.5%SP=93%),while sNGAL was not significantly correlated.CONCLUSION In our population,sNGAL does not predict CRS-1,probably as a consequence of the mild renal injury and the low severity of heart disease.So,these data might suggest that patient selection should be taken into account when considering the utility of NGAL measurement as a biomarker of kidney damage.     

重症急性肾损伤患儿尿中性粒细胞明胶酶相关脂质运载蛋白和尿白细胞介素18联合检测的临床价值

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)和尿白细胞介素18 (uIL-18)联合检测对危重症儿童急性肾损伤(AKI)的早期诊断价值和判断病情严重程度及预后中的作用.方法 选取2012年5月至2013年12月广州市妇女儿童医疗中心儿科重症监护室的重症AKI患儿37例(重症AKI组)、重症非AKI患儿22例(重症非AKI组),以及来院健康体检的0～ 14岁儿童30名(健康对照组)为研究对象.检测分析观察对象的uNGAL和uIL-18变化,以及与内生肌酐清除率(Ccr)的关系.结果 重症AKI组uNGAL(156.88 ±59.67) μg/L、uIL-18 (3.95±1.08) μg/L水平较重症非AKI组[(26.38±12.01)、(0.24 ±0.15) μg/L]以及健康对照组[(20.08 ±8.03)、(0.17 ±0.13)ug/L]明显升高(F值分别为125.69、302.97,P均＜0.01).重症AKI患儿AKI诊断前2d的uNGAL和uIL-18的ROC曲线下面积分别为0.882(95％ CI为0.787～0.977,P＜0.05)和0.840(95％ CI为0.729 ～ 0.951,P＜0.05);AKI诊断前1 d uNGAL和uIL-18的ROC曲线下面积分别为0.867(95％ CI为0.766 ～0.968,P＜0.05)和0.873(95％ CI为0.767 ～ 0.979,P＜0.05).AKI诊断前1 d,两者与Ccr呈负相关(r=-0.578,P＜0.05,r=-0.480,P＜0.05).AKI诊断当天,两者与Ccr呈负相关(r=-0.434,P＜0.05,r=-0.660,P＜0.05).结论 uNGAL和uIL-18联合检测可作为重症患儿发生AKI早期诊断和判断短期预后的标志物.     

尿肾损伤分子1和中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤患者早期连续性肾脏替代治疗的预测价值

目的探讨尿肾损伤分子1（KIM-1）及中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对脓毒症合并急性肾损伤（AKI）患者早期连续性肾脏替代治疗（CRRT）的预测价值。 方法选择温州市人民医院2012年7月至2015年11月收治的脓毒症合并AKI的患者159例,根据是否CRRT治疗,分为非CRRT组（92例）及CRRT组（67例）。收集所有患者尿液标本,采用酶联免疫吸附测定法检测尿KIM-1及NGAL水平。对两组患者的一般资料进行比较,并采用Logistic回归分析影响脓毒症合并AKI患者早期CRRT治疗的相关因素。同时通过受试者工作特征曲线（ROC）评价尿KIM-1、NGAL浓度在预测脓毒症AKI患者需CRRT的价值。 结果非CRRT组及CRRT组患者在年龄[（65 ± 18）岁vs.（77 ± 11）岁,t=26.380,P<0.001]、腹腔感染[8/92 vs. 23/67,χ²=16.228,P<0.001]、四肢皮肤软组织感染[19/92 vs. 2/67,χ²=10.556,P<0.001]、冠心病[46/92 vs. 50/67,χ²=9.828,P=0.002]、糖尿病[24/92 vs. 38/67,χ²=15.289,P<0.001]、慢性心功能不全[36/92 vs. 52/67,χ²=23.229,P<0.001]、气管插管留置>48 h [32/92 vs. 35/67,χ²=5.239,P=0.024]、急性病生理学和长期健康评价（APACHE）Ⅱ评分[（16 ± 6）分vs.（22 ± 5）分,t=40.671,P<0.001]、尿KIM-1 [（17 ± 4）ng·L^-1·Cr^-1 vs.（29 ± 19）ng·L^-1·Cr^-1,t=34.849,P<0.001]及NGAL水平[（5.7 ± 1.4）ng·L^-1·Cr^-1 vs.（7.7 ± 1.6）ng·L^-1·Cr^-1,t=65.483,P<0.001]的比较差异均有统计学意义。Logistic回归分析统计结果显示：糖尿病、慢性心功能不全、APACHEⅡ评分>18分、尿KIM-1浓度>21.0 ng·L^-1·Cr^-1及NGAL浓度>6.5 ng·L^-1·Cr^-1是影响脓毒症AKI患者选择CRRT治疗的相关因素;尿KIM-1、NGAL水平及两者联合预测患者需CRRT治疗的ROC曲线下面积分别为：0.783（95%CI：0.702~0.864,P<0.05）、0.819（95%CI：0.753~0.886,P<0.05）及0.867（95%CI：0.810~0.923,P<0.05）;NGAL及KIM-1的约登指数分别为0.465和0.502,两者联合后,约登指数为0.603。 结论尿KIM-1及NGAL水平对早期预测脓毒症合并AKI患者介入CRRT治疗有一定的应用价值,且两者联合检测更具有预测价值。     

血中性粒细胞明胶酶相关脂质运载蛋白对ICU中急性肾损伤的早期诊断价值

目的研究检测血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对重症患者急性肾损伤(AKI)的早期诊断价值。方法以2011年1月到2011年9月收入首都医科大学附属复兴医院ICU的重症患者作为研究对象,登记患者284例,最终有268例患者纳入研究,其中AKI组112例,非AKI组156例,并选取40例健康体检者作为健康对照组。研究组留取患者入选时血样和入选后1～4 d血样,用酶联免疫吸附法(ELISA)检测血清NGAL(pNGAL)水平。用受试者工作特征曲线(ROC)评价pNGAL对AKI的早期诊断作用以及预测需肾脏替代治疗(RRT)和AKI严重程度的关系。结果血NGAL可以诊断入ICU后48 h内的AKI发生,ROC曲线下面积为0.82(95%CI 0.68～0.93);预测RRT的使用,ROC曲线下面积为0.84(95%CI 0.73～0.95);与AKI的严重程度密切相关(R=0.554,P<0.001)。结论在成人普通ICU中血NGAL可以成为AKI的早期诊断标记物,能预测RRT的使用,与AKI的严重程度密切相关。     

Plasma and urine neutrophil gelatinase-associated lipocalin in the diagnosis of new onset acute kidney injury in critically ill patients

Introduction

Neutrophil gelatinase-associated lipocalin (NGAL) has been demonstrated to be a useful early diagnostic biomarker of acute kidney injury (AKI) where the timing of the insult is certain. However, NGAL is not well validated in adult critical care practice because of indeterminate timing of injury. Therefore, we sought to establish the predictive ability of both urine and plasma NGAL to detect AKI in ICU patients.

Method

This prospective observational study was performed in a busy large district general hospital mixed surgical-medical ICU in Reading, UK. Consecutive adult admissions to the ICU, with absence of chronic kidney disease, renal transplant or AKI as defined by RIFLE criteria were included. Blood and urine specimens were collected at admission and every 24 hours until 72 hours and tested for NGAL. The purpose of the study was to assess whether urinary NGAL (uNGAL) or plasma NGAL (pNGAL) can predict the occurrence of AKI at an earlier point of time than the conventional markers, that is creatinine and urine output as is used in RIFLE criteria.

Results

Over a 12-month period, 194 patients were enrolled. In total, 59 (30.4%) patients developed AKI. The admission pNGAL and uNGAL were significantly higher in the patients who developed AKI compared to the non-AKI patients (436 ng/mL (240, 797) versus 168 ng/mL (121.3, 274.3) P <0.001 and 342 ng/mL (61.5, 1,280) versus 34.5 ng/mL (11.5, 107.75) P <0.001 respectively). Hospital mortality was higher in the AKI group (17% versus 4%). Plasma NGAL performed fairly on admission (AUROC 0.77) and thereafter performance improved at 24 and 48 hours (AUROC 0.88 and 0.87) following ICU admission. Urine NGAL had a fair predictive value on admission (AUROC 0.79) and at 24 hours (AUROC 0.78) and was good at 48 hours (AUROC 0.82).

Conclusions

In critically ill patients without pre-existing kidney disease, both pNGAL and uNGAL measured at admission can predict AKI (defined by RIFLE criteria) occurrence up to 72 hours post-ICU admission and their performance (AUROC) was fair. The accuracy of NGAL appeared to improve slightly as patients progressed through their ICU stay. Serial measurements of NGAL (both pNGAL and uNGAL) may be of added value in an ICU setting to predict the occurrence of AKI.     

Challenges facing early detection of acute kidney injury in the critically ill

Recent advances in the detection of acute kidney injury (AKI) afford the possibility of early intervention. Proteomics and genomics have identified many markers of tubular cell injury, some of which are manifest in the urine. One trial has used novel injury biomarkers to recruit patients to an intervention prior to an elevation in plasma creatinine. This trial and other recent studies have shown that the use of biomarkers of injury will depend on the time the patient presents following insult to the kidney, the likely cause of that insult, and the pre-injury renal function of that patient. The definition of AKI is likely to change in the near future to include a measure of injury. We anticipate novel therapies becoming available following successful trials that utilize the methodology of early intervention following an elevated injury biomarker.     

血清中性粒细胞明胶酶相关脂质运载蛋白检测在急性肾功能损伤早期诊断中的临床意义

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)检测在急性肾功能损伤(AKI)早期诊断中的意义。方法收集无慢性肾病的重症监护病房(ICU)、冠心病监护病房(CCU)患者60例,分别在其术前及术后6、12、48 h采集血样,其中27例发生AKI(AKI组),以其余33例未发生AKI(无AKI组)。应用酶联免疫吸附试验(ELISA)检测血清NGAL浓度,碱性苦味酸法检测血清肌酐(SCr)浓度,胶乳增强免疫浊度法检测血清半胱氨酸蛋白酶抑制剂C(Cys C)浓度。以48 h内SCr高于基础水平50%作为AKI的诊断标准,应用受试者工作特征(ROC)曲线评估NGAL在AKI早期诊断中的效力。结果与术前比较,AKI组术后6、12、48 h的血清NGAL明显升高,Cys C在术后12、48 h明显升高,而SCr在术后48 h才显著升高。无AKI组术前与术后6、12、48 h的NGAL、SCr、Cys C浓度差异无统计学意义(P>0.05)。术后6、12、48 h血清NGAL的ROC曲线下面积为0.51[95%可信区间(CI):0.25～0.78]、0.80(95%CI:0.58～0.95)、0.85(95%CI:0.61～0.99)。结论血清NGAL在术后6 h上升,术后12 h即能较好地预测AKI,其预测AKI时间早于Cys C和SCr。血清NGAL可能在AKI早期诊断中有良好的应用价值。     

Serum bicarbonate may independently predict acute kidney injury in critically ill patients:An observational study

AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 2010 to 2012).The ICU has a case mix of medical and surgical patients excluding cardiac surgical,trauma and neurosurgical patients.We analysed 2035 consecutive patients admitted to ICU during the study period.Data were collected by two investigators independently and in duplicate using a standardised spread sheet to ensure accuracy.Ambiguous data were checked for accuracy where indicated.AKI was defined using the Kidney Disease Improving Global Outcomes criteria.Patients were divided into two groups;patients who developed AKI or those who did not,in order to compare the baseline characteristics,and laboratory and physiologic data of the two cohorts.Regression analysis was used to identify if serum bicarbonate on admission predicted the development of AKI.RESULTS:Of 2036 patients 152(7.5%)were excluded due to missing data.AKI developed in 43.1%of the patients.The AKI group,compared to the nonAKI group,was sicker based on their lower systolic,diastolic and mean arterial pressures and a higher acutephysiology and chronic health evaluation(APACHE)Ⅲand SAPSⅡscores.Moreover,patients who developed AKI had more co-morbidities and a higher proportion of patients who developed AKI required mechanical ventilation.The multi-regression analysis of independent variables showed that serum bicarbonate on admission(OR=0.821;95%CI:0.796-0.846;P0.0001),APACHEⅢ(OR=1.011;95%CI:1.007-1.015;P0.0001),age(OR=1.016;95%CI:1.008-1.024;P0.0001)and presence of sepsis at ICU admission(OR=2.819;95%CI:2.122-23.744;P=0.004)were each significant independent predictors of AKI.The area under the ROC curve was 0.8(95%CI:0.78-0.83),thereby demonstrating that the predictive model has relatively good discriminating power for predicting AKI.CONCLUSION:Serum bicarbonate on admission may independently be used to make a diagnosis of AKI.     

Urinary neutrophil gelatinase-associated lipocalin as a marker for disease activity in lupus nephritis

The neutrophil gelatinase-associated lipocalin (NGAL) has been emerging as a novel biomarker of acute kidney injury while its value in lupus nephritis is uncertain. The aim of this study was to assess urinary NGAL levels as a marker for disease activity in patients with lupus nephritis.This study included 70 systemic lupus erythematosus (SLE) patients; 50 with active lupus nephritis (LN) and 20 without as well as 20 matched controls. The neutrophil gelatinase-associated lipocalin (NGAL) in both serum and urine samples was measured by enzyme-linked immunosorbent assay (ELISA). Patients with active LN received standard treatment then assessed for response as well as the value of urinary NGAL (uNGAL). Our results revealed that, The SLE patients with or without LN had an elevated urinary NGAL as compared to controls (p?相似文献   

A promising marker in early diagnosis of septic acute kidney injury of critically ill patients: urine insulin like growth factor binding protein-7

Aim: An ideal biomarker for early diagnosis of septic acute kidney injury (AKI) should reflect renal stress or damage at initiation point, at cellular level. The aim of this study was to assess the role of a urinary cell cycle arrest marker, insulin-like growth factor-binding protein 7 (IGFBP7) in early diagnosis of septic AKI in adult critical care patients.

Methods: This was a single-center prospective cohort study. Patients without AKI, admitted to a medical intensive care unit (ICU) between January 2010 and March 2013, were included. According to ‘sepsis’ and ‘AKI’ development during their ICU stay, they were grouped as ‘sepsis-non AKI’, ‘sepsis-AKI’ and ‘non-sepsis-non AKI (control)’. Among these groups, urine IGFBP7 was studied and compared with Human ELISA Kit/96 Test/USCNK^® first on admission and then on daily collected serial urine samples.

Results: A total of 118 patients formed the cohort; 52 in sepsis-non AKI, 43 in sepsis-AKI, 23 in control group. Admission urine IGFBP7 predicted septic AKI development with 72% sensitivity and 70% specificity for a threshold level of 2.5?ng/mL with an area under the receiver operating characteristics curve (AUC) of 0.79 (95% CI: 0.70–0.88). No impact of sepsis was observed on urine IGFBP7 levels in the absence of AKI. In the septic AKI group urine IGFBP7 levels continuously increased up to the day of AKI development and high levels were suspended for 10 days further.

Conclusion: Admission urine IGFBP7 levels and following its course in ICUs can be used as a promising new biomarker for the early diagnosis of septic AKI development without being affected by sepsis itself.     

Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: a prospective cohort study

IntroductionChildren admitted to a pediatric intensive care unit (ICU) are at high risk of developing acute kidney injury (AKI). Although serum creatinine (SCr) levels are used in clinical practice, they are insensitive for early diagnosis of AKI. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are novel AKI biomarkers whose performance in pediatric ICU patients is largely unknown. In this study, we aimed to characterize uNGAL and KIM-1 patterns in children following ICU admission and to assess their properties in relation to identifying children at risk for AKI development.MethodsFrom June 2010 until January 2014, we conducted a prospective observational cohort study of term-born children ages 1 day to 1 year on mechanical ventilation. Blood and urine samples were obtained every 6 to 12 hours up to 72 hours post-admission. Blood samples were assayed for SCr, and urine samples were assayed for uNGAL and KIM-1. The RIFLE (risk, injury, failure, loss, end-stage renal disease) classification as 150%, 200% or 300% of median SCr reference values was used to define AKI.ResultsA total of 100 children were included (80 survived). Their median age at admission was 27.7 days (interquartile range (IQR), 1.5 to 85.5). The median duration of mechanical ventilation was 5.8 days (IQR, 3.1 to 11.4). Thirty-five patients had evidence of AKI within the first 48 hours post-admission, of whom 24 (69%) already had AKI when they entered the ICU. uNGAL and KIM-1 concentrations in AKI peaked between 6 to 12 hours and between 12 to 24 hours post-admission, respectively. The maximal area under the receiver operating characteristic curve (AUC) for uNGAL was 0.815 (95% confidence interval (CI), 0.685 to 0.945, P <0.001) at 0 to 6 hours post-admission. The discriminative ability of KIM-1 was moderate, with a largest AUC of 0.737 (95% CI, 0.628 to 0.847; P <0.001) at 12 to 24 hours post-admission. At the optimal cutoff point (126 ng/ml), uNGAL concentration predicted AKI development correctly in 16 (84%) of 19 children, up to 24 hours before a rise in SCr became apparent.ConclusionsLevels of uNGAL and KIM-1 increase in patients with AKI following ICU admission and peak at 6 to 12 hours and 12 to 24 hours post-admission, respectively. uNGAL seems to be a reliable marker for identifying children who will develop AKI 24 hours later.