EARLY DIAGNOSIS OF ACUTE KIDNEY INJURY BY URINARY NEUTROPHIL GELATINASE ASSOCIATED LIPOCALIN IN ADULT CRITICALLY ILL PATIENTS

Authors

  • Muhammad Shoaib shifa international hospital
  • Syed Nayer Mahmud shifa international hospital
  • Muhammad Safdar SHIFA INTERNATIONAL HOSPITAL

Abstract

Background: Acute kidney injury (AKI) is a major cause of mortality and morbidity in the hospitalized patients. It is also a risk factor for chronic kidney disease and advance renal failure. Early diagnosis with new biomarkers for AKI can prevent and/or reverse the process before rise in serum creatinine and symptomatic renal failure. This study is aimed at the accuracy of Urine neutrophil gelatinase associated lipocalin (NGAL) for detection of AKI at an early stage. Methods: It is a descriptive, cross sectional study conducted in the Medical Intensive Care Unit of Shifa International Hospital, Islamabad. Total 97 patients admitted in intensive care unit, age from 18 to 75 years, fulfilling the inclusion criteria were included by non-probability, consecutive sampling technique. Duration of study was six months, from 1st February 2014 till 31st July 2014. Urine samples of study population were tested for NGAL and simultaneously serum creatinine levels were checked, which were repeated at 48 hours for diagnosis of AKI. Patients with AKI and positive values of NGAL were considered true positive while patients without AKI and negative values of NGAL were considered true negative. Accuracy of NGAL was then calculated and effect modifiers like age and gender checked by chi square testing. Results: Mean age of the participants was 57.76 years with the range of 26 to 74 years. Out of the total population of 97 patients, 48.5% were males and remainder 51.5% were females. The study found that the accuracy of the urinary NGAL in diagnosis of AKI when compared with serum creatinine was 90.7%. Conclusion: Urine NGAL is an accurate marker of AKI in critically ill patients. Therefore, it should be included in the diagnostic workup of AKI in early stages.Keywords: Urine neutrophil gelatinase associated lipocalin (Urine NGAL); Acute kidney injury; Serum creatinine; critically ill patients

References

Fang Y, Ding X, Zhong Y, Zou J, Teng J, Tang Y, et al. Acute kidney injury in a Chinese hospitalized population. Blood Purif 2010;30(2):120–6.

Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract 2013;2013:479730.

Baitello AL, Marcatto G, Yagi RK. Risk factors for injury acute renal in patients with severe trauma and its effect on mortality. J Bras Nefrol 2013;35(2):127–31.

Colpaert K, Hoste EA, Steurbaut K, Benoit D, Van Hoecke S, De Turck F, et al. Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class. Crit Care Med 2012;40(4):1164–70.

Constantin JM, Futier E, Perbet S, Roszyk L, Lautrette A, Gillart T, et al. Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: a prospective study. J Crit Care 2010;25(1):176.e1–6.

Youssef DM, Esh AM, Helmy Hassan E, Ahmed TM. Serum NGAL in critically ill children in ICU from a single center in Egypt. ISRN Nephrol 2013;2013:140905.

Khilji SA, Khan AH. Acute renal failure after cardiopulmonary bypass surgery. J Ayub Med Coll Abbottabad 2004;16(3):25–8.

Coca SG, Bauling P, Schifftner T, Howard CS, Teitelbaum I, Parikh CR. Contribution of acute kidney injury toward morbidity and mortality in burns: a contemporary analysis. Am J Kidney Dis 2007;49(4):517–23.

Schrier RW. Early intervention in acute kidney injury. Nat Rev Nephrol 2010;6(1):56–9.

Gowda S, Desi PB, Kulkarni SS, Hull VV, Math AA, Vernekar SN. Markers of renal function tests. N Am J Med Sci 2010;2(4):170–3.

Branten AJ, Vervoort G, Wetzels JF. Serum creatinine is a poor marker of GFR in nephrotic syndrome. Nephrol Dial Transplant 2005;20(4):707–11.

Macedo E, Mehta RL. Prerenal failure: from old concepts to new paradigms. Curr Opin Crit Care 2009;15(6):467–73.

Klahr S, Miller SB. Acute oliguria. N Engl J Med 1998;338(10):671–5.

Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996;334(22):1448–60.

Nickolas TL, O’Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 2008;148(11):810–9.

Pepin MN, Bouchard J, Legault L, Ethier J. Diagnostic performance of fractional excretion of urea and fractional excretion of sodium in the evaluations of patients with acute kidney injury with or without diuretic treatment. Am J Kid Dis 2007;50(4):566–73.

Uchino S, Bellomo R, Bagshaw SM, Goldsmith D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant 2010;25(6):1833–9.

Devarajan P. NGAL for the detection of acute kidney injury in the emergency room. Biomark Med 2014;8(2):217–9.

Parikh A, Rizzo JA, Canetta P, Forster C, Sise M, Maarouf O, et al. Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (sCr) for acute kidney injury (AKI) diagnosis. PLoS One 2017;12(5):e0178091.

Haase-Fielitz A, Bellomo R, Devarajan P, Bennett M, Story D, Matalanis G, et al. The predictive performance of plasma neutrophil gelatinase-associated lipocalin (NGAL) increases with grade of acute kidney injury. Nephrol Dial Transplant 2009;24(11):3349–54.

Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Dobrzycki S. Neutrophil-gelatinase-associated lipocalin and renal function after percutaneous coronary interventions. Am J Nephrol 2006;26(3):287–92.

Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365(9466):1231–8.

Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care 2007;11(4):R84.

Published

2018-12-10

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