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Urine neutrophil gelatinase-associated lipocalin (NGAL) as an initial biomarker of acute kidney injury (AKI) in an intensive care unit (ICU) patients: a preliminary study

  • Ira Puspitawati ,
  • Ahmad Yun Jufan ,
  • Vidya Cahyaningrum ,
  • Chandra Trianna Dewi ,
  • Isniyanti Chasanah ,
  • Teguh Triyono ,

Abstract

Background: Acute kidney injury (AKI) is one of the complications in critical patients that can increase morbidity and mortality. The condition of AKI is reversible and must be detected as early as possible. One of a potential marker for early detection is urine Neutrophil gelatinase-associated lipocalin (NGAL). This study aims to evaluate urine NGAL as an early AKI detection marker among critically ill patients.

Methods: This is an observational prospective cohort study involving 39 patients who were admitted to the Intensive care unit (ICU) of Dr. Sardjito General Hospital Yogyakarta during June-August 2018. The inclusion criteria were ICU patients with age>19 years old, and exclusion criteria were chronic renal failure and kidney transplantation. The AKI established based on an increase in serum creatinine levels ≥0,3 mg/dl in 48 hours or urine volume <0.5 ml /kg/hour in 6 hours. Mann Whitney test, Spearman correlation, and Chi-Square were used for statistical analysis. Data were analyzed using SPSS version 17 for windows.

Results: The results showed that there were no significant differences between the urine NGAL levels of AKI and non-AKI patients (130 (85-177) ng/dL; 56.65 (2.8-1500) ng/dL, p=0.407). In this study, only 3 cases of AKI were obtained from 39 subjects. Further analysis was carried out by looking at the correlation between urine NGAL levels and urine leukocyte count. The results showed a moderate correlation between them (r=0.6, p=0.001). The proportion of patients with elevated urine NGAL levels was greater in the group of patients with elevated urine leukocyte counts compared to the group with normal urine leukocyte counts (86,7%; 13,3%, p=0,008).).

Conclusions: Evaluation of urinary NGAL application as an early marker of AKI was not optimal in this study. An increase of urine leukocytes interfered urine NGAL.

References

  1. Maxwell RA, Bell CM. Acute Kidney Injury in the Critically Ill. Surg Clin North Am. 2017; 97(6):1399-1418
  2. Bentley M, Corwin HL, Dasta J. Drug-induced acute kidney injury in the critically ill adult: recognition and prevention strategies. Crit Care Med. 2010; 38(6 Suppl):S169-74
  3. Bagshaw SM, Bellomo R. Early diagnosis of acute kidney injury. Curr Opin Crit Care. 2007; 13(6):638-44.
  4. Borregaard N, Sehested M, Nielsen BS, Sengeløv H, Kjeldsen L.. Biosynthesis of granule proteins in normal human bone marrow cells. Gelatinase Is A Marker Of Terminal Neutrophil Differentiation. Blood. 1995; 85(3):812-7.
  5. Cullen MR, Murray PT, Fitzgibbon MC. Establishment of a reference interval for urinary neutrophil gelatinase-associated lipocalin. Ann Clin Biochem 2012; 49: 190-193
  6. Mahmoodpoor A, Hamishehkar H, Fattahi V, Sanaie S, Arora P, Nader ND. Urinary versus plasma neutrophil gelatinase-associated lipocalin (NGAL) as a predictor of mortality for acute kidney injury in intensive care unit patients. J Clin Anesth. 2018; 44:12-17
  7. Yegenaga I, Kamis F, Baydemir C, Erdem E, Celebi K, Eren N, Baykara N. Neutrophil gelatinase-associated lipocalin is a better biomarker than Cystatin C dor the prediction than cystatin C for the prediction of imminent acute kidney injury in critically ill patients. Ann Clin Biochem. 2018; 55(2):190-197
  8. Egal M, de Geus HRH, Groeneveld AB. Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically III Patients: A Post Hoc Analysis. Nephron. 2016; 134(2): 81-88
  9. Mori K, Lee HT, Rapoport D, Drexler IR, Foster K, Yang J et al. Endocytic delivery of lipocalinsiderophore-iron complex rescues the kidney from ischemia reperfusion injury. J Clin Invest 2005; 115(3):610–621
  10. Koo CK, Hong JW, Lee HS, Jeh SU, Choi YD, Rha HK, Ham WK. Accuracy of Urinary Neutrophil Gelatinase-Associated Lipocalinin Quantifying Acute Kidney Injury after Partial Nephrectomy in Patients with Normal Contralateral Kidney. PLoS One. 2015; 10(7):e0133675.
  11. Xu SY, Carlson M, Engström A, Garcia R, Peterson CG, Venge P. Purification and characterization of a human neutrophil lipocalin (HNL) from the secondary granules of human neutrophils. Scand J Clin Lab Invest. 1994; 54(5):365-376
  12. Proverbio D, Spada E, Baggiani L, Bagnagatti De Giorgi, Ferro E, Martino PA, Perego R. Short communication: Relationship between urinary neutrophil gelatinase-associated lipocalin and non infectious pyuria dogs. Dis Markers. 2015; 2015:387825
  13. Yilmaz A, Sevketoglu E, Gedikbasi A, Karyagar S, Kiyak A, Mulazimoglu M, Aydogan G, Ozpacaci T, Hatipoglu S. Early prediction of urinary tract infection with urinary neutrophil gelatinase associated lipocalin. Pediatr Nephrol. 2009; 24(12):2387–92.

How to Cite

Puspitawati, I., Jufan, A. Y., Cahyaningrum, V., Dewi, C. T., Chasanah, I., & Triyono, T. (2019). Urine neutrophil gelatinase-associated lipocalin (NGAL) as an initial biomarker of acute kidney injury (AKI) in an intensive care unit (ICU) patients: a preliminary study. Bali Medical Journal, 8(2), 390–393. https://doi.org/10.15562/bmj.v8i2.1458

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Ira Puspitawati
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Ahmad Yun Jufan
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Vidya Cahyaningrum
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Chandra Trianna Dewi
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Isniyanti Chasanah
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Teguh Triyono
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