Urinary neutrophil gelatinase-associated lipocalin distinguishes pre-renal from intrinsic renal failure and predicts outcomes

Item Type:	Article
Title:	Urinary neutrophil gelatinase-associated lipocalin distinguishes pre-renal from intrinsic renal failure and predicts outcomes
Creators Name:	Singer, E. and Elger, A. and Elitok, S. and Kettritz, R. and Nickolas, T.L. and Barasch, J. and Luft, F.C. and Schmidt-Ott, K.M.
Abstract:	In established acute kidney injury (AKI), serum creatinine poorly differentiates prerenal from intrinsic AKI. In this study, we tested whether urinary neutrophil gelatinase-associated lipocalin (NGAL) distinguishes between intrinsic and prerenal AKI, and tested its performance in predicting a composite outcome that included progression to a higher RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease) class, dialysis, or death. Urinary NGAL was measured using a standardized clinical platform in 161 hospitalized patients with established AKI. Sixteen patients were excluded because of postrenal obstruction or insufficient clinical information. Of the remaining 145 patients, 75 had intrinsic AKI, 32 had prerenal AKI, and 38 patients could not be classified. Urinary NGAL levels effectively discriminated between intrinsic and prerenal AKI (area under the receiver-operating characteristic curve 0.87). An NGAL level over 104 μg/l indicated intrinsic AKI (likelihood ratio 5.97), whereas an NGAL level <47 μg/l made intrinsic AKI unlikely (likelihood ratio 0.2). Patients experiencing the composite outcome had significantly higher median urinary NGAL levels on inclusion. In logistic regression analysis, NGAL independently predicted the composite outcome when corrected for demographics, comorbidities, creatinine, and RIFLE class. Hence, urinary NGAL is useful in classifying and stratifying patients with established AKI.
Keywords:	Acute Kidney Injury, Diagnosis, Outcomes
Source:	Kidney International
ISSN:	0085-2538
Publisher:	Nature Publishing Group
Volume:	80
Number:	4
Page Range:	405-414
Date:	August 2011
Additional Information:	Comment in: Kidney Int (2012) 81, 321. Authors' reply in: Kidney Int (2012) 81, 321–322.
Official Publication:	https://doi.org/10.1038/ki.2011.41
PubMed:	View item in PubMed

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