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New Biomarker May Improve Acute Kidney Injury Diagnosis

Last Updated: April 19, 2011.

Neutrophil gelatinase-associated lipocalin may be a biomarker for detecting early subclinical acute kidney injury and its adverse outcomes in absence of diagnostic increases in serum creatinine, according to a study published in the April 26 issue of the Journal of the American College of Cardiology.

TUESDAY, April 19 (HealthDay News) -- Neutrophil gelatinase-associated lipocalin (NGAL) may be a biomarker for detecting early subclinical acute kidney injury (AKI) and its adverse outcomes in absence of diagnostic increases in serum creatinine, according to a study published in the April 26 issue of the Journal of the American College of Cardiology.

Michael Haase, M.D., from the Charité-University Medicine Berlin, and colleagues assessed whether NGAL levels in urine or blood can detect AKI based on data from 10 prospective observational studies, including 2,322 patients with cardiorenal syndrome type 1 without serum creatinine diagnostic increases. Based on study-specific NGAL cut-off and consensus diagnostic increases in serum creatinine, AKI patients were characterized: NGAL negative-creatinine negative (NGAL(−)/sCREA(−)), NGAL positive-creatinine negative (NGAL(+)/sCREA(−)), NGAL negative-creatinine positive (NGAL(−)/sCREA(+)), and NGAL positive-creatinine positive (NGAL(+)/sCREA(+)). Outcomes included renal replacement therapy and hospital mortality, separately or in combination, and duration of intensive-care and in-hospital stay.

The investigators found that 55.8 percent of participants were NGAL(−)/sCREA(−), 19.2 percent were NGAL(−)/sCREA(+), 4.6 percent were NGAL(−)/sCREA(+), and 20.4 percent were (NGAL(+)/sCREA(+). From NGAL(−)/sCREA(−) to (NGAL(+)/sCREA(+), there was a stepwise increase in subsequent renal replacement therapy initiation, hospital mortality, and the combination of the two. There was an increase in the average number of intensive-care and in-hospital days with increasing biomarker positivity. Outcomes were similar for urine and blood NGAL levels.

"The study findings show that NGAL complements serum creatinine in AKI diagnosis and prognosis," the authors write.

Several authors disclosed financial relationships with Abbot and Diagnostics Biosite Inc., both of which are involved in the development of neutrophil gelatinase-associated lipocalin.

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