Urine Neutrophil Gelatinase-Associated Lipocalin and Interleukin-18 Predict Acute Kidney Injury after Cardiac Surgery*
ABSTRACT About 30-50% patients develop acute kidney injury (AKI) after cardiac surgery, which is still diagnosed by serum creatinine on clinic. However, the increase of serum creatinine is insensitive and delayed. The aim of this study is to test the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) are early biomarkers for AKI in patients after cardiac surgery.
Thirty-three cases undergoing cardiac surgery were classified into an AKI group and non-AKI group, according to the AKI definition (> 26.5 micromol/L increase of serum creatinine, more than or equal to 50% increase of serum creatinine within 48 h, or a reduction in urine output < 0.5 mL/Kg per hour for more than six hours). The concentrations of serum NGAL, urine NGAL, and urine IL-18 at different time-points were measured.
Nine cases (27.27%) developed postoperative AKI, but diagnosis with serum creatinine was 12-48 h postoperation. The concentrations of serum NGAL were not significantly increased postoperation. The concentrations of urine NGAL and IL-18 were significantly increased in the AKI group, which reached the peak at 2-4 h postoperation, and a more significant difference could be seen after correction for urine creatinine. The concentrations of urine NGAL and IL-18 2 h postoperation, either corrected for urine creatinine or not, showed good sensitivity and specificity. Increased levels of urine NGAL and IL-18 2 h postoperation were significantly correlated with increased level of serum creatinine 12 h postoperation. Logistic regression analysis showed that urine NGAL corrected for urine creatinine 2 h postoperation and urine IL-18 2 h postoperation emerged as powerful independent predictors of AKI after cardiac surgery.
The concentrations of urine NGAL and IL-18 could be useful biomarkers for AKI in patients after cardiac surgery, especially after correction for urine creatinine.
- SourceAvailable from: Mina Hur
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- "In previous studies, plasma and urine NGAL levels were considered good predictive markers in children and adult patients immediately after surgery         . Among these studies, only a small number included cardiac surgery patients, and a plasma NGAL cut-off value predictive of AKI was not clear in these patients  . "
ABSTRACT: Development of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is relatively common and associated with increased mortality. Recently, plasma neutrophil gelatinase-associated lipocalin (NGAL) was used for prediction of AKI. We evaluated the clinical usefulness of plasma NGAL.Clinical Biochemistry 10/2014; 48(1-2). DOI:10.1016/j.clinbiochem.2014.09.019 · 2.28 Impact Factor
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- "Thus the question arises whether NGAL release after CPB is a marker of renal tubular injury or of a general inflammatory response. In particular, as urinary NGAL is a more specific biomarker of tubular injury than plasma NGAL (Xin et al., 2008), measuring both plasma and urine NGAL in patients receiving either on-CPB or off-CPB CABG may help differentiate between the inflammatory and tubular effects of CPB and relate such effects to measures of glomerular filtration rate (creatinine) typically used clinically to diagnose AKI in the clinic. We hypothesised that patients receiving off-pump CABG would have a different plasma and urinary NGAL profile compared to patients receiving CABG on-pump. "
ABSTRACT: Abstract Context: Cardiac surgery. Objective: To compare plasma and urinary neutrophil gelatinase-associated lipocalin (P-/U-NGAL) in on-pump (n = 43) versus off-pump (n = 40) surgery. Materials and methods: We obtained perioperative P-/U-NGAL and outcome data. Results: P-/U-NGAL increased after surgery. P-NGAL was higher post-surgery in on pump patients (139 versus 67 µg L(-1); p < 0.001), but not at 24 h. There were no differences in U-NGAL. Correlation between P-/U-NGAL and plasma creatinine was weak. Discussion: P-NGAL acts like a neutrophil activation biomarker and U-NGAL like a tubular injury marker. Conclusion: On-pump patients had greater neutrophil activation. On- versus off-pump surgery had similar impact on tubular cells.Biomarkers 02/2014; 19(1):22-8. DOI:10.3109/1354750X.2013.863974 · 2.52 Impact Factor
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ABSTRACT: ABstrACt Acute kidney injury (AKI) commonly occurs in hospitalised patients resulting in short and long-term morbidity and mortality. A subset of patients especially those with cardiovascular diseases appear particularly vulnerable. The diagnosis of AKI currently depends on changes in serum creatinine and is usually made at least 24 to 48 hours after the initial renal insult. This hinders formulation of possible early therapeutic strategies which could otherwise reduce the clinical sequelae of AKI. Neutrophil gelatinase-associated lipocalin (NGAL) is released in both serum and urine, and has shown great promise in identifying AKI as early as two to four hours after renal injury. NGAL has been demonstrated to be both specific and sensitive in a variety of renal conditions associated with AKI, compared to serum creatinine. This article discusses the emerging role of NGAL in the diagnostic and prognostic evaluation of AKI secondary to cardiovascular diseases and interventions including its benefits and pitfalls. NGAL has been shown to be useful in the diagnosis of AKI particularly for contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) and renal dysfunction complicating acute and chronic heart failure. Larger prospective outcome studies with therapeutic interventions are warranted to further validate the role of NGAL in the diagnosis of AKI and in cardiorenal syndrome.12/2011; 20(4). DOI:10.1177/201010581102000406