Urine Test Points Quickly to Acute Kidney Injury

March 13, 2008

Levels of neutrophil gelatinase-associated lipocalin (NGAL), measured in urine, provide an earlier biomarker of acute kidney injury after cardiopulmonary bypass than serum creatinine in a pediatric population, according to research published online March 12 in the Clinical Journal of the American Society of Nephrology.

THURSDAY, March 13 (HealthDay News) -- Levels of neutrophil gelatinase-associated lipocalin (NGAL), measured in urine, provide an earlier biomarker of acute kidney injury after cardiopulmonary bypass than serum creatinine in a pediatric population, according to research published online March 12 in the Clinical Journal of the American Society of Nephrology.

Michael Bennett, Ph.D., of the University of Cincinnati School of Medicine in Ohio, and colleagues first found using 136 urine samples that the ARCHITECT assay provided measurements that were highly correlated with those from research-based ELISA. The researchers also analyzed data from 196 children undergoing cardiopulmonary bypass, 51 percent of whom developed acute kidney injury.

The investigators found that mean urine NGAL levels rose 15-fold within two hours after the procedure in children who later developed acute kidney injury, and 25-fold at four and six hours. For urine NGAL at two hours, the sensitivity was 0.82 and specificity was 0.90 for predicting acute kidney injury using a cutoff value of 100 ng/mL.

"Our results clearly indicate that urine NGAL is a powerful early biomarker of acute kidney injury that precedes the increase in serum creatinine by several hours to days," the authors write. "What is the potential clinical utility of our findings? Ideally, an early elevation in urine NGAL would trigger an immediate paradigm shift in the clinical management of the patient. At the very least, clinicians informed of such a situation would be aware of the potential for development of clinical acute kidney injury, and biomarkers, such as NGAL, may add substantively to existing clinical scoring systems for acute kidney injury prediction."

Cincinnati Children's Hospital and Columbia University have signed an exclusive licensing agreement with Abbott Diagnostics for developing urine NGAL as a biomarker of acute renal failure.

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