New Test Helps Predict Acute Kidney Injury in ICU Patients

The researchers found that compared with those who did not develop AKI those who did had higher median uNGAL at enrollment. The increase in uNGAL in patients who later developed AKI occurred before any change in serum creatinine (SCr) level, which is typically used to diagnose AKI. After adjustment for age, SCr level closest to enrollment, illness severity, sepsis, and ICU location, uNGAL remained independently associated with the development of AKI. However, the researchers cautioned that adjusted uNGAL only marginally improved the predictive performance of the clinical model alone. The study was published in the August 2009 issue of the Journal of the American Society of Nephrology.

"Although a single measurement of [urine NGAL] exhibited moderate predictive utility for the development and severity of AKI in a heterogeneous ICU population, its additional contribution to conventional clinical risk predictors appears limited,” conclude lead author T. Alp Ikizler, M.D., and colleagues of the division of nephrology.
"The role of urine NGAL in predicting more important measures of AKI severity, including dialysis provision or mortality, remains to be fully explored in larger cohorts.”

NGAL, a ubiquitous 25-kDa protein, is generally expressed in low concentrations, but it increases greatly in the presence of epithelial injury and inflammation. A significant rise in uNGAL 2 days before the rise in SCr was observed in children with AKI following cardiopulmonary bypass (CPB). Adults who developed AKI after cardiac surgery also had significantly elevated levels by one to three hours after the operation. Other human studies demonstrated a strong relationship between uNGAL and AKI in renal transplantation, diarrhea-associated hemolytic-uremic syndrome, and lupus nephritis.

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