Comparison of urinary neutrophil glucosaminidase-associated lipocalin, cystatin C, and α1-microglobulin for early detection of acute renal injury after cardiac surgery

Heise, Daniel; Rentsch, Kerstin; Braeuer, Anselm; Friedrich, Martin; Quintel, Michael
January 2011
European Journal of Cardio-Thoracic Surgery;Jan2011, Vol. 39 Issue 1, p38
Academic Journal
Abstract: Objective: Acute renal injury is a frequent complication after cardiac surgery that necessitates additional treatment and increases mortality. To apply measures for optimizing renal function in a well-directed and effective way, it is most important to detect acute kidney injury at an early stage. The present study compares three markers of renal tubular function for detection of acute renal injury according to the acute kidney injury (Acute Kidney Injury Network (AKIN)) criteria. Methods: Urinary concentration of the tubular markers neutrophil glucosaminidase-associated lipocalin (NGAL), α1-microglobulin (α1MG), and cystatin C (CysC) were measured in 50 patients after elective cardiac surgery. Samples were taken once preoperatively and postoperatively every 12h for up to 5 days. Based on the highest recorded postoperative AKIN score, patients were divided into two groups (AKIN 0 and AKIN 1–3). Statistical analysis was done for marker concentrations at three time points: preoperative, after admission to the intensive care unit (ICU), and at the highest postoperative AKIN level. In addition, all concentrations of marker proteins were multiplied by the ratio of creatinine concentrations in serum and urine; these products were also analyzed statistically. In this way, we were able to eliminate the influence of varying degrees of diuresis on marker concentrations. Results: As early as at admission to the ICU, all marker proteins showed significantly higher concentrations compared with preoperative values. However, differences in concentrations between the groups AKIN 0 and AKIN 1–3 were only statistically significant for NGAL. Using receiver operating characteristic (ROC) analysis, we found that only NGAL concentrations were suitable for detecting acute kidney injury with adequate sensitivity and specificity (area under the curve (AUC)=0.773). Levels of α1MG yielded a comparable accuracy when urinary concentrations were multiplied by the serum/urine creatinine ratio (AUC=0.712). Conclusion: An increase in urinary NGAL is an early sign of acute kidney injury after cardiac surgery. After multiplication by the serum/urine creatinine ratio, urinary α1MG is also suitable for detection of acute kidney injury at an early stage.


Related Articles

  • Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery. Koyner, Jay L.; Bennett, Michael R.; Worcester, Elaine M.; Qing Ma; Raman, Jai; Jeevanandam, Valluvan; Kasza, Kristen E.; Connor, Michael F. O'; Konczal, David J.; Trevino, Sharon; Devarajan, Prasad; Murray, Patrick T. // Kidney International;Oct2008, Vol. 74 Issue 8, p1059 

    There is a need to develop early biomarkers of acute kidney injury following cardiac surgery, where morbidity and mortality are increased by its presence. Plasma cystatin C (CyC) and plasma and urine Neutrophil Gelatinase Associated Lipocalin (NGAL) have been shown to detect kidney injury...

  • Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation. Sirota, Jeffrey C.; Walcher, Angela; Faubel, Sarah; Jani, Alkesh; McFann, Kim; Devarajan, Prasad; Davis, Connie L.; Edelstein, Charles L. // BMC Nephrology;2013, Vol. 14 Issue 1, p1 

    Background: AKI is common following liver transplantation and is associated with significant morbidity and mortality. Biomarkers of AKI have not been well established in this setting but are needed to help guide patient care and facilitate development of novel therapeutics. Methods: Serum...

  • Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy. Royakkers, Annick A. N. M.; Korevaar, Johanna C.; Van Suijlen, Jeroen D. E.; Hofstra, Lieuwe S.; Kuiper, Michael A.; Spronk, Peter E.; Schultz, Marcus J.; Bouman, Catherine S. C. // Intensive Care Medicine;Mar2011, Vol. 37 Issue 3, p493 

    Purpose: To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Methods: Multicenter prospective...

  • Acute Kidney Injury: Controversies Revisited. Yong, Kenneth; Dogra, Gursharan; Boudville, Neil; Pinder, Mary; Wai Lim // International Journal of Nephrology;2011, p1 

    This paper addresses the epidemiology of AKI specifically in relation to recent changes in AKI classification and revisits the controversies regarding the timing of initiation of dialysis and the use of peritoneal dialysis as a renal replacement therapy for AKI. In summary, the new RIFLE/AKIN...

  • Biomarkers of acute kidney injury in neonatal encephalopathy. Sweetman, DU; Molloy, EJ // European Journal of Pediatrics;Mar2013, Vol. 172 Issue 3, p305 

    Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies...

  • Neutrophil gelatinase-associated lipocalin and albuminuria as predictors of acute kidney injury in patients treated with goal-directed haemodynamic therapy after major abdominal surgery. Cullen, MR; Jhanji, S; Pearse, RM; Fitzgibbon, MC // Annals of Clinical Biochemistry;May2014, Vol. 51 Issue 3, p392 

    The article presents a study which evaluates the clinical utility of neutrophil gelatinase-associated lipocalin (NGAL) and albuminurias as biomarkers for acute kidney injury (AKI) prediction. Urine from 109 patients who underwent abdominal surgery and treated with intravenous fluid and...

  • Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status. Haase-Fielitz, Anja; Haase, Michael; Devarajan, Prasad // Annals of Clinical Biochemistry;May2014, Vol. 51 Issue 3, p335 

    The article presents a study which evaluates the clinical utility of neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker of acute kidney injury (AKI) prediction. Data from MEDLINE, PubMed and EMBASE studies reporting on the use of NGAL as a biomarker of AKI were analyzed in the...

  • Defining acute kidney injury: playing hide-and-seek with the unknown man? Van Biesen, Wim; Van Massenhove, Jill; Hoste, Eric; Vanholder, Raymond // Nephrology Dialysis Transplantation;Feb2011, Vol. 26 Issue 2, p399 

    No abstract available.

  • Urinary biomarkers in the early diagnosis of acute kidney injury. Han, W. K.; Waikar, S. S.; Johnson, A.; Betensky, R. A.; Dent, C. L.; Devarajan, P.; Bonventre, J. V. // Kidney International;Apr2008, Vol. 73 Issue 7, p863 

    A change in the serum creatinine is not sensitive for an early diagnosis of acute kidney injury. We evaluated urinary levels of matrix metalloproteinase-9 (MMP-9), N-acetyl-β-D-glucosaminidase (NAG), and kidney injury molecule-1 (KIM-1) as biomarkers for the detection of acute kidney injury....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics