Dynamic Changes of s-NGAL in Patients with Acute Kidney Injury of Various Origin
Introduction. Acute kidney injury (AKI) is a severe, polyethiologic complication of many diseases. The most significant factor to provide benefit of AKI treatment is early diagnostics. Blood neutrophil gelatinase-associated lipocalin (s-NGAL) is arguably the most promising emerging biomarker (25 kDa, protein) for detection of AKI. There are urine NGAL (u-NGAL), and plasma NGAL (p-NGAL). Experiments on animals have shown that NGAL is one of the earliest proteins induced renal tubular cells in ischemic or nephrotoxic stress. This protein on the one hand reflects the severity of renal damage, with another — protects renal tubules from further destruction. The most specific for AKI, especially in the absence of urine is considered s-NGAL.
The aim of our study: a comparative validation of s-NGAL level changes in patients with prerenal, renal and postrenal AKI during oliguric stage and in stage of recovery of diuresis.
Material and Methods. The study included 35 patients with prerenal (12), renal (16) and subrenal AKI (7) in oliguric stage (group 1) and in the stage of recovery diuresis (group 2). The average age of the patients was 48 ± 10 years. The Level of s-NGAL (ng/ml) was determined by ELISA analyzer SunRise TouchScreen, test system Human lipocaline-2/NGAL ELIZA (Biovendor, Czech Republic). The obtained data were processed using the licensed program MedStat. To assess correlation of s-NGAL with levels of azotemia, electrolytes (potassium, sodium, chloride), and resistive index (RI) in renal artery a standard Pearson coefficient (r) was used.
Results. In patients with prerenal and renal AKI in oliguric stage s-NGAL level was elevated and significantly different from those of the control group, amounted to 31.99 ± 0.49 and 32.99 ± 0.34 ng/ml. There was not significant difference between s-NGAL levels in prerenal and renal AKI in oliguric stage. In patients with subrenal AKI s-NGAL at admission was elevated in comparison with those in the control group, but was significantly (p < 0.001) lower than in prerenal and renal AKI (14.56 ± 0.42 ng/ml). In the stage of restoration of diuresis in prerenal AKI s-NGAL level significantly decreased, but remained elevated compared with the control group. In renal AKI patients s-NGAL levels did not differ from those on admission and in 2 patients were even slightly higher (33.0 ± 1.3 ng/ml), inspite of restoration of diuresis and subnormal levels of azotemia. So, in severe AKI s-NGAL level remains high even in polyuric stage, which confirms the fact of incomplete recovery of renal structure and function. In patients with subrenal AKI s-NGAL level decreased soon after restoration of urine passage and were near the control group data. Strong direct correlation was found between s-NGAL and RI in oliguric stage, as well as s-NGAL and RI in the stage of diuresis recovery. There was not significant correlation with other markers of AKI.
Conclusion. Thus, s-NGAL may consider being an additional criterion for diagnostics of different variants of AKI and severity of renal dysfunction.
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