[논문]Neutrophil Gelatinase-Associated Lipocalin and Kidney Diseases

Yim, Hyung Eun

doi:10.3339/chikd.2015.19.2.79

Neutrophil Gelatinase-Associated Lipocalin and Kidney Diseases 원문보기

Childhood kidney diseases, v.19 no.2, 2015년, pp.79 - 88

Yim, Hyung Eun (Department of Pediatrics, College of Medicine, Korea University)

Abstract ▼ AI-Helper

Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as one of the most promising biomarkers of renal epithelial injury. Numerous studies have presented the diagnostic and prognostic utility of urinary and plasma NGAL in patients with acute kidney injury, chronic kidney disease, renal injury after kidney transplantation, and other renal diseases. NGAL is a member of the lipocalin family that is abundantly expressed in neutrophils and monocytes/macrophages and is a mediator of the innate immune response. The biological significance of NGAL to hamper bacterial growth by sequestering iron-binding siderophores has been studied in a knock-out mouse model. Besides neutrophils, NGAL is detectable in most tissues normally encountered by microorganisms, and its expression is upregulated in epithelial cells during inflammation. A growing number of studies have supported the clinical utility of NAGL for detecting invasive bacterial infections. Several investigators including our group have reported that measuring NGAL can be used to help predict and manage urinary tract infections and acute pyelonephritis. This article summarizes the biology and pathophysiology of NGAL and reviews studies on the implications of NGAL in various renal diseases from acute kidney injury to acute pyelonephritis.

주제어

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문제 정의

Several investigators includ-ing our group have shown that urinary and plasma NGAL levels can be used to predict and manage urinary tract infection (UTI) and acute pyelonephritis (APN)^14-18). This review addresses the biologic and pathophysiologic features on NGAL and describes the results of experimental and clinical studies on the diagnostic and prognostic utility of NGAL in patients with AKI, CKD, and various renal diseases including APN.

대상 데이터

Next, we confirmed that plasma NGAL is a sensitive and specific biomarker for identifying APN and monitoring the treatment response in children with UTIs. A total of 123 children were enrolled (53 APN and 70 lower UTI). After adjusting for age and sex, plasma NGAL levels were higher in the APN group than those in the lower UTI group.

성능/효과

After adjusting for age and sex, plasma NGAL levels were higher in the APN group than those in the lower UTI group. NGAL levels were significantly correlated with serum levels of WBCs, CRP, and Cr, as well as fever duration. A multivariate analysis revealed that log-transformed plasma NGAL was the only independent predictor of APN.
The uNGAL/ Cr ratio was more elevated in the UTI group than that in the control subjects and in patients with APN than in those with lower UTIs. The best uNGAL cutoff values for predicting UTI and APN were 23.95 ng/ml (sensitivity, 82.4%; specificity, 83.6%; AUC, 0.⁸⁹⁾ and 73 ng/ml (sensitivity, 75%; specificity, 73.7%; AUC, 0.⁸⁾, respectively. The optimal uNGAL/Cr ratio cutoff values for predicting UTI and APN were 276.
⁸⁾, respectively. The optimal uNGAL/Cr ratio cutoff values for predicting UTI and APN were 276.5 ng/mg Cr (sensitivity, 76%; specificity, 90%; AUC, 0.⁹⁾ and 390 ng/mg Cr (sensitivity, 90.3%; specificity, 63.2%; AUC, 0.⁷⁸⁾, respectively. The uNGAL/ Cr ratios in the APN and UTI groups decreased after antibiotic treatment compared to those before treatment.
They demonstrated that uNGAL levels increased significantly higher in a UTI group than in controls. Using the best uNGAL cutoff of 20 ng/ml for diagnosing UTI, sensitivity and specificity were 97% and 76%, respectively (AUC, 0.979). However, they did not compare NGAL concentrations between patients with APN and those with lower UTIs.

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