Urinary Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Diagnosis and Prognosis of Acute Kidney Injury (AKI) in Cirrhotic Patients

Title: Urinary Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Diagnosis and Prognosis of Acute Kidney Injury (AKI) in Cirrhotic Patients

Authors: Mona H. Elzohri MD, Effat AE.Tony MD, Mohamed H .Mustafa MD, Nabawia M. Tawfik MD, Tarek T. Elmelegy MD, Radwa A. Ellisy MSc

DOI: https://dx.doi.org/10.18535/jmscr/v5i2.118

Abstract

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge.

Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis.

Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge.

Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p<0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality.

Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Keywords: AKI: Acute kidney injury, NGAL : Urinary neutrophil gelatinase associated lipocalin , cirrhosis, ATN: Acute tubular necrosis , HRS: Hepatorenal syndrome.

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Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

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