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NGAL is an early predictive biomarker of contrast-induced nephropathy in children

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Abstract

We hypothesized that neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of contrast-induced nephropathy (CIN). We prospectively enrolled 91 children (age 0–18 years) with congenital heart disease undergoing elective cardiac catheterization and angiography with contrast administration (CC; Ioversol). Serial urine and plasma samples were analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay (ELISA). CIN, defined as a 50% increase in serum creatinine from baseline, was found in 11 subjects (12%), but detection using increase in serum creatinine was only possible 6–24 h after CC. In contrast, significant elevation of NGAL concentrations in urine (135 ± 32 vs. 11.6 ± 2 ng/ml without CIN, p < 0.001) and plasma (151 ± 34 vs. 36 ± 4 without CIN, p < 0.001) were noted within 2 h after CC in those subjects. Using a cutoff value of 100 ng/ml, sensitivity, specificity, and area under the receiver-operating characteristic (ROC) curve for prediction of CIN were excellent for the 2-h urine NGAL (73%, 100%, and 0.92, respectively) and 2-h plasma NGAL (73%, 100%, and 0.91, respectively). By multivariate analysis, the 2-h NGAL concentrations in the urine (R 2 = 0.52, p < 0.0001) and plasma (R 2 = 0.72, p < 0.0001) were found to be powerful independent predictors of CIN. Patient demographics and contrast volume were not predictive of CIN.

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Acknowledgements

Dr. Devarajan is supported by grants from the NIH/NIDDK (RO1-DK53289, P50-DK52612, R21-DK070163), a Grant-in-Aid from the American Heart Association Ohio Valley Affiliate, and a Translational Research Initiative Grant from Cincinnati Children’s Hospital Medical Center. We are indebted to our patients and their families for their participation.

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Authors and Affiliations

  1. Division of Cardiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Russel Hirsch, Catherine Dent, Holly Pfriem, Janene Allen & Robert H. Beekman III

  2. Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Qing Ma, Sudha Dastrala, Michael Bennett, Mark Mitsnefes & Prasad Devarajan

  3. Division of Nephrology & Hypertension, MLC 7022, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Prasad Devarajan

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  1. Russel Hirsch
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  2. Catherine Dent
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  3. Holly Pfriem
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  10. Prasad Devarajan
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Correspondence to Prasad Devarajan.

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Hirsch, R., Dent, C., Pfriem, H. et al. NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol 22, 2089–2095 (2007). https://doi.org/10.1007/s00467-007-0601-4

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  • DOI: https://doi.org/10.1007/s00467-007-0601-4

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