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Comparing different markers of tubular dysfunction in transfusion-dependent thalassemia patients

  • Nephrology - Original Paper
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Abstract

Background

Renal tubular dysfunction was reported in transfusion-dependent thalassemia (TDT) patients and ranges from mild to severe. The objectives of our study were identification of the best marker of early renal tubular dysfunction in TDT patients among the three most commonly used urinary biomarkers, named neutrophil gelatinase-associated lipocalin (NGAL), retinol-binding protein (RBP) and N-acetyl-D-glucosaminidase (NAG) and correlation of these biomarkers with different patient variables.

Methodology

Sixty-one TDT patients and another 62 healthy children were enrolled in a cross-sectional study. Morning urine samples were taken for measurement of calcium, phosphorus, creatinine, microalbumin and markers of tubular dysfunction (NGAL, NAG and RBP). Urine NGAL/creatinine (UrNGAL/Cr), urine NAG/creatinine (UrNAG/Cr) and urine RBP/creatinine (UrRBP/Cr) ratios were used for accuracy. Patients were classified into 2 groups: group A, with tubular dysfunction and group b, without tubular dysfunction.

Results

Group A showed statistically significant higher UrNGAL/Cr (p < 0.001), UrRBP/Cr (p < 0.001) and UrNAG/Cr (p <0.001) than group B. In group A, microalbuminuria was detected only in 7 patients (28%) while it was detected in 12 patients (33.3%) in group B. By using ROC curve analysis, the diagnostic cutoff values for UrNGAL/Cr, UrRBP/Cr and UrNAG/Cr were 3713.38, 1614.85 and 56.56 ng/g, respectively. We found a statistically significant superiority of UrNGAL/Cr over UrRBP/Cr (p < 0.001) and UrRBP/Cr over UrNAG/Cr (p < 0.001).

Conclusion

Evaluation of UrNGAL/Cr, UrRBP/Cr and UrNAG/Cr could early discriminate tubular dysfunction TDT patients from those with normal tubular function. UrNGAL/Cr is more accurate in early detection of tubular dysfunction when compared with the other two biomarkers.

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Authors and Affiliations

  1. Pediatric Department, Cairo University, Cairo, Egypt

    Ilham Youssry, Samuel Makar, Khalil Abdelkhalek & Happy Sawires

  2. Chemical Pathology Department, Cairo University, Cairo, Egypt

    Dina Hisham

Authors
  1. Ilham Youssry
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  2. Samuel Makar
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  3. Khalil Abdelkhalek
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  4. Dina Hisham
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Contributions

Ilham Youssry: the principle investigator- revising the manuscript. Samuel Makar: the coordinator of the team work – revising the manuscript. Khaliel Abdelkhalek: handling the patients as regard investigations and time plan-– revising the manuscript. Dina Hesham: handling the lab. Part of the study – revising the methodology and results sections. Happy Sawires: handling statistics – writing the manuscript – submitting the manuscript (the corresponding author).

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Correspondence to Happy Sawires.

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Youssry, I., Makar, S., Abdelkhalek, K. et al. Comparing different markers of tubular dysfunction in transfusion-dependent thalassemia patients. Int Urol Nephrol 54, 421–428 (2022). https://doi.org/10.1007/s11255-021-02914-7

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  • DOI: https://doi.org/10.1007/s11255-021-02914-7

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