Pediatric Nephrology

, 22:2089 | Cite as

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

  • Russel Hirsch
  • Catherine Dent
  • Holly Pfriem
  • Janene Allen
  • Robert H. BeekmanIII
  • Qing Ma
  • Sudha Dastrala
  • Michael Bennett
  • Mark Mitsnefes
  • Prasad Devarajan
Original Article

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 (R2 = 0.52, p < 0.0001) and plasma (R2 = 0.72, p < 0.0001) were found to be powerful independent predictors of CIN. Patient demographics and contrast volume were not predictive of CIN.

Keywords

Acute renal failure Acute kidney injury Biomarkers Lipocalin Contrast agents 

Notes

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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Copyright information

© IPNA 2007

Authors and Affiliations

  • Russel Hirsch
    • 1
  • Catherine Dent
    • 1
  • Holly Pfriem
    • 1
  • Janene Allen
    • 1
  • Robert H. BeekmanIII
    • 1
  • Qing Ma
    • 2
  • Sudha Dastrala
    • 2
  • Michael Bennett
    • 2
  • Mark Mitsnefes
    • 2
  • Prasad Devarajan
    • 2
    • 3
  1. 1.Division of Cardiology, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Division of Nephrology & Hypertension, MLC 7022Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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