title: Urinary neutrophil gelatinase-associated lipocalcin in D+HUS: a novel marker of renal injury.
abstract: BACKGROUND
  Diarrhea-associated hemolytic uremic syndrome (D+HUS) causes acute renal failure. Neutrophil gelatinase-associated lipocalcin (NGAL) is an early indicator of kidney injury.
  
  
  OBJECTIVE
  To determine if urinary NGAL excretion is a biomarker of severe renal injury and predicts the need for dialysis in D+HUS.
  
  
  METHODS
  Patients were randomly selected from among participants in the SYNSORB Pk trial. Urine samples were collected daily if available during the first week of hospitalization. NGAL levels were determined by ELISA.
  
  
  RESULTS
  34 children, age 5.9+/-3.9 yr, were studied; ten (29%) required dialysis. Patients were categorized based on urinary NGAL concentration within five days of hospitalization - <200 ng/ml and >or=200 ng/ml. Twenty patients (58%) had increased urinary NGAL excretion. The severity of D+HUS at enrollment was similar in the two groups. However, children with increased urinary NGAL levels had higher peak BUN and creatinine concentrations (P<0.01) and required dialysis more often, 9/20 versus 1/14 (P=0.024) compared to children with normal excretion.
  
  
  CONCLUSIONS
  The majority of patients with D+HUS have renal tubular epithelial injury, as evidenced by elevated urinary NGAL excretion. Urinary NGAL levels below 200 ng/ml within five days of hospitalization may be an adjunctive marker that defines less severe renal involvement.
authors.affiliation: Department of Pediatrics (Division of Nephrology), Schneider Children's Hospital of the North Shore-Long Island Jewish Medical Center, New Hyde Park, New York, NY, USA. trachtma@lij.edu
authors.forename: Howard
authors.initials: H
authors.lastname: Trachtman
authors.forename: Erica
authors.initials: E
authors.lastname: Christen
authors.forename: Avital
authors.initials: A
authors.lastname: Cnaan
authors.forename: Jilma
authors.initials: J
authors.lastname: Patrick
authors.forename: Volker
authors.initials: V
authors.lastname: Mai
authors.forename: Jaya
authors.initials: J
authors.lastname: Mishra
authors.forename: Aditya
authors.initials: A
authors.lastname: Jain
authors.forename: Nathan
authors.initials: N
authors.lastname: Bullington
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D015415:Biomarkers / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications*; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000652:urine*; D006801:Humans; D007223:Infant; D000071068:Lipocalin-2; D054834:Lipocalins; D008297:Male; D011518:Proto-Oncogene Proteins / Q000652:urine*; D051437:Renal Insufficiency / Q000652:urine*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins