Urinary neutrophil gelatinase-associated lipocalcin in D+HUS: a novel marker of renal injury.
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.
Trachtman
Howard
H
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
Christen
Erica
E
Cnaan
Avital
A
Patrick
Jilma
J
Mai
Volker
V
Mishra
Jaya
J
Jain
Aditya
A
Bullington
Nathan
N
Devarajan
Prasad
P
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*
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins