title: Urinary neutrophil gelatinase-associated lipocalin as biomarker in the differential diagnosis of impairment of kidney function in cirrhosis.
abstract: OBJECTIVE
  Impairment of kidney function is common in cirrhosis but differential diagnosis remains a challenge. We aimed at assessing the usefulness of neutrophil gelatinase-associated lipocalin (NGAL), a biomarker of tubular damage, in the differential diagnosis of impairment of kidney function in cirrhosis.
  
  
  METHODS
  Two-hundred and forty-one patients with cirrhosis, 72 without ascites, 85 with ascites, and 84 with impaired kidney function, were studied. Urinary levels of NGAL were measured by ELISA.
  
  
  RESULTS
  Patients with impaired kidney function had higher urinary NGAL levels compared to patients with and without ascites. Patients with urinary tract infection (n=25) had higher uNGAL values than non-infected patients. Patients with acute tubular necrosis (ATN) had uNGAL levels markedly higher (417μg/g creatinine (239-2242) median and IQ range) compared to those of patients with pre-renal azotemia due to volume depletion 30 (20-59), chronic kidney disease (CKD) 82 (34-152), and hepatorenal syndrome (HRS) 76 (43-263) μg/g creatinine (p<0.001 for all). Among HRS patients, the highest values were found in HRS-associated with infections, followed by classical (non-associated with active infections) type-1 and type-2 HRS (391 (72-523), 147 (83-263), and 43 (31-74) μg/g creatinine, respectively; p<0.001). Differences in uNGAL levels between classical type 1 HRS and ATN on the one hand and classical type 1 HRS and CKD and pre-renal azotemia on the other were statistically significant (p<0.05).
  
  
  CONCLUSIONS
  uNGAL levels may be useful in the differential diagnosis of impairment of kidney function in cirrhosis. Urinary tract infections should be ruled out because they may increase uNGAL excretion.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fagundes
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Pépin
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.forename: Rogelio
authors.initials: R
authors.lastname: Barreto
authors.forename: Gregori
authors.initials: G
authors.lastname: Casals
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pereira
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Elisabet
authors.initials: E
authors.lastname: Garcia
authors.forename: Verónica
authors.initials: V
authors.lastname: Prado
authors.forename: Esteban
authors.initials: E
authors.lastname: Poch
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jiménez
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D015415:Biomarkers; D003937:Diagnosis, Differential; D005260:Female; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000652:urine; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis / Q000652:urine; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000652:urine*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins