Neutrophil gelatinase-associated lipocalin (NGAL) and endothelial progenitor cells (EPCs) evaluation in aortic aneurysm repair.
BACKGROUND
Acute kidney injury (AKI) develops in 10% of patients after surgical abdominal aortic aneurysm (AAA) repair. Neutrophil gelatinase-associated lipocalin (NGAL) is a predictor of AKI and Endothelial Progenitor Cells (EPCs) represent a potential repair mechanism for vascular lesions. We evaluated the diagnostic power of serum (s) and urine (u) NGAL in detecting a possible event of AKI in patients undergoing surgical treatment for AAA repair. We also investigated the influence of vascular injury on EPCs.


METHODS
We examined 50 patients who underwent open AAA repair. Blood and urine was collected preoperatively and every hour after surgery until 8 h to quantify sNGAL, uNGAL and circulating EPCs. AKI, was defined as a ≥25% decrease in eGFR compared with baseline values.


RESULTS
There was an inverse correlation between eGFR, sNGAL and uNGAL, while a direct correlation between sNGAL APACHE II Score and EPCs was found. At receiver operating characteristic (ROC) analysis, sNGAL and uNGAL showed a very good diagnostic profile. Kaplan Meier curves showed that NGAL is a highly sensitive predictor of incidence of AKI. Univariate followed by multivariate Cox proportional hazard regression analysis showed that uNGAL and sNGAL predicted AKI independently of other potential confounders, including eGFR and APACHE II Score. Patients had at baseline and after surgical stress a significantly higher number of EPCs than control group.


CONCLUSIONS
NGAL represents an independent renal predictor of incidence of AKI. EPCs reflect the degree of vascular damage and could be considered as an indicator of disease with a reparative-regenerative vascular-endothelial function.
Antonio
A
Lacquaniti
Massimiliano
M
Giardina
Silvia
S
Lucisano
Roberto
R
Messina
Antoine
A
Buemi
Claudia D
CD
Risitano
Valeria
V
Chirico
Michele
M
Buemi
Section of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Messina, Via Salita Villa Contino, 30, 98100 Messina, Italy. buemim@unime.it.
Antonio
A
David
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery* / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015331:Cohort Studies; D042783:Endothelial Cells / Q000378:metabolism*; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D011518:Proto-Oncogene Proteins / Q000097:blood* / Q000652:urine; D013234:Stem Cells / Q000378:metabolism*
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins