title: Urine neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury after kidney surgery.
abstract: OBJECTIVE
  We evaluated urine NGAL as a marker of acute kidney injury in patients undergoing partial nephrectomy. We sought to identify the preoperative clinical features and surgical factors during partial nephrectomy that are associated with renal injury, as measured by increased urine NGAL vs controls.
  
  
  METHODS
  Using patients treated with radical nephrectomy or thoracic surgery as controls, we prospectively collected and analyzed urine and serum samples from patients treated with partial or radical nephrectomy, or thoracic surgery between April 2010 and April 2012. Urine was collected preoperatively and at multiple time points postoperatively. Differences in urine NGAL levels were analyzed among the 3 surgical groups using a generalized estimating equation model. The partial nephrectomy group was subdivided based on a preoperative estimated glomerular filtration rate of less than 60, or 60 ml/minute/1.73 m(2) or greater.
  
  
  RESULTS
  Of 162 patients included in final analysis more than 65% had cardiovascular disease. The median estimated glomerular filtration rate was greater than 60 ml/minute/1.73 m(2) in the radical and partial nephrectomy, and thoracic surgery groups (61, 78 and 84.5 ml/minute/1.73 m(2), respectively). Preoperatively, a 10 unit increase in the estimated glomerular filtration rate was associated with a 4 unit decrease in urine NGAL in the partial nephrectomy group. Postoperatively, urine NGAL in the partial nephrectomy group was not higher than in controls and did not correlate with ischemia time. Patients with partial nephrectomy with a preoperative estimated glomerular filtration rate of less than 60 ml/minute/1.73 m(2) had higher urine NGAL postoperatively than those with a higher preoperative estimated rate.
  
  
  CONCLUSIONS
  Urine NGAL does not appear to be a useful marker for detecting renal injury in healthy patients treated with partial nephrectomy. However, patients with poorer preoperative renal function have higher baseline urine levels and appear more susceptible to acute kidney injury, as detected by urine levels and Acute Kidney Injury Network criteria, than those with a normal estimated glomerular filtration rate.
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. preston.sprenkle@yale.edu
authors: Preston C
authors: PC
authors: Sprenkle
authors: James
authors: J
authors: Wren
authors: Alexandra C
authors: AC
authors: Maschino
authors: Andrew
authors: A
authors: Feifer
authors: Nicholas
authors: N
authors: Power
authors: Tarek
authors: T
authors: Ghoneim
authors: Itay
authors: I
authors: Sternberg
authors: Martin
authors: M
authors: Fleisher
authors: Paul
authors: P
authors: Russo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000652:urine; D000209:Acute-Phase Proteins / Q000378:metabolism* / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000071068:Lipocalin-2; D054834:Lipocalins / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D011300:Preoperative Care / Q000379:methods; D011518:Proto-Oncogene Proteins / Q000378:metabolism* / Q000652:urine; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
references: Kidney Int. 2011 May;79(10):1119-30
references: 21307838
references: J Am Soc Nephrol. 2010 Jan;21(1):189-97
references: 19762491
references: Clin J Am Soc Nephrol. 2010 Feb;5(2):211-9
references: 20056755
references: Am J Transplant. 2006 Jul;6(7):1639-45
references: 16827865
references: Kidney Int. 2009 Nov;76(10):1089-97
references: 19741590
references: Am J Physiol Renal Physiol. 2012 May 1;302(9):F1104-11
references: 22262478
references: Clin J Am Soc Nephrol. 2008 May;3(3):665-73
references: 18337554
references: BJU Int. 2010 Jun;105(11):1494-507
references: 20553456
references: J Urol. 2010 Oct;184(4):1286-90
references: 20723936
references: Lancet. 2005 Apr 2-8;365(9466):1231-8
references: 15811456
references: BJU Int. 2013 Aug;112(4):517-25
references: 23510358
references: J Urol. 2009 Aug;182(2):435-43; discussion 443-4
references: 19524967
references: BJU Int. 2006 Jan;97(1):149-56
references: 16336347
references: J Urol. 2011 Oct;186(4):1229-35
references: 21849192
references: Intensive Care Med. 2010 Mar;36(3):444-51
references: 19956925
references: Am J Kidney Dis. 2009 Dec;54(6):1012-24
references: 19850388
references: Arch Intern Med. 2011 Feb 14;171(3):226-33
references: 21325112
references: J Urol. 2011 May;185(5):1598-603
references: 21419452
references: J Am Soc Nephrol. 2004 Jun;15(6):1597-605
references: 15153571
references: Kidney Int. 2012 Sep;82(6):718-22
references: 22695331
references: Clin J Am Soc Nephrol. 2010 Dec;5(12):2154-65
references: 20798258
references: Crit Care. 2007;11(2):R31
references: 17331245
references: J Urol. 1998 Sep;160(3 Pt 1):926-31
references: 9720589
references: Ann Intern Med. 2009 May 5;150(9):604-12
references: 19414839
references: Eur Urol. 2010 Sep;58(3):340-5
references: 20825756
references: J Am Soc Nephrol. 2009 Jan;20(1):223-8
references: 19020007