title: Urinary neutrophil gelatinase-associated lipocalin levels predict cisplatin-induced acute kidney injury better than albuminuria or urinary cystatin C levels.
abstract: Cisplatin-induced acute kidney injury (AKI) is a major concern among clinicians in prescribing cisplatin-based chemotherapy. This study evaluated and compared the ability of urinary biomarkers, including urinary neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and the urinary albumin to creatinine ratio (ACR) to predict cisplatin-induced AKI. Thirty-three cancer patients receiving cisplatin-based chemotherapy were prospectively studied, including 10 (30%) who developed AKI (the study group). Changes of urinary biomarkers were compared at 4 hours, 8 hours, and 12 hours, and 1 day, 2 days, 3 days, and 4 days after cisplatin intravenous infusions (75mg/m(2)) versus the baseline. There was a significant increase in urinary NGAL levels from 12 hours to 4 days (p<0.05) compared to baseline after cisplatin infusion in the AKI group. The magnitude of these changes over time differed significantly by group (p<0.001). The area under the receiver operating curve describing the relationship between urinary NGAL levels and AKI within 12 hours was 0.865 (95% confidence interval=0.691-1.000). Urinary NGAL levels independently predicted AKI 12 hours after cisplatin (p=0.045) after adjustments for age, gender, body mass index, baseline serum creatinine, and urinary total protein. Urinary NGAL levels may be an early biomarker of AKI in patients receiving cisplatin-based treatment.
authors.affiliation: Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan.
authors.forename: Hugo You-Hsien
authors.initials: HY
authors.lastname: Lin
authors.forename: Su-Chu
authors.initials: SC
authors.lastname: Lee
authors.forename: Sheng-Fung
authors.initials: SF
authors.lastname: Lin
authors.forename: Hui-Hua
authors.initials: HH
authors.lastname: Hsiao
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Liu
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Yang
authors.forename: Daw-Yang
authors.initials: DY
authors.lastname: Hwang
authors.forename: Chi-Chih
authors.initials: CC
authors.lastname: Hung
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Jinn-Yuh
authors.initials: JY
authors.lastname: Guh
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000419:Albuminuria / Q000150:complications / Q000652:urine*; D002945:Cisplatin / Q000009:adverse effects*; D003404:Creatinine / Q000652:urine; D055316:Cystatin C / Q000652:urine*; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve
chemical_list: D000209:Acute-Phase Proteins; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine; D002945:Cisplatin