title: Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) occurs in up to 13% of patients undergoing percutaneous coronary intervention (PCI). Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for renal impairment. We investigated whether increased urinary NGAL concentrations were predictive of CI-AKI within 2 days after PCI or of a higher re-hospitalization rate within 9 months.
  
  
  METHODS
  Consecutive patients (n = 128), with stable coronary heart disease and eGFR ≥ 30 mL/min/1.73 m(2), undergoing PCI were included. Venous serum samples for measurement of creatinine, blood urea nitrogen, and cystatin C and urine samples for NGAL measurement were collected 4 hours and 1 and 2 days after contrast medium application. Patients were followed over 9 months to determine clinical endpoints.
  
  
  RESULTS
  CI-AKI was observed in 14 patients (10.9%) after PCI. NGAL concentrations before PCI were significantly higher in patients with subsequent CI-AKI (19.8 ng/mL [14.4-35.8] vs. 11.6 ng/mL [5.6-28.2]; p = 0.04). There was no significant difference in NGAL concentrations 4 h after PCI between patients with and without CI-AKI. One day after PCI, NGAL concentrations were significant higher in patients developing CI-AKI (100.1 ng/mL [41.5-129.2] vs. 16.6 ng/mL [9.1-28.1]; p < 0.001). Compared to common biomarkers, NGAL best predicted CI-AKI (AUC 0.939 [95% CI 0.89-0.99; p < 0.001]). The re-hospitalization rate due to progressive renal insufficiency within 9 months was higher in the group with CI-AKI than the group without (4 [28.6%] vs. 4 [3.5%], p < 0.01).
  
  
  CONCLUSIONS
  Urinary NGAL is a biomarker for predicting CI-AKI when measured 1 day after PCI.
authors.affiliation: Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim.
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.forename: Luise
authors.initials: L
authors.lastname: Gaede
authors.forename: Oliver
authors.initials: O
authors.lastname: Doerr
authors.forename: Johannes
authors.initials: J
authors.lastname: Blumenstein
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.forename: Olaf
authors.initials: O
authors.lastname: Teichert
authors.forename: Matthias
authors.initials: M
authors.lastname: Willmer
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D001806:Blood Urea Nitrogen; D003287:Contrast Media / Q000009:adverse effects*; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy; D003404:Creatinine / Q000652:urine; D055316:Cystatin C / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000652:urine*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000209:etiology / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D003287:Contrast Media; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine