title: Neutrophil gelatinase-associated lipocalin: ready for routine clinical use? An international perspective.
abstract: Acute kidney injury (AKI) remains a challenge in terms of diagnosis and classification, its morbidity and mortality remaining high in the face of improving clinical protocols. Current clinical criteria use serum creatinine (sCr) and urine output to classify patients. Ongoing research has identified novel biomarkers that may improve the speed and accuracy of patient evaluation and prognostication, yet the route from basic science to clinical practice remains poorly paved. International evidence supporting the use of plasma neutrophil gelatinase-associated lipocalin (NGAL) as a valuable biomarker of AKI and chronic kidney disease (CKD) for a number of clinical scenarios was presented at the 31st International Vicenza Course on Critical Care Nephrology, and these data are detailed in this review. NGAL was shown to be highly useful alongside sCr, urinary output, and other biomarkers in assessing kidney injury; in patient stratification and continuous renal replacement therapy (CRRT) selection in paediatric AKI; in assessing kidney injury in conjunction with sCr in sepsis; in guiding resuscitation protocols in conjunction with brain natriuretic peptide in burn patients; as an early biomarker of delayed graft function and calcineurin inhibitor nephrotoxicity in kidney transplantation from extended criteria donors; as a biomarker of cardiovascular disease and heart failure, and in guiding CRRT selection in the intensive care unit and emergency department. While some applications require further clarification by way of larger randomised controlled trials, NGAL nevertheless demonstrates promise as an independent biological marker with the potential to improve earlier diagnosis and better assessment of risk groups in AKI and CKD. This is a critical element in formulating quick and accurate decisions for individual patients, both in acute scenarios and in long-term care, in order to improve patient prognostics and outcomes.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Mina
authors.initials: M
authors.lastname: Hur
authors.forename: Nam
authors.initials: N
authors.lastname: Tran
authors.forename: Eric C
authors.initials: EC
authors.lastname: Howell
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cantaluppi
authors.forename: Dinna N
authors.initials: DN
authors.lastname: Cruz
authors.forename: Kevin
authors.initials: K
authors.lastname: Damman
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Andrew
authors.initials: A
authors.lastname: Lewington
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000209:Acute-Phase Proteins / Q000652:urine; D000367:Age Factors; D015415:Biomarkers / Q000097:blood* / Q000652:urine; D002056:Burns / Q000097:blood / Q000628:therapy; D002315:Cardiopulmonary Bypass; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis; D002986:Clinical Trials as Topic; D016638:Critical Illness; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood* / Q000652:urine; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011518:Proto-Oncogene Proteins / Q000097:blood* / Q000652:urine; D017582:Renal Replacement Therapy; D012151:Resuscitation; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D020097:Natriuretic Peptide, Brain