Clinical application of neutrophil gelatinase-associated lipocalin in the revised chronic kidney disease classification.
BACKGROUND
A revised classification of chronic kidney disease (CKD) was proposed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2012. Neutrophil gelatinase-associated lipocalin (NGAL) was considered as one of the most promising biomarkers in clinical nephrology. The aim of this study was to examine the level of NGAL in patients with different impairment of GFR based on the new classification, and to evaluate whether NGAL in serum or urine was associated with different risk categories in CKD patients.


METHODS
A cross-sectional study was performed in 240 patients with CKD. NGAL, serum cystatin C, β₂-macroglobulin (β₂-MG), urine α₁-macroglobulin (α₁-MG) and albuminuria were tested in patients with various degrees of renal impairment.


RESULTS
Good correlation was found between the NGAL and the cystatin C, β₂-MG and the α₁-MG (r > 0.7). The level of sNGAL in CKD stage 3b was more than that in CKD stage 3a (P = 0.025). The concentration of the NGAL increased progressively with the increasing of risk categories (proposed by the revised CKD classification). The cutoff value of NGAL was calculated from stage 2 to stage 5. ROC analysis showed good AUC (sNGAL > 0.8, uNGAL > 0.7) and high specificity (sNGAL > 87%, uNGAL > 90%) on the cutoff value of NGAL.


CONCLUSIONS
The results confirm NGAL as a useful biomarker in clinical nephrology which is helpful to diagnosis and evaluate the categories for CKD proposed by the KDIGO.
Department of Clinical Laboratory, Chinese People's Liberation Army General Hospital Beijing 100853, China.
Daijun
D
Xiang
Ningbo Women & Children's Hospital Ningbo 315031, China.
Hongrui
H
Zhang
Department of Clinical Laboratory, Chinese People's Liberation Army General Hospital Beijing 100853, China.
Jie
J
Bai
Department of Clinical Laboratory, Chinese People's Liberation Army General Hospital Beijing 100853, China.
Junlong
J
Ma
Department of Clinical Laboratory, Chinese People's Liberation Army General Hospital Beijing 100853, China.
Mianyang
M
Li
School of Labroratory Medicine and Life Science, Wenzhou Medical College Whenzhou 325000, China.
Jimin
J
Gao
Department of Clinical Laboratory, Chinese People's Liberation Army General Hospital Beijing 100853, China.
Chengbin
C
Wang
D000209:Acute-Phase Proteins / Q000652:urine*; D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000652:urine; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult; D000511:alpha-Macroglobulins / Q000032:analysis
D000209:Acute-Phase Proteins; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D000511:alpha-Macroglobulins; D003404:Creatinine
KDIGO; Neutrophil gelatinase-associated lipocalin; chronic kidney disease