title: Urine ratio of neutrophil gelatinase-associated lipocalin to creatinine as a marker for early detection of cisplatin-associated nephrotoxicity.
abstract: BACKGROUND
  Cisplatin is a widely used chemotherapeutic agent with a major side effect of nephrotoxicity. Delayed increase in serum creatinine after cisplatin injection makes serum creatinine not to be an ideal marker for early detection of cisplatin nephrotoxicity. Recently several new biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) have been proposed for early detection of acute kidney injury (AKI). This study assessed kinetic of urine NGAL-creatinine ratio in patients who received cisplatin-containing chemotherapy.
  
  
  METHODS
  Patients with a glomerular filtration rates greater than 45 mL/min who received cisplatin-containing chemotherapy were included. Urine creatinine and NGAL concentrations were measured before cisplatin infusion and 6, 24, 48, and 72 hours after cisplatin administration. To minimize hydration effects, urine NGAL levels were adjusted according to urine creatinine.
  
  
  RESULTS
  Twenty-four patients were assessed. According to the Acute Kidney Injury Network criteria, 2 patients (8%) experienced cisplatin-associated AKI. The median increases in urine NGAL-creatinine ratio  were 335% (interquartile range, 320% to 350%) in the patients with AKI and 100% (interquartile range, 73% to 190%) in those without AKI (P = .02) during the first 24 hours after cisplatin administration. A urine NGAL-creatinine ratio greater than 26.9 ng/mg 24 hours after cisplatin infusion had a sensitivity of 86% and a specificity of 50% to detect cisplatin-associated nephrotoxicity.
  
  
  CONCLUSIONS
  Urine NGAL-creatinine ratio significantly increased in patients with cisplatin-associated AKI. Urine NGAL-creatinine ratio within the first 24 hours after cisplatin infusion may better predict cisplatin-associated nephrotoxicity than serum creatinine level.
authors.forename: Foroud
authors.initials: F
authors.lastname: Shahbazi
authors.forename: Sanambar
authors.initials: S
authors.lastname: Sadighi
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy; Nephrology Research Center; Tehran University of Medical Sciences, Tehran, Iran. dashtis@sina.tums.ac.ir.
authors.forename: Simin
authors.initials: S
authors.lastname: Dashti-Khavidaki
authors.forename: Farhad
authors.initials: F
authors.lastname: Shahi
authors.forename: Mehrzad
authors.initials: M
authors.lastname: Mirzania
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D003404:Creatinine / Q000652:urine*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012680:Sensitivity and Specificity
chemical_list: D000209:Acute-Phase Proteins; D000970:Antineoplastic Agents; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine; D002945:Cisplatin