title: Neutrophil Gelatinase Associated Lipocalin (NGAL) in Leptospirosis Acute Kidney Injury: A Multicenter Study in Thailand.
abstract: AKI is one of the most serious complications of leptospirosis, an important zoonosis in the tropics. Recently, NGAL, one of the novel AKI biomarkers, is extensively studied in various specific settings such as sepsis, cardiac surgery, and radiocontrast nephropathy. In this multicenter study, we aimed to study the role of NGAL as an early marker and an outcome predictor of leptospirosis associated AKI. Patients who presented with clinical suspiciousness of leptospirosis were prospectively enrolled in 9 centers from August 2012 to November 2014. The first day of enrollment was the first day of clinical suspicious leptospirosis. Blood and urine samples were serially collected on the first three days and day 7 after enrollment. We used three standard techniques (microscopic agglutination test, direct culture, and PCR technique) to confirm the diagnosis of leptospirosis. KDIGO criteria were used for AKI diagnosis. Recovery was defined as alive and not requiring dialysis during hospitalization or maintaining maximum KDIGO stage at hospital discharge. Of the 221 recruited cases, 113 cases were leptospirosis confirmed cases. Thirty seven percent developed AKI. Median uNGAL and pNGAL levels in those developing AKI were significantly higher than in patients not developing AKI [253.8 (631.4) vs 24.1 (49.6) ng/ml, p < 0.001] and [1,030 (802.5) vs 192.0 (209.0) ng/ml, p < 0.001], respectively. uNGAL and pNGAL levels associated with AKI had AUC-ROC of 0.91, and 0.92, respectively. Both of urine NGAL and pNGAL level between AKI-recovery group and AKI-non recovery were comparable. From this multicenter study, uNGAL and pNGAL provided the promising result to be a marker for leptospirosis associated AKI. However, both of them did not show the potential role to be the predictor of renal recovery in this specific setting.
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.|Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Nattachai
authors.initials: N
authors.lastname: Srisawat
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Kearkiat
authors.initials: K
authors.lastname: Praditpornsilpa
authors.affiliation: Department of Microbiology and Immunology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Kanitha
authors.initials: K
authors.lastname: Patarakul
authors.affiliation: Prapokklao hospital, Chantaburi, Thailand.
authors.forename: Malee
authors.initials: M
authors.lastname: Techapornrung
authors.affiliation: Krasang hospital, Buriram, Thailand.
authors.forename: Tinnapop
authors.initials: T
authors.lastname: Daraswang
authors.affiliation: Tungsong hospital, Nakhon Si Thammarat, Thailand.
authors.forename: Theerapon
authors.initials: T
authors.lastname: Sukmark
authors.affiliation: Maharaj Nakhon Si Thammarat hospital, Nakhon Si Thammarat, Thailand.
authors.forename: Kamol
authors.initials: K
authors.lastname: Khositrangsikun
authors.affiliation: Uttaradit hospital, Uttaradit, Thailand.
authors.forename: Apinya
authors.initials: A
authors.lastname: Fakthongyoo
authors.affiliation: Nan hospital, Nan, Thailand.
authors.forename: Petchdee
authors.initials: P
authors.lastname: Oranrigsupak
authors.affiliation: Roiet hospital, Roiet, Thailand.
authors.forename: Laksamon
authors.initials: L
authors.lastname: Praderm
authors.affiliation: Mahasarakarm hospital, Mahasarakarm, Thailand.
authors.forename: Ummarit
authors.initials: U
authors.lastname: Suwattanasilpa
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Sadudee
authors.initials: S
authors.lastname: Peerapornratana
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Passisd
authors.initials: P
authors.lastname: Loahaveeravat
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Nattachai
authors.initials: N
authors.lastname: Suwachittanont
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Thaksa-on
authors.initials: TO
authors.lastname: Wirotwan
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Chayanat
authors.initials: C
authors.lastname: Phonork
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Sarinya
authors.initials: S
authors.lastname: Kumpunya
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Khajohn
authors.initials: K
authors.lastname: Tiranathanagul
authors.affiliation: Department of Microbiology and Immunology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Chintana
authors.initials: C
authors.lastname: Chirathaworn
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-ong
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Kriang
authors.initials: K
authors.lastname: Tungsanga
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.|Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand.
authors.forename: Visith
authors.initials: V
authors.lastname: Sitprija
authors.affiliation: Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Natavudh
authors.initials: N
authors.lastname: Townamchai
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D000209:Acute-Phase Proteins / Q000652:urine*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007922:Leptospirosis / Q000150:complications*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000097:blood* / Q000652:urine*; D020127:Recovery of Function; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins