title: Urinary neutrophil gelatinase associated lipocalin as a biomarker in ifosfamide induced chronic renal failure.
abstract: OBJECTIVE
  Neutrophil gelatinase associated lipocalin (NGAL) have been used with great success in acute renal failure and in some cases in chronic nephrotoxicity. In this work, we aimed to investigate urinary NGAL as an early marker of chronic renal failure (CRF).
  
  
  METHODS
  We investigated urinary NGAL of 29 children treated with ifosfamide chemotherapy and compared them with those of 12 healthy children. Urinary β2 microglobulin, serum cystatin C, and creatinine clearance analyses were also studied.
  
  
  RESULTS
  The median age was 11 years (4-21) and median remission time was 4.3 years (1.8-14.4). The cumulative dose of ifosfamide was 36 g. Glomerular filtration rate was decreased in 41.4% and urine β2 microglobulin levels and serum cystatin C levels were elevated in 31% of the patients. As the remission time increased, serum creatinine and cystatin C levels were also increased. The sensitivity for β2 microglobulin and cystatin C in demonstrating CRF was 35.2% and 23% and specificity was 33.2% and 50% respectively. The 24-hour urine NGAL cut-off level for demonstrating CRF was found to be 1.065 ng/mL/24 hours. The sensitivity and specificity for this cut-off value were 83% and 77%, respectively.
  
  
  CONCLUSIONS
  NGAL levels were significantly higher in the study group as compared with the control group. Although ifosfamide treatment was suggested to be safe with no complication of renal failure under a dose of 80 g/m2, chronic renal failure and deficits in glomerular and tubular function could be seen when the remission time increased. Elevated NGAL levels may be a good option in determining CRF.
authors.affiliation: Department of Pediatric Oncology, Pediatric Nephrology, Hacettepe University, Ankara, Turkey. vural73@yahoo.com.
authors.forename: V
authors.initials: V
authors.lastname: Kesik
authors.forename: E
authors.initials: E
authors.lastname: Demirkaya
authors.forename: M
authors.initials: M
authors.lastname: Buyukpamukçu
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D011518:Proto-Oncogene Proteins / Q000652:urine*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000139:chemically induced* / Q000652:urine; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D018906:Antineoplastic Agents, Alkylating; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine; D007069:Ifosfamide