Neutrophil gelatinase-associated lipocalin (NGAL) predicts the occurrence of malaria-induced acute kidney injury.
BACKGROUND
Acute kidney injury (AKI) is a frequently encountered complication of imported Plasmodium falciparum infection. Markers of structural kidney damage have been found to detect AKI earlier than serum creatinine-based prediction models but have not yet been evaluated in imported malaria. This pilot study aims to explore the predictive performance of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for AKI in travellers with imported P. falciparum infection.


METHODS
Thirty-nine patients with imported falciparum malaria from the Rotterdam Malaria Cohort with available serum and urine samples at presentation were included. Ten of these patients met the criteria for severe malaria. The predictive performance of NGAL and KIM-1 as markers for AKI was compared with that of serum creatinine.


RESULTS
Six of the 39 patients (15 %) developed AKI. Serum and urine NGAL and urine KIM-1 were all found to have large areas under the receiver operating characteristics curves (AUROC) for predicting AKI. Urine NGAL was found to have an excellent performance with positive predictive value (PPV) of 1.00 (95 % CI 0.54-1.00), a negative predictive value (NPV) of 1.00 (95 % CI 0.89-1.00) and an AUROC of 1.00 (95 % CI 1.00-1.00).


CONCLUSIONS
A good diagnostic performance of NGAL and KIM-1 for AKI was found. Particularly, urine NGAL was found to have an excellent predictive performance. Larger studies are needed to demonstrate whether these biomarkers are superior to serum creatinine as predictors for AKI in P. falciparum malaria.
Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands. mvanwolfswinkel@gmail.com.|Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands. mvanwolfswinkel@gmail.com.
Marlies E
ME
van Wolfswinkel
Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands.
Liese C
LC
Koopmans
Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
Dennis A
DA
Hesselink
Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
Ewout J
EJ
Hoorn
Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands.
Rob
R
Koelewijn
Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands.
Jaap J
JJ
van Hellemond
Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands.
Perry J J
PJ
van Genderen
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology*; D000328:Adult; D000368:Aged; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1 / Q000032:analysis* / Q000097:blood*; D006801:Humans; D000071068:Lipocalin-2 / Q000097:blood* / Q000652:urine*; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D014195:Travel
C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D000071068:Lipocalin-2
Acute kidney injury; KIM-1; Malaria; NGAL; Plasmodium falciparum