title: Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study.
abstract: A patent ductus arteriosus (PDA) is frequently found in very preterm neonates and is associated with increased risk of morbidity and mortality. A shunt across a PDA can result in an unfavorable distribution of the cardiac output and may in turn result in poor renal perfusion. Urinary Neutrophil Gelatinase-associated Lipocalin (U-NGAL) is a marker of renal ischemia and may add to the evaluation of PDA. Our primary aim was to investigate if U-NGAL is associated with PDA in very preterm neonates. Secondary, to investigate whether U-NGAL and PDA are associated with AKI and renal dysfunction evaluated by fractional excretion of sodium (FENa) and urine albumin in a cohort of very preterm neonates.
  
  
  
  A cohort of 146 neonates born at a gestational age less than 32 weeks were consecutively examined with echocardiography for PDA and serum sodium, and urine albumin and sodium were measured on postnatal day 3 and U-NGAL and serum creatinine day 3 and 6. AKI was defined according to modified neonatal Acute Kidney Injury Network (AKIN) criteria. The association between U-NGAL and PDA was investigated. And secondly we investigated if PDA and U-NGAL was associated with AKI and renal dysfunction.
  
  
  
  U-NGAL was not associated with a PDA day 3 when adjusted for gestational age and gender. A PDA day 3 was not associated with AKI when adjusted for gestational age and gender; however, it was associated with urine albumin. U-NGAL was not associated with AKI, but was found to be associated with urine albumin and FENa.
  
  
  
  Based on our study U-NGAL is not considered useful as a diagnostic marker to identify very preterm neonates with a PDA causing hemodynamic changes resulting in early renal morbidity. The interpretation of NGAL in preterm neonates remains to be fully elucidated.
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark. anna.sellmer@clin.au.dk.|Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark. anna.sellmer@clin.au.dk.
authors.forename: Anna
authors.identifier: 0000-0003-2464-5703
authors.initials: A
authors.lastname: Sellmer
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, Denmark.
authors.forename: Bodil H
authors.initials: BH
authors.lastname: Bech
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.
authors.forename: Jesper V
authors.initials: JV
authors.lastname: Bjerre
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Schmidt
authors.affiliation: Department of Cardiothoracic surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.
authors.forename: Vibeke E
authors.initials: VE
authors.lastname: Hjortdal
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Esberg
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Rittig
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.|Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200, Aarhus, Denmark.
authors.forename: Tine B
authors.initials: TB
authors.lastname: Henriksen
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000652:urine; D004452:Echocardiography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D000071068:Lipocalin-2 / Q000652:urine*; D008297:Male; D012964:Sodium / Q000097:blood
chemical_list: D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D012964:Sodium; D003404:Creatinine
keywords: Acute kidney injury; Neutrophil gelatinase-associated lipocalin; Patent ductus arteriosus; Very preterm neonates