title: Neutrophil gelatinase-associated lipocalin (NGAL) fails as an early predictor of contrast induced nephropathy in chronic kidney disease (ANTI-CI-AKI study).
abstract: The aim of the study was to evaluate the diagnostic accuracy of urinary neutrophil gelatinase- associated lipocalin (uNGAL) in patients with chronic kidney disease (CKD) as an early biomarker for contrast induced acute kidney injury (CI-AKI) and to investigate whether patients with an uNGAL increase might benefit from an additional intravenous volume expansion with regard to CI-AKI-incidence. We performed a prospective randomized controlled trial in 617 CKD-patients undergoing intra-arterial angiography. Urinary NGAL was measured the day before and 4-6hrs after angiography. In the event of a significant rise of uNGAL patients were randomized either into Group A, who received intravenous saline post procedure or Group B, who did not receive post-procedural i.v. fluids. Ten patients (1.62%) exhibited a significant rise of uNGAL after angiography and were randomized of whom one developed a CI-AKI. In the entire cohort the incidence of CI-AKI was 9.4% (58 patients) resulting in a specificity of 98.4% (95% CI: 97.0-99.3%) and a sensitivity of 1.72% (95% CI: 0.044-9.2%) of uNGAL for the diagnosis of CI-AKI. In this study uNGAL failed to predict CI-AKI and was an inadequate triage tool to guide an early intervention strategy to prevent CI-AKI.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01292317.
authors.affiliation: Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Ribitsch
authors.affiliation: Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.|Intensive Care Unit, Department of Internal Medicine, MUG, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Schilcher
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Quehenberger
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.affiliation: Department of Vascular and Interventional Radiology, University Clinic of Radiology, Medical University of Graz, Austria.
authors.forename: Rupert H
authors.initials: RH
authors.lastname: Portugaller
authors.affiliation: Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria.
authors.forename: Martini
authors.initials: M
authors.lastname: Truschnig-Wilders
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Zweiker
authors.affiliation: Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Marianne
authors.initials: M
authors.lastname: Brodmann
authors.affiliation: Division of Transplantation Surgery, Medical University of Graz, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Stiegler
authors.affiliation: Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Rosenkranz
authors.affiliation: Department of Medicine, University of Otago Christchurch and Emergency Medicine Department, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: John W
authors.initials: JW
authors.lastname: Pickering
authors.affiliation: Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.
authors.forename: Joerg H
authors.initials: JH
authors.lastname: Horina
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000473:pathology / Q000652:urine*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D000071068:Lipocalin-2 / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000473:pathology / Q000652:urine*
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D000071068:Lipocalin-2