Urinary Neutrophil Gelatinase-Associated Lipocalin Does Not Distinguish Acute Rejection from Other Causes of Acute Kidney Injury in Pediatric Renal Transplant Recipients.
BACKGROUND
The aim of this prospective single center study was to investigate the ability of urinary neutrophil gelatinase-associated lipocalin (NGAL) to distinguish acute rejection from other causes of acute kidney injury (AKI) in children after renal transplantation.


METHODS
Fifteen children fulfilled the inclusion criteria (acute kidney injury (AKI) with allograft biopsy, at least 21 days after renal transplantation, no sepsis) during 2013 - 2014 in our pediatric transplantation center. The mean age was 14.8  2.8, median time after renal transplantation was 0.4 years (range 0.1 - 3.8). Urinary NGAL was measured in spot urine by Chemiluminescent Microparticle Immunoassay technology.


RESULTS
Four patients had biopsy proven acute rejection (rejection group), eleven children had AKI of other cause (non-rejection group). The median urinary NGAL concentration in the rejection group was not significantly different from NGAL in the non-rejection group (7.3 ng/mL, range 3.0 - 42.3 vs. 8.6 ng/mL, range 3.4 - 54.7, p = 0.48). There was a significant negative correlation between eGFR and urinary NGAL concentrations (r = -0.77, p < 0.001).


CONCLUSIONS
Our small study suggests that in children after renal transplantation, urinary NGAL cannot be used as a specific marker for distinguishing acute rejection from other non-rejection causes of AKI. Urinary NGAL was mainly associated with graft function but not with the etiology of AKI.
Tomas
T
Seeman
Karel
K
Vondrak
Jiri
J
Dusek
Nadezda
N
Simankova
Jakub
J
Zieg
Jaromir
J
Hacek
Maria
M
Chadimova
Bruno
B
Sopko
Magdalena
M
Fortova
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D000293:Adolescent; D000367:Age Factors; D064591:Allografts; D015415:Biomarkers / Q000652:urine; D001706:Biopsy; D002648:Child; D018153:Czech Republic; D003937:Diagnosis, Differential; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D006801:Humans; D007118:Immunoassay; D007668:Kidney / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D000071068:Lipocalin-2 / Q000652:urine*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016482:Urinalysis
D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2