From the Guidelines
Neutrophil Gelatinase-Associated Lipocalin (NGAL) is an early marker of acute kidney (renal) rejection.
Key Biomarkers
- NGAL is a damage biomarker that can detect kidney injury earlier than traditional criteria such as creatinine and urine output levels 1.
- The use of NGAL in combination with functional biomarkers, such as cystatin C, can improve the diagnostic accuracy of acute kidney injury (AKI) and predict its severity 1.
- NGAL has been shown to be superior to serum creatinine (sCr) in predicting the severity of AKI in certain patient populations, such as children undergoing cardiopulmonary bypass 1.
Clinical Application
The integration of NGAL and other biomarkers into routine clinical practice has the potential to improve AKI care by enabling earlier detection and more precise delineation of the pathophysiology, site, mechanisms, and severity of injury 1.
Recommendation
A combination of damage and functional biomarkers, including NGAL, along with clinical information, is suggested to improve the diagnostic accuracy of AKI and recognize different pathophysiological processes 1.
From the Research
Early Markers of Acute Kidney Rejection
- Neutrophil Gelatinase-Associated Lipocalin (NGAL) is an early marker of acute kidney injury, with studies showing its expression increases significantly in AKI 2, 3, 4, 5.
- NGAL has been found to be a valuable marker for the early detection of acute kidney injury, particularly in kidney transplant rejection 3, 5.
- Kidney Injury Molecule-1 (KIM-1) is another marker of renal tubular injury, but its diagnostic utility in acute pancreatitis is unclear 6.
- Forkhead Box P3 (FoxP3) and beta-2 Microglobulin are not mentioned as early markers of acute kidney rejection in the provided studies.
- The studies suggest that NGAL, KIM-1, and other biomarkers may be useful in detecting and predicting the clinical course of acute kidney injury, but further research is needed to confirm their significance 2, 3, 4, 5.
Biomarker Expression and Detection
- NGAL levels can be detected in urine and serum, and have been found to increase significantly in acute kidney injury 3, 4, 5.
- KIM-1 is a promising marker of renal tubular injury, but its expression may be influenced by non-renal factors and may only be observed with more frequent monitoring 6.
- The timing of biomarker expression is crucial, with NGAL levels providing a significant predictive value when measured before 72 hours 5.
- Urinary and serum NGAL appears to be an independent predictor of not only kidney complications but also cardiovascular and liver-related diseases 5.