Calprotectin and neutrophil gelatinase-associated lipocalin in the differentiation of pre-renal and intrinsic acute kidney injury.

Urinary calprotectin has recently been identified as a promising biomarker for the differentiation of pre-renal and intrinsic acute kidney injury (AKI). This study compares the diagnostic performance of calprotectin and neutrophil gelatinase-associated lipocalin (NGAL) in this differential diagnosis. Urinary calprotectin and NGAL concentrations were assessed in a study population of 87 subjects including 38 cases of intrinsic AKI, 24 cases of pre-renal AKI and 25 healthy controls. Urinary tract obstruction, renal transplantation and metastatic cancer were defined as exclusion criteria. Mean calprotectin concentrations were significantly lower in pre-renal (190.2 ± 205.7 ng mL(-1) ) than in intrinsic AKI (6250.1 ± 7167.2 ng mL(-1) , P < 0.001). Receiver-operating characteristic (ROC) analysis provided an AUC of 0.99. Mean NGAL concentrations were significantly higher in intrinsic than in pre-renal AKI as well (458.1 ± 695.3 vs. 64.8 ± 62.1 ng mL(-1) , P = 0.001) providing an AUC of 0.82. A combination of the present study population with the cohort of the proof of concept study led to a population of 188 subjects (58 pre-renal AKI, 90 intrinsic AKI, 40 healthy controls). ROC analyses provided an AUC of 0.97 for calprotectin and 0.76 for NGAL yielding sensitivity and specificity values of 93.3 and 94.8% (calprotectin) vs. 75.3 and 72.4% (NGAL). Optimal cut-off values were 440 ng mL(-1) (calprotectin) and 52 ng mL(-1) (NGAL). Pyuria increased calprotectin concentrations independent of renal failure. This study shows that both calprotectin and NGAL are able to differentiate between pre-renal and intrinsic AKI after exclusion of pyuria. In the present population, calprotectin presents a higher sensitivity and specificity than NGAL.

Seibert FS ，Pagonas N ，Arndt R ，Heller F ，Dragun D ，Persson P ，Schmidt-Ott K ，Zidek W ，Westhoff TH ... -  《-》

Urinary calprotectin, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin for the prediction of adverse outcome in pediatric acute kidney injury.

Westhoff JH ，Seibert FS ，Waldherr S ，Bauer F ，Tönshoff B ，Fichtner A ，Westhoff TH ... -  《-》

Urinary Calprotectin Differentiates Between Prerenal and Intrinsic Acute Renal Allograft Failure.

Seibert FS ，Rosenberger C ，Mathia S ，Arndt R ，Arns W ，Andrea H ，Pagonas N ，Bauer F ，Zidek W ，Westhoff TH ... -  《-》

Diagnostic performance of urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin for acute kidney injury in an obstructive nephropathy patient.

We investigated the diagnostic performance of urinary kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) for acute kidney injury (AKI) in 90 obstructive nephropathy patients. Urine samples were obtained preoperatively and 4, 8, 12, 24, 48 and 72 h postoperatively, and urinary KIM-1 and NGAL contents were measured by enzyme linked immunosorbent assay and corrected against urine creatinine content. The receiver operating characteristic (ROC) curves were used to determine the area under the curve (AUCs) of urinary KIM-1 and NGAL for AKI. The baseline urinary KIM-1 contents were higher in AKI patients than non-AKI patients (P < 0.01). Urinary NGAL contents were also higher in AKI patients than non-AKI patients (P < 0.001). The area under the curve (AUC) of urinary KIM-1 was 0.900 (P = 0.004) and at a cutoff of 338.26 pg/mg Cr, the sensitivity was 90% and the specificity was 75%. The AUC of urinary NGAL was 0.900 (P = 0.004) and at a cutoff of 261.76 ng/mg Cr, the sensitivity was 90% and the specificity was 87.5%. The combined AUC of urinary KIM-1 and NGAL was 0.938 (P = 0.002) with a sensitivity of 90% and a specificity of 100%. Cox regression analysis revealed that urinary KIM-1content 72 h after operation correlated with the prognosis of AKI patients (P = 0.009). When kidney viability was stratified by urinary KIM-1 content 72 h postoperatively, Kaplan-Meier analysis showed that patients with a urinary content of KIM-1 < 138.20 pg/mg had a higher kidney viability rate than those with a urinary content of KIM-1 > 138.20 pg/mg. Urinary KIM-1 and NGAL had a good accuracy for detecting AKI. KIM-1 72 h postoperatively can predict the renal outcome of obstructive nephropathy.

Xue W ，Xie Y ，Wang Q ，Xu W ，Mou S ，Ni Z ... -  《-》

Urinary neutrophil gelatinase-associated lipocalin accurately detects acute allograft rejection among other causes of acute kidney injury in renal allograft recipients.

Heyne N ，Kemmner S ，Schneider C ，Nadalin S ，Königsrainer A ，Häring HU ... -  《-》