Role of plasma neutrophil gelatinase associated lipocalin in the diagnosis of pediatric acute kidney injury

Background: Open heart surgery is usually indicated as treatment for congenital heart diseases in children, and one of the major complications of this procedure is cardiac surgery associated acute kidney injury (CSA-AKI). This is diagnosed late because there are no clear cut markers for early assessment of sudden decline in renal function. The aim is to assess the role of Neutrophil Gelatinase Associated Lipocalin (NGAL) in the diagnosis of cardiac surgery-associated AKI (CSA-AKI).

Method:  Forty (40) children aged 15 years and below, who had open heart surgery for congenital heart diseases were recruited for this prospective longitudinal study. Concentrations of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in plasma were measured and compared at 0-, 4-, 8-, 12-, 24-, and 48- hours with plasma creatinine.  Quantifications of NGAL were done using Enzyme-linked Immunosorbent Assay (ELISA) while creatinine was done on an automated analyzer (Cobas C311, Roche).

Results: Mean plasma NGAL concentrations at 0, 4, 8, 12, 24 and 48 hours were 70.50±21.47ng/ml, 105.32±24.95ng/ml, 113.58±28.51ng/ml, 103.47±26.49ng/ml, 94.43±22.78ng/ml and 89.18±20.44ng/ml respectively with peak concentration at 8hrs while that of creatinine were 48.98±11.6µmol/L, 59.65±13.06µmol/L, 63.00±16.53µmol/L, 64.90±17.65µmol/L, 68.50±19.99µmol/L and 70.78±21.86µmol/L respectively with peak concentration at 48hrs. NGAL had a better diagnostic ability with an AUC of 0.987, while creatinine had an AUC of 0.429.

Conclusion:  The findings being reported in this study showed that NGAL predicted AKI earlier, at 8hrs after surgery and with a higher sensitivity and specificity, compared to creatinine in children who had open heart surgery for congenital heart diseases.