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Park, Koo, Lee, Kim, Yun, Kim, Whang, Joo, Lee, Chin, and Park: Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery
Original Article

Kosin Medical Journal 2017;32(2):212-220.

Published online: 19 January 2017

DOI: https://doi.org/10.7180/kmj.2017.32.2.212

Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

Se Jun Park1, Hoseok Koo1, Kyoung Jin Lee1, Seo Hyun Kim1, Seo Young Yun1, Seunghyup Kim1, Dong Hee Whang2, Shin Young Joo2, Byungmo Lee3, HoJun Chin4, Sihyung Park5

1Department of Internal Medicine, Inje University, Seoul Paik Hospital, Seoul, Korea

2Department of Clinical Pathology, Inje University, Seoul Paik Hospital, Seoul, Korea

3Department of Surgery, Inje University, Seoul Paik Hospital, Seoul, Korea

4Department of Internal Medicine, Seoul National university Bundang Hospital, Gyeonggido, Korea

5Department of Internal Medicine, Inje University, Haeundae Paik Hospital, Busan, Korea

Corresponding Author: Se Jun Park, Department of Internal Medicine, Inje University Seoul Paik Hospital, 9, Mareunnae-ro, Jung-gu, Seoul 04551, Korea. Tel: +82-2-2270-0015, Fax: +82-2-2270-0579, E-mail: sejun111@hanmail.net

Received 13 February 20163 March 2016       Accepted 23 May 2016

Copyright © 2017 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The neutrophil gelatinase-associated lipocalin (NGAL) level following non cardiac surgery is useful for predicting acute kidney damage. However, there is insufficient conclusive evidence as to whether NGAL can be used to predict subclinical AKI following non-cardiac surgery.

Methods

We measured serum NGAL and creatinine levels in 41 patients following non-cardiac surgery, and the increase of these variables was used to predict acute decreases in kidney function.

Results

The study included a total of 41 patients. The mean age was 64.65 ± 17.09 years. The serum creatinine concentration was increased 12 hours after surgery. The mean SD serum NGAL decreased after 4hours after surgery and continued to decrease after 12 hours after surgery. The incidence of subclinical AKI determined by the 4 hour serum NGAL level was 10(24.4%), and the incidence of serum creatinine elevation was 0(0.0%). The incidence of subclinical AKI determined by the 12 hour serum NGAL level was 4(9.8%), and the incidence of subclinical AKI determined by serum creatinine was 4(9.8%). The elevation of NGAL was more rapid than the serum creatinine 4 hours after surgery

Conclusions

We verified the usefulness of the serum NGAL level as a predictive factor for subclinical AKI after non-cardiac surgery.

Keywords: Acute kidney injury, Creatinine, NGAL, Prognostic factor, Surgery

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Fig. 1.
Change in serum NGAL and serum creatinine after the operations with mean and standard error. (A) Serum creatinine (B) NGAL, neutrophil geletinase-associated lipocalin.
kmj-32-212f1.tif
Fig. 2.
Incidence of subclinical AKI with NGAL and AKI with serum creatinine after the OP. OP : operation; NGAL : neutrophil gelatinase-associated lipocalin; AKI : acute kidney injury; CV : coefficient of variation
kmj-32-212f2.tif
Table 1.
Baseline characteristics of patients
Variable Value (n = 41)
Age 64.65 ± 17.09
Sex (M:F), n(%) 27:14 (58.6:41.4)
BMI (kg/㎡) 24.77 ± 4.75
DM (Y:N), n(%) 14:27 (41.4:58.6)
Hypertension 22:19 (52.7:46.3)
BUN (mg/dL) 15.46 ± 11.34
Hemoglobin (g/dL) 11.34 ± 2.20
Hematocrit (%) 33.11 ± 5.98
Albumin (g/dL) 3.78 ± 0.47
Cholesterol (mg/dL) 167.10 ± 48.85
Na (mmol/L) 138.36 ± 2.71
K (mmol/L) 4.31 ± 0.56
Cl (mmol/L) 105.56 ± 3.54
Estimated GFR 53.61 ± 29.77
Urine Output 6 hrs before operation (ml) 633 ± 382
Duration of anesthesia (min) 111.46 ± 55.56
Duration of surgery (min) 139.51 ± 104.56
Anesthesia method
Epidural n(%) 1 (4.5)
Spinal n(%) 8 (36.4)
General n(%) 25 (40.9)
Local n(%) 7 (18.2)
Type of surgery
CSn(%) 2 (4.8)
GSn(%) 3 (7.3)
GYNn(%) 3 (7.3)
NSn(%) 1 (2.4)
OSn(%) 26 (63.4)
PSn(%) 1 (2.4)
UROn(%) 5 (12.1)

Values are presented as mean ± standard deviation and number (%).

BMI : body mass index, DM : diabetes mellitus, BUN : blood urea nitrogen, GFR : glomerular filtration rate

CS : cardiac surgery, GS : general surgery, GYN : gynecology, NS : neurosurgery, OS : orthopedic surgery

PS : plastic surgery, URO : urology

Table 2.
Serum NGAL, creatinine on 4, 12 hours after the operations and the incidence of subclinical acute kidney injury as judged by sesrum NGAL.
Pre OP Post OP 4 hr Post OP 12 hr
NGAL (ng/mL) 268.48 ± 225.88 252.41 ± 212.53 231.82 ± 205.25
Creatinine (mg/dL) 1.55 ± 1.07 1.47 ± 1.07 1.53 ± 1.06
Subclinical AKI n(%) 10(24.4) 8(19.6)
AKI based on NGAL 10(24.4) 4(9.8)
AKI based on Cr 0(0.0) 4(9.8)

Values are presented as mean ± standard deviation and number (%).

OP : operation; NGAL : neutrophil gelatinase-associated lipocalin; AKI : acute kidney injury.

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