Korean J Intern Med.  2015 May;30(3):345-353. 10.3904/kjim.2015.30.3.345.

Plasma neutrophil gelatinase-associated lipocalin as a potential predictor of adverse renal outcomes in immunoglobulin A nephropathy

• Park GY
• Yu CH
• Kim JS
• Kang YJ
• Kwon O
• Choi JY
• Cho JH
• Kim CD
• Kim YL
• Park SH

• KMID: 2160707
• DOI: http://doi.org/10.3904/kjim.2015.30.3.345

Abstract

BACKGROUND/AIMS
Neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN).
METHODS
In total, 91 patients with biopsy-proven IgAN at a single center were evaluated. pNGAL was measured using a commercial enzyme-linked immunosorbent assay kit (R&D Systems). Adverse renal outcome was defined as chronic kidney disease (CKD) stage 3 or above at the last follow-up. Pearson correlation coefficient and Cox regression were used for analyses.
RESULTS
The mean age of all patients (male:female, 48:43) was 35 years (range, 18 to 77). pNGAL ranged between 21.68 and 446.40 ng/mL (median, 123.97) and showed a correlation with age (r = 0.332, p = 0.001), creatinine (r = 0.336, p = 0.001), estimated glomerular filtration rate (r = -0.397, p < 0.001), uric acid (r = 0.289, p = 0.006), and the protein-to-creatinine ratio (r = 0.288, p = 0.006). During a mean follow-up period of 37.6 months, 11 patients (12.1%) had CKD stage 3 or above. In a multivariate Cox regression model, hypertension (hazard ratio [HR], 8.779; 95% confidence interval [CI], 1.526 to 50.496; p = 0.015), proteinuria > 1 g/day (HR, 5.184; 95% CI, 1.124 to 23.921; p = 0.035), and pNGAL (HR, 1.012; 95% CI, 1.003 to 1.022; p = 0.013) were independent predictors associated with adverse renal outcome.
CONCLUSIONS
pNGAL showed strong correlations with other clinical prognostic factors and was also an independent predictor of adverse renal outcome. We suggest pNGAL as a potential predictor for prognosis in IgAN, while further studies are needed to confirm the clinical value.

Keyword

Glomerulonephritis, IGA; Neutrophil gelatinase-associated lipocalin; Prognosis; Renal insufficiency, chronic

MeSH Terms

Acute-Phase Proteins
Adolescent
Adult
Aged
Biomarkers/blood
Biopsy
Chi-Square Distribution
Creatinine/blood
Disease Progression
Enzyme-Linked Immunosorbent Assay
Female
Glomerular Filtration Rate
Glomerulonephritis, IGA/*blood/complications/pathology/physiopathology
Humans
Kidney/*metabolism/pathology/physiopathology
Linear Models
Lipocalins/*blood
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Proto-Oncogene Proteins/*blood
Renal Insufficiency, Chronic/blood/etiology
Republic of Korea
Retrospective Studies
Risk Factors
Time Factors
Young Adult
Acute-Phase Proteins
Biomarkers
Creatinine
Lipocalins
Proto-Oncogene Proteins