Korean J Intern Med.  2015 May;30(3):354-361. 10.3904/kjim.2015.30.3.354.

High serum and urine neutrophil gelatinaseassociated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy

• Rhee H
• Shin N
• Shin MJ
• Yang BY
• Kim IY
• Song SH
• Lee DW
• Lee SB
• Kwak IS
• Seong EY

• KMID: 2160708
• DOI: http://doi.org/10.3904/kjim.2015.30.3.354

Abstract

BACKGROUND/AIMS
Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN.
METHODS
The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease.
RESULTS
There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as T2 (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004).
CONCLUSIONS
In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression.

Keyword

Glomerulonephritis, IGA; Prognosis; Serum neutrophil gelatinase-associated lipocalin; Tubular biomarker; Urine neutrophil gelatinase-associated lipocalin

MeSH Terms

Acute-Phase Proteins/*urine
Adult
Biomarkers/blood/urine
Biopsy
Chi-Square Distribution
Disease Progression
Enzyme-Linked Immunosorbent Assay
Female
Glomerular Filtration Rate
Glomerulonephritis, IGA/*blood/complications/pathology/physiopathology/*urine
Humans
Kaplan-Meier Estimate
Kidney/*metabolism/pathology/physiopathology
Lipocalins/*blood/*urine
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Proto-Oncogene Proteins/*blood/*urine
Retrospective Studies
Risk Factors
Young Adult
Acute-Phase Proteins
Biomarkers
Lipocalins
Proto-Oncogene Proteins