Ann Lab Med.  2018 Nov;38(6):524-529. 10.3343/alm.2018.38.6.524.

Plasma Neutrophil Gelatinase-Associated Lipocalin as a Marker of Tubular Damage in Diabetic Nephropathy

• Kim SY
• Jeong TD
• Lee W
• Chun S
• Sunwoo S
• Kim SB
• Min WK

• KMID: 2429117
• DOI: http://doi.org/10.3343/alm.2018.38.6.524

Abstract

BACKGROUND
An increase in neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular injury. Diabetic nephropathy causes typical changes in the kidney, characterized by glomerulosclerosis and eventual tubular damage. We validated the usefulness of plasma NGAL (pNGAL) as a biomarker of tubular damage in patients with diabetic nephropathy.
METHODS
We included 376 patients with diabetes mellitus (260 patients with chronic renal insufficiency who had not received hemodialysis and 116 hemodialyzed due to diabetic nephropathy) and 24 healthy controls. Patients with chronic renal insufficiency were divided into three groups according to urinary albumin excretion (UAE) levels. pNGAL levels were measured using the Triage NGAL test (Alere, San Diego, CA, USA) and were compared between groups. We also examined whether pNGAL level was related to the degree of albuminuria and cystatin C-based glomerular filtration rate (GFR).
RESULTS
Mean pNGAL levels of the healthy controls, chronic renal insufficiency patients with diabetes mellitus, and hemodialyzed patients were 61.9±5.3 ng/mL, 93.4±71.8 ng/mL, and 1,536.9±554.9 ng/mL, respectively. pNGAL level increased significantly in patients with severe albuminuria (P < 0.001) and had a moderate correlation with the degree of albuminuria (r=0.467; P < 0.001) and GFR (r=0.519; P < 0.001). Multivariate regression analysis showed that the pNGAL level was associated with tubular damage independent of patient age, sex, and GFR.
CONCLUSIONS
pNGAL level independently reflects the degree of tubular damage in patients with diabetic nephropathy. Measurement of pNGAL, combined with UAE, would enable simultaneous, highly reliable assessments of tubular damage for such patients.

Keyword

Neutrophil gelatinase-associated lipocalin; Diabetic nephropathy; Hemodialysis; Tubular damage

MeSH Terms

Albuminuria
Diabetes Mellitus
Diabetic Nephropathies*
Glomerular Filtration Rate
Humans
Kidney
Lipocalins*
Neutrophils*
Plasma*
Renal Dialysis
Renal Insufficiency, Chronic
Triage
Lipocalins

Figure

• 

  Fig. 1 Levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) among different groups. pNGAL levels are significantly higher in the hemodialysis group. Abbreviation: HD, hemodialysis.

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  Fig. 2 Urinary albumin excretion (UAE) levels (A) and glomerular filtration rate (GFR) (B) of normoalbuminuria, microalbuminuria, and macroalbuminuria patients with diabetes mellitus. The number of subjects in each group is indicated in parentheses.

• 

  Fig. 3 Correlation of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and albuminuria (A) and cystatin C-based glomerular filtration rate (GFR) in patients with diabetes mellitus. Moderate correlation between plasma neutrophil gelatinase-associated lipocalin (pNGAL) levels and the degree of albuminuria in patients with diabetes mellitus (r=0.467, P<0.001). (B) Moderate correlation between pNGAL levels and cystatin C-based glomerular filtration rate (GFR) in patients with diabetes mellitus (r=0.519, P<0.001).

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