J Korean Med Sci.  2020 Mar;35(10):e65. 10.3346/jkms.2020.35.e65.

Associations of Plasma Neutrophil Gelatinase-associated Lipocalin, Anemia, and Renal Scarring in Children with Febrile Urinary Tract Infections

• Lee JH
• Yim HE
• Yoo KH

• KMID: 2471799
• DOI: http://doi.org/10.3346/jkms.2020.35.e65

Abstract

BACKGROUND
Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs).
METHODS
We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR).
RESULTS
Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard β = −0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.07-5.27; P < 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P < 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591-0.843) was higher than that of post-treatment CRP (0.520; 95% CI, 0.395-0.643; P < 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring.
CONCLUSION
Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.

Keyword

Fibrosis; Hypoxia; Inflammation; Lipocalin-2

MeSH Terms

Anemia*
Anoxia
C-Reactive Protein
Child*
Cicatrix*
Erythrocyte Count
Erythropoiesis
Fibrosis
Humans
Inflammation
Linear Models
Lipocalins*
Medical Records
Neutrophils*
Plasma*
Pyelonephritis
Retrospective Studies
Risk Factors
Thiram
Urinary Tract Infections*
Urinary Tract*
Vesico-Ureteral Reflux
C-Reactive Protein
Lipocalins
Thiram