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Archives of Medical Science
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vol. 14
Clinical research

Urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, N-acetyl-β-D-glucosaminidase levels and mortality risk in septic patients with acute kidney injury

Heng Fan, Yu Zhao, Min Sun, Jian-Hua Zhu

Arch Med Sci 2018; 14, 6: 1381–1386
Online publish date: 2018/10/23
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The aim of the study was to confirm whether higher levels of urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and N-acetyl--D-glucosaminidase (NAG) are associated with mortality risk scores in severe septic patients with acute kidney injury (AKI).

Material and methods
A prospective observational study was performed in an adult critical care unit. A total of 135 patients were included. The levels of urinary NGAL, KIM-1 and NAG were compared between patients with acute physiology and chronic health evaluation (APACHE II) score > 25 (group A, n = 31) and APACHE II score ≤ 25 (group B, n = 104).

Median level of NGAL was 105.1 ng/ml (77.6–132.5) in group A versus 40.0 ng/ml (18.6–60.5) in group B (p < 0.001), KIM-1 was 16.2 ng/ml (10.2–22.3) versus 3.3 ng/ml (1.8–4.6) (p < 0.001), and NAG was 32.0 U/l (17.5–46.4) versus 15.0 U/l (7.7–22.3) (p < 0.001). The area under the receiver operating characteristic curve for NGAL was 0.70 (95% CI: 0.60–0.79), KIM-1 was 0.75 (95% CI: 0.66–0.83), and NAG was 0.69 (95% CI: 0.60–0.79). A NGAL level > 102.5 ng/ml had 95% sensitivity and 76% specificity, KIM-1 > 7.3 ng/ml had 96% sensitivity and 61% specificity, and NAG > 15.4 U/l had 86% sensitivity and 74% specificity.

In severe septic AKI patients, high levels of NGAL, KIM-1 and NAG are associated with mortality risk scores. Urinary NGAL, KIM-1 and NAG concentrations higher than 102.5 ng/ml, 7.3 ng/ml and 15.4 U/l respectively may be used to predict increased of death risk scores.


sepsis, acute kidney injury, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, N-acetyl--D-glucosaminidase

Koyner JL, Garg AX, Coca SG, et al. Biomarkers predict progression of acute kidney injury after cardiac surgery. J Am Soc Nephrol 2012; 23: 905-14.
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294: 813-8.
Wald R, Quinn RR, Luo J, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 2009; 302: 1179-85.
Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009; 54: 1012-24.
Fan H, Zhao Y, Zhu JH, Song FC. Urine neutrophil gelatinase-associated lipocalin in septic patients with and without acute kidney injury. Ren Fail 2014; 36: 1399-403.
Fadel FI, Abdel Rahman AM, Mohamed MF, et al. Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery. Arch Med Sci 2012; 8: 250-5.
Devarajan P. Neutrophil gelatinase-associated lipocalin: a promising biomarker for human acute kidney injury. Biomark Med 2010; 4: 265-80.
Wasilewska A, Taranta-Janusz K, Dębek W, et al. KIM-1 and NGAL: new markers of obstructive nephropathy. Pediatr Nephrol 2011; 26: 579-86.
Guo Q, Li HY, Li YM, et al. Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country. Arch Med Sci 2014; 10: 970-8.
Tucker SM, Pierce RJ, Price RG. Characterisation of human N-acetyl-beta-D-glucosaminidase isoenzymes as an indicator of tissue damage in disease. Clin Chim Acta 1980; 102: 29-40.
Fujita H, Narita T, Morii T, et al. Increased urinary excretion of N-acetylglucosaminidase in subjects with impaired glucose tolerance. Ren Fail 2002; 24: 69-75.
Liangos O, Perianayagam MC, Vaidya VS, et al. Urinary N-acetyl-beta-(D)-glucosaminidase activity and kidney injury molecule-1 level are associated with adverse outcomes in acute renal failure. J Am Soc Nephrol 2007; 18: 904-12.
Lipińska-Gediga M, Mierzchała-Pasierb M, Durek G, et al. Procalcitonin kinetics – prognostic and diagnostic significance in septic patients. Arch Med Sci 2016; 12: 112-9.
Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204-12.
Khanagavi J, Gupta T, Aronow WS, et al. Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes. Arch Med Sci 2014; 10: 251-7.
Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6: 2-8.
Ichimura T, Hung CC, Yang SA, et al. Kidney injury molecule-1: a tissue and urinary biomarker for nephrotoxicant-induced renal injury. Am J Physiol Renal Physiol 2004; 286: F552-63.
Vaidya VS, Ramirez V, Ichimura T, et al. Urinary kidney injury molecule-1: a sensitive quantitative biomarker for early detection of kidney tubular injury. Am J Physiol Renal Physiol 2006; 290: F517-29.
Van Timmeren MM, van den Heuvel MC, Bailly V, et al. Tubular kidney injury molecule-1 (KIM-1) in human renal disease. J Pathol 2007; 212: 209-17.
Torregrosa I, Montoliu C, Urios A, et al. Urinary KIM-1, NGAL and L-FABP for the diagnosis of AKI in patients with acute coronary syndrome or heart failure undergoing coronary angiography. Heart Vessels 2015; 30: 703-11.
Zhou Y, Vaidya VS, Brown RP, et al. Comparison of kidney injury molecule-1 and other nephrotoxicity biomarkers in urine and kidney following acute exposure to gentamicin, mercury, and chromium. Toxicol Sci 2008; 101: 159-70.
Mishra J, Ma Q, Prada A, et al. Identification of neutrophil gelatinaseassociated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003; 14: 2534-43.
Sinha V, Vence LM, Salahudeen AK. Urinary tubular proteinbased biomarkers in the rodent model of cisplatin nephrotoxicity: a comparative analysis of serum creatinine, renal histology, and urinary Kim-1, NGAL, and NAG in the initiation, maintenance, and recovery phases of acute kidney injury. J Investig Med 2013; 61: 564-8.
Park HC, Hwang JH, Kang AY, et al. Urinary N-acetyl- -D glucosaminidase as a surrogate marker for renal function in autosomal dominant polycystic kidney disease: 1 year prospective cohort study. BMC Nephrology 2012; 13: 93.
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