High serum and urine neutrophil gelatinaseassociated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy.
10.3904/kjim.2015.30.3.354
- Author:
Harin RHEE
1
;
Nari SHIN
;
Min Ji SHIN
;
Byung Yun YANG
;
Il Young KIM
;
Sang Heon SONG
;
Dong Won LEE
;
Soo Bong LEE
;
Ihm Soo KWAK
;
Eun Young SEONG
Author Information
1. Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. sey-0220@hanmail.net
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Glomerulonephritis, IGA;
Prognosis;
Serum neutrophil gelatinase-associated lipocalin;
Tubular biomarker;
Urine neutrophil gelatinase-associated lipocalin
- MeSH:
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
- From:The Korean Journal of Internal Medicine
2015;30(3):354-361
- CountryRepublic of Korea
- Language:English
-
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.
