Anna Mathew, MD; Amit X. Garg, MD
How accurate is a single measure of urinary neutrophil gelatinase–associated lipocalin (NGAL) for diagnosing acute kidney injury (AKI)? How does it compare with other urinary proteins?
Prospective cohort study.
An emergency department (ED) in New York, New York, USA.
635 consecutive patients ≥ 18 years of age (mean age 60 y, 51% men) who attended the ED between 6 a.m. and midnight. Patients receiving hemodialysis or who did not have > 1 serum creatinine measurement were excluded.
Urinary NGAL was measured using an immunoblotting procedure, serum creatinine using the Jaffe reaction, urinary N-acetyl-β-D-glucosaminidase (NAG) using an enzyme measurement, and α1–microglobulin and α1–acid glycoprotein using immunonephelometery.
Clinical diagnosis of AKI was defined as new-onset, 1.5-fold increase in serum creatinine level or 25% decrease in glomerular filtration rate from baseline (based on Risk, Injury, Failure, Loss, and End-stage [RIFLE] criteria) that was sustained for ≥ 3 days despite volume resuscitation.
Included sensitivity, specificity, likelihood ratios (LRs), and area under the receiver-operating characteristic (AUROC) curve.
4.7% of patients had AKI. Diagnostic test characteristics are shown in the Table. At reported cutpoints, the positive LR for NGAL was large compared with that for serum creatinine (Table); the AUROC curves for the 2 tests were similar (P = 0.6).
A single measure of urinary neutrophil gelatinase–associated lipocalin was accurate for diagnosing acute kidney injury.
Diagnostic test characteristics of neutrophil gelatinase–associated lipocalin (NGAL), serum creatinine, N-acetyl-β-D-glucosaminidase (NAG), α1-microglobulin, and α1-acid glycoprotein for diagnosing acute kidney injury*
*AUROC = area under the receiver-operating characteristic; other diagnostic terms defined in Glossary.
Mathew A, Garg AX. A single measure of urinary neutrophil gelatinase–associated lipocalin was accurate for diagnosing acute kidney injury. Ann Intern Med. ;149:JC6–13. doi: 10.7326/0003-4819-149-12-200812160-02013
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Published: Ann Intern Med. 2008;149(12):JC6-13.
Acute Kidney Injury, Nephrology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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