Cardiology Letters 2016, 25(1):9-15

Urinary NGAL as a predictor of acute kidney injury in patients with acute heart failure

Danková M¹, Pázmanová T¹, Hricák V², Gergel J³, Svobodová V⁴, Žitný B⁴, Daňová K⁵, Remišová S¹, Ponťuch P¹

¹ IV. interná klinika LFUK a UNB, Bratislava

² Oddelenie akútnej kardiológie, NÚSCH a.s., Bratislava

³ Medirex a.s., Bratislava

⁴ STU Vital s. r. o., Bratislava

⁵ Oddelenia laboratórnej medicíny, NÚSCH a.s., Bratislava, Slovenská republika

Aim: To assess differences in the levels of urinary neutrophil gelatinase-associated lipocalin (u-NGAL) as a marker of acute kidney injury (AKI) in patients with acute heart failure (AHF) in relation to NT-proBNP and a dose of intravenously administered furosemide.

Patients and Methods: We analysed urine samples in 60 patients with acute heart failure admitted to the Coronary Care Unit of the 4th Department of Internal Medicine and to the Department of Emergency Cardiology of National Institute of Cardiovascular Diseases. Urine samples were collected immediately at admission and after 24 hours. The supernatants were stored at -72 °C and analysed by ELISA (Bioporto, Denmark). AKI was defined according to KDIGO based on serum creatinine concentration and urine output and patients were divided into two groups: without AKI (AKI-, n=49) and with AKI (AKI+, n=11). Data were analysed using the statistical program JMP7.

Results: The median age of all patients was 69 (IQR 61-79) years with the gender distribution 32/18 (M/F). Patients in the AKI+ group had significantly higher u-NGAL levels on admission compared with the AKI- patients (median 87 vs. 18.2 ng/ml; p=0.004) and also after 24 hours (163.7 vs. 34.5 ng/ml; p=0.0004). There was no difference between groups in serum creatinine on admission, but a significant increase in serum creatinine was found in the AKI+ group after 24 hours (117.6 vs. 94.5 µmol/l, p=0.02). The initial intravenous dose of furosemide was higher in the AKI + compared with AKI- (arithmetic mean 85.9 vs 32.4 mg, p=0.002) and correlated with u-NGAL on admission (r=0.39, p=0.006) and after 24 hours (r=0.38,p=0.01). We have found positive correlation between u-NGAL on admission and NT-proBNP (r=0.39, p=0.002) and also between u-NGAL after 24hours and NT-proBNP (r=0.35, p=0.01). Based on ROC analysis, sensitivity of u-NGAL on admission for AKI was 72,7%, specificity 80,4% and AUC ROC 0.78.

Conclusions: Urinary NGAL on admission and after 24 hours predicted kidney injury before the rise in serum creatinine, and correlated with increasing levels of serum NT-proBNP and an initial dose of intravenously administered furosemide.

Keywords: urinary NGAL; acute kidney injury; NT-proBNP; acute heart failure

Published: January 1, 2016  Show citation