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Marakala V. Neutrophil Gelatinase-Associated Lipocalin (NGAL) in kidney injury- A systematic review. Clin Chim Acta 2022; 536:135-141. [PMID: 36150522 DOI: 10.1016/j.cca.2022.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neutrophil Gelatinase Associated Lipocalin (NGAL) is a secretory protein of neutrophils that can be found both in plasma and urine. Previous works have demonstrated a valuable marker for the early detection of acute kidney injury. In this systematic review, we aimed to assess whether NGAL could be helpful in the diagnosis and prognosis of systemic diseases with kidney involvement. METHODS MEDLINE, PubMed, and EMBASE databases were searched for NGAL, described as a human biomarker for diseases (total: 1690). Specifically, included studies describing the use of NGAL for determining kidney injury outcomes and other conditions associated with kidney dysfunction, including cardiovascular diseases, cardiac surgery, and critically ill systemic disorders. RESULTS A total of 24 validated studies were included in the systemic review after applying the exclusion criteria. In all these studies, NGAL appeared to have a predictive value irrespective of age, from newborn to 78 years. The results indicate that NGAL levels can accurately predict the outcome and severity of acute kidney injury occur in several disease processes, including contrast-induced AKI during cardiac surgery, kidney transplant rejection, chronic heart failure, and systemic inflammation in critically ill patients, even though the significance of NGAL is highly variable across studies. Very high plasma NGAL levels were observed in the patients before the acute rejection of the kidney, indicating the prognostic potential of the NGAL. Specifically, the assays conducted before 72 hrs provided a significant predictive value. CONCLUSION Urinary and serum NGAL appears to be an independent predictor of not only kidney complications but also cardiovascular and liver-related diseases. The kidney is also involved in pathogenesis.
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Affiliation(s)
- Vijaya Marakala
- Department of Basic Medical Sciences, College of Medicine, University of Bisha, Bisha 61922, Saudi Arabia.
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Urinary Proteomics in Kidney Transplantation. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42:7-16. [PMID: 35032373 DOI: 10.2478/prilozi-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although kidney transplantation is the best treatment option for end stage kidney disease, it is still associated with long-term graft failure. One of the greater challenges for transplant professionals is the ability to identify grafts with a high risk of failure before initial decline of eGFR with irreversible graft changes. Transplantation medicine is facing an emerging need for novel disease end point-specific biomarkers, with practical application in preventive screening, early diagnostic, and improved prognostic and therapeutic utility. The aim of our review was to evaluate the clinical application of urinary proteomics in kidney transplant recipients at risk for any type of future graft failure.
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Fu R, Tajima S, Suetsugu K, Watanabe H, Egashira N, Masuda S. Biomarkers for individualized dosage adjustments in immunosuppressive therapy using calcineurin inhibitors after organ transplantation. Acta Pharmacol Sin 2019; 40:151-159. [PMID: 29950613 DOI: 10.1038/s41401-018-0070-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/10/2018] [Indexed: 01/10/2023] Open
Abstract
Calcineurin inhibitors (CNIs), such as cyclosporine A and tacrolimus, are widely used immunosuppressive agents for the prevention of post-transplantation rejection and have improved 1-year graft survival rates by up to 90%. However, CNIs can induce severe reactions, such as acute or chronic allograft nephropathy, hypertension, and neurotoxicity. Because CNIs have varied bioavailabilities, narrow therapeutic ranges, and individual propensities for toxic effects, therapeutic drug monitoring is necessary for all CNIs. Identifying the genetic polymorphisms in drug-metabolizing enzymes will help to determine personalized dosage regimens for CNIs, as CNIs are substrates for CYP3A5 and P-glycoprotein (P-gp, MDR1). CNIs are often concomitantly administered with voriconazole or proton pump inhibitors (PPIs), giving rise to drug interaction problems. Voriconazole and PPIs can increase the blood concentrations of CNIs, and both are primarily metabolized by CYP2C19. Thus, it is expected that interactions between CNIs and voriconazole or PPI would be affected by CYP2C19 and CYP3A5 polymorphisms. CNI-induced acute kidney injury (AKI) is a serious complication of transplantations. Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) are noninvasive urinary biomarkers that are believed to be highly sensitive to CNI-induced AKI. In this article, we review the adverse events and pharmacokinetics of CNIs and the biomarkers related to CNIs, including CYP3A5, CYP2C19, MDR1, NGAL, and KIM-1. We hope that these data will help to identify the optimal biomarkers for monitoring CNI-based immunosuppressive therapy after organ transplantation.
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Moledina DG, Parikh CR, Garg AX, Thiessen-Philbrook H, Koyner JL, Patel UD, Devarajan P, Shlipak MG, Coca SG. Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study. PLoS One 2015; 10:e0129619. [PMID: 26053382 PMCID: PMC4460181 DOI: 10.1371/journal.pone.0129619] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/11/2015] [Indexed: 01/15/2023] Open
Abstract
Background Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown. Methods In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality. Results During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Pre-operative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04–2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0–1.7 and adjusted HR 1.78, 95% CI 1.2–2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79–1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87–1.61 for peak pNGAL). Conclusions Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.
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Affiliation(s)
- Dennis G. Moledina
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Jay L. Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Uptal D. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Michael G. Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, California, United States of America
| | - Steven G. Coca
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
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