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    Plasma neutrophil gelatinase-associated lipocalin as a potential predictor of adverse renal outcomes in immunoglobulin A nephropathy

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    https://www.riss.kr/link?id=A103901970

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    Background/Aims: Neutrophil gelatinase-associated lipocalin (NGAL) is a wellknown biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN).
    Methods: In total, 91 patients with biopsy-proven IgAN at a single center were evaluated. pNGAL was measured using a commercial enzyme-linked immunosorbent assay kit (R&D Systems). Adverse renal outcome was defined as chronic kidney disease (CKD) stage 3 or above at the last follow-up. Pearson correlation coefficient and Cox regression were used for analyses.
    Results: The mean age of all patients (male:female, 48:43) was 35 years (range, 18 to 77). pNGAL ranged between 21.68 and 446.40 ng/mL (median, 123.97) and showed a correlation with age (r = 0.332, p = 0.001), creatinine (r = 0.336, p = 0.001), estimated glomerular filtration rate (r = –0.397, p < 0.001), uric acid (r = 0.289, p = 0.006), and the protein-to-creatinine ratio (r = 0.288, p = 0.006). During a mean follow-up period of 37.6 months, 11 patients (12.1%) had CKD stage 3 or above. In a multivariate Cox regression model, hypertension (hazard ratio [HR], 8.779; 95% confidence interval [CI], 1.526 to 50.496; p = 0.015), proteinuria > 1 g/day (HR, 5.184; 95% CI, 1.124 to 23.921; p = 0.035), and pNGAL (HR, 1.012; 95% CI, 1.003 to 1.022; p = 0.013) were independent predictors associated with adverse renal outcome.
    Conclusions: pNGAL showed strong correlations with other clinical prognostic factors and was also an independent predictor of adverse renal outcome. We suggest pNGAL as a potential predictor for prognosis in IgAN, while further studies are needed to confirm the clinical value.
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    Background/Aims: Neutrophil gelatinase-associated lipocalin (NGAL) is a wellknown biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN). Methods...

    Background/Aims: Neutrophil gelatinase-associated lipocalin (NGAL) is a wellknown biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN).
    Methods: In total, 91 patients with biopsy-proven IgAN at a single center were evaluated. pNGAL was measured using a commercial enzyme-linked immunosorbent assay kit (R&D Systems). Adverse renal outcome was defined as chronic kidney disease (CKD) stage 3 or above at the last follow-up. Pearson correlation coefficient and Cox regression were used for analyses.
    Results: The mean age of all patients (male:female, 48:43) was 35 years (range, 18 to 77). pNGAL ranged between 21.68 and 446.40 ng/mL (median, 123.97) and showed a correlation with age (r = 0.332, p = 0.001), creatinine (r = 0.336, p = 0.001), estimated glomerular filtration rate (r = –0.397, p < 0.001), uric acid (r = 0.289, p = 0.006), and the protein-to-creatinine ratio (r = 0.288, p = 0.006). During a mean follow-up period of 37.6 months, 11 patients (12.1%) had CKD stage 3 or above. In a multivariate Cox regression model, hypertension (hazard ratio [HR], 8.779; 95% confidence interval [CI], 1.526 to 50.496; p = 0.015), proteinuria > 1 g/day (HR, 5.184; 95% CI, 1.124 to 23.921; p = 0.035), and pNGAL (HR, 1.012; 95% CI, 1.003 to 1.022; p = 0.013) were independent predictors associated with adverse renal outcome.
    Conclusions: pNGAL showed strong correlations with other clinical prognostic factors and was also an independent predictor of adverse renal outcome. We suggest pNGAL as a potential predictor for prognosis in IgAN, while further studies are needed to confirm the clinical value.

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    참고문헌 (Reference)

    1 Levy M, "Worldwide perspective of IgA nephropathy" 12 : 340-347, 1988

    2 Ding H, "Urinary neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for renal tubulointerstitial injury in IgA nephropathy" 123 : 227-234, 2007

    3 Phillips AO., "The role of renal proximal tubular cells in diabetic nephropathy" 3 : 491-496, 2003

    4 Nielsen SE, "The effect of RAAS blockade on markers of renal tubular damage in diabetic nephropathy: u-NGAL, u-KIM1 and u-LFABP" 72 : 137-142, 2012

    5 Li PK, "Prognostic indicators of IgA nephropathy in the Chinese: clinical and pathological perspectives" 17 : 64-69, 2002

    6 D’Amico G, "Prognostic indicators in idiopathic IgA mesangial nephropathy" 59 : 363-378, 1986

    7 Radford MG Jr, "Predicting renal outcome in IgA nephropathy" 8 : 199-207, 1997

    8 Xie J, "Predicting progression of IgA nephropathy: new clinical progression risk score" 7 : e38904-, 2012

    9 Bartosik LP, "Predicting progression in IgA nephropathy" 38 : 728-735, 2001

    10 Bolignano D, "Neutrophil gelatinase-associated lipocalin reflects the severity of renal impairment in subjects affected by chronic kidney disease" 31 : 255-258, 2008

    1 Levy M, "Worldwide perspective of IgA nephropathy" 12 : 340-347, 1988

    2 Ding H, "Urinary neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for renal tubulointerstitial injury in IgA nephropathy" 123 : 227-234, 2007

    3 Phillips AO., "The role of renal proximal tubular cells in diabetic nephropathy" 3 : 491-496, 2003

    4 Nielsen SE, "The effect of RAAS blockade on markers of renal tubular damage in diabetic nephropathy: u-NGAL, u-KIM1 and u-LFABP" 72 : 137-142, 2012

    5 Li PK, "Prognostic indicators of IgA nephropathy in the Chinese: clinical and pathological perspectives" 17 : 64-69, 2002

    6 D’Amico G, "Prognostic indicators in idiopathic IgA mesangial nephropathy" 59 : 363-378, 1986

    7 Radford MG Jr, "Predicting renal outcome in IgA nephropathy" 8 : 199-207, 1997

    8 Xie J, "Predicting progression of IgA nephropathy: new clinical progression risk score" 7 : e38904-, 2012

    9 Bartosik LP, "Predicting progression in IgA nephropathy" 38 : 728-735, 2001

    10 Bolignano D, "Neutrophil gelatinase-associated lipocalin reflects the severity of renal impairment in subjects affected by chronic kidney disease" 31 : 255-258, 2008

    11 Mori K, "Neutrophil gelatinase-associated lipocalin as the real-time indicator of active kidney damage" 71 : 967-970, 2007

    12 Devarajan P., "Neutrophil gelatinase-associated lipocalin (NGAL): a new marker of kidney disease" 241 : 89-94, 2008

    13 Bolignano D, "Neutrophil gelatinase-associated lipocalin (NGAL) as a marker of kidney damage" 52 : 595-605, 2008

    14 Bolignano D, "Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease" 4 : 337-344, 2009

    15 Bhavsar NA, "Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) as predictors of incident CKD stage 3: the Atherosclerosis Risk in Communities (ARIC) Study" 60 : 233-240, 2012

    16 Berthoux FC, "Natural history of primary IgA nephropathy" 28 : 4-9, 2008

    17 D’Amico G., "Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome" 24 : 179-196, 2004

    18 Nickolas TL, "NGAL (Lcn2)monomer is associated with tubulointerstitial damage in chronic kidney disease" 82 : 718-722, 2012

    19 Okazaki K, "Influence of the period between onset of IgA nephropathy and medical intervention on renal prognosis" 3 : 518-523, 2011

    20 Bogenschutz O, "IgA nephritis: on the importance of morphological and clinical parameters in the long-term prognosis of 239 patients" 10 : 137-147, 1990

    21 Peters HP, "High urinary excretion of kidney injury molecule-1 is an independent predictor of end-stage renal disease in patients with IgA nephropathy" 26 : 3581-3588, 2011

    22 Kiryluk K, "Genetic studies of IgA nephropathy: past, present, and future" 25 : 2257-2268, 2010

    23 Mori K, "Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury" 115 : 610-621, 2005

    24 Katafuchi R, "An important role of glomerular segmental lesions on progression of IgA nephropathy: a multivariate analysis" 41 : 191-198, 1994

    25 Goto M, "A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study" 24 : 3068-3074, 2009

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