Lab Test Predicts Acute Kidney Injury in ICU Patients

THURSDAY July 23, 2009 -- A new laboratory test can help predict if a person admitted to an intensive care unit is at risk for acute kidney injury, a frequent complication in ICUs, according to a new study.

Many patients admitted to the ICU have some evidence of acute kidney injury, most often a change in their urine output or in the chemical composition of their urine. Unfortunately, not much is known about the syndrome.

But this new test, called urine neutrophil gelatinase-associated lipocalin (NGAL), can determine if critically ill adults are at an elevated risk of developing acute kidney injury, according to a study to be published in an upcoming issue of the Journal of the American Society of Nephrology.

Patients with higher levels of NGAL in their urine were more likely to develop acute kidney injury, even after adjustments for other factors were made, according to researchers at Columbia University in New York City.

Another study in the journal showed the promise of this new test, as urine NGAL can help diagnose HIV-related kidney disease in African-Americans and black Africans.

Levels of urine NGAL were significantly higher in patients with HIV-associated nephropathy (HIVAN) than in patients with other forms of kidney disease, regardless of whether they had HIV or not, the researchers found.

HIVAN is the leading cause of chronic kidney disease in HIV patients, and 95 percent of the people affected are of African descent, according to background information in a news release from the American Society of Nephrology.

Studies in mice suggested that NGAL may even have a role in the development of tubular diseases and microcysts, which are HIVAN features.

"NGAL was very specifically expressed in renal cysts -- generating the new idea that NGAL may control the development of cysts in HIV-associated nephropathy," Dr. Jonathan Barasch of Columbia said in the news release. He noted that he and Dr. Prasad Devarajan identified NGAL in the kidney 10 years ago. "Its translation into a clinical entity in such a short time is quite a story. Almost every paper is positive for the association of NGAL and renal dysfunction/disease," he said.

Dr. T. Alp Ikizler of Vanderbilt University in Nashville, Tenn., commented on NGAL's effectivenss: "As a standalone marker, urine NGAL performed moderately well in predicting ongoing and subsequent acute kidney injury," he stated in the news release.

More information

The National Kidney Foundation has a health guide for topics related to kidney disease.

Posted: July 2009


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