OBJECTIVE: Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI. DESIGN: Prospective observational study. SETTING: Two adult ICUs in Melbourne, Australia. PATIENTS: Critically ill patients with septic and non-septic AKI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82). CONCLUSION: Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.
OBJECTIVE: Sepsis is the most common trigger for acute kidney injury (AKI) in critically illpatients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI. DESIGN: Prospective observational study. SETTING: Two adult ICUs in Melbourne, Australia. PATIENTS: Critically illpatients with septic and non-septic AKI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82). CONCLUSION: Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.
Authors: Eric A J Hoste; Norbert H Lameire; Raymond C Vanholder; Dominique D Benoit; Johan M A Decruyenaere; Francis A Colardyn Journal: J Am Soc Nephrol Date: 2003-04 Impact factor: 10.121
Authors: Nathan I Shapiro; Stephen Trzeciak; Judd E Hollander; Robert Birkhahn; Ronny Otero; Tiffany M Osborn; Eugene Moretti; H Bryant Nguyen; Kyle J Gunnerson; David Milzman; David F Gaieski; Munish Goyal; Charles B Cairns; Long Ngo; Emanuel P Rivers Journal: Crit Care Med Date: 2009-01 Impact factor: 7.598
Authors: Michael Haase; Anja Haase-Fielitz; Rinaldo Bellomo; Prasad Devarajan; David Story; George Matalanis; Michael C Reade; Sean M Bagshaw; Narelle Seevanayagam; Siven Seevanayagam; Laurie Doolan; Brian Buxton; Duska Dragun Journal: Crit Care Med Date: 2009-01 Impact factor: 7.598
Authors: N Moniaux; S Chakraborty; M Yalniz; J Gonzalez; V K Shostrom; J Standop; S M Lele; M Ouellette; P M Pour; A R Sasson; R E Brand; M A Hollingsworth; M Jain; S K Batra Journal: Br J Cancer Date: 2008-04-08 Impact factor: 7.640