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High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy.
Korean J Intern Med. 2015 May; 30(3):354-61.KJ

Abstract

BACKGROUND/AIMS

Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN.

METHODS

The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease.

RESULTS

There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as T2 (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004).

CONCLUSIONS

In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression.

Authors+Show Affiliations

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. ; Department of Pathology, Pusan National University School of Medicine, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25995666

Citation

Rhee, Harin, et al. "High Serum and Urine Neutrophil Gelatinase-associated Lipocalin Levels Are Independent Predictors of Renal Progression in Patients With Immunoglobulin a Nephropathy." The Korean Journal of Internal Medicine, vol. 30, no. 3, 2015, pp. 354-61.
Rhee H, Shin N, Shin MJ, et al. High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy. Korean J Intern Med. 2015;30(3):354-61.
Rhee, H., Shin, N., Shin, M. J., Yang, B. Y., Kim, I. Y., Song, S. H., Lee, D. W., Lee, S. B., Kwak, I. S., & Seong, E. Y. (2015). High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy. The Korean Journal of Internal Medicine, 30(3), 354-61. https://doi.org/10.3904/kjim.2015.30.3.354
Rhee H, et al. High Serum and Urine Neutrophil Gelatinase-associated Lipocalin Levels Are Independent Predictors of Renal Progression in Patients With Immunoglobulin a Nephropathy. Korean J Intern Med. 2015;30(3):354-61. PubMed PMID: 25995666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy. AU - Rhee,Harin, AU - Shin,Nari, AU - Shin,Min Ji, AU - Yang,Byung Yun, AU - Kim,Il Young, AU - Song,Sang Heon, AU - Lee,Dong Won, AU - Lee,Soo Bong, AU - Kwak,Ihm Soo, AU - Seong,Eun Young, Y1 - 2015/04/29/ PY - 2014/08/11/received PY - 2014/08/26/revised PY - 2014/09/05/accepted PY - 2015/5/22/entrez PY - 2015/5/23/pubmed PY - 2016/3/19/medline KW - Glomerulonephritis, IGA KW - Prognosis KW - Serum neutrophil gelatinase-associated lipocalin KW - Tubular biomarker KW - Urine neutrophil gelatinase-associated lipocalin SP - 354 EP - 61 JF - The Korean journal of internal medicine JO - Korean J Intern Med VL - 30 IS - 3 N2 - BACKGROUND/AIMS: Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN. METHODS: The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease. RESULTS: There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as T2 (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004). CONCLUSIONS: In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression. SN - 2005-6648 UR - https://www.unboundmedicine.com/medline/citation/25995666/High_serum_and_urine_neutrophil_gelatinase_associated_lipocalin_levels_are_independent_predictors_of_renal_progression_in_patients_with_immunoglobulin_A_nephropathy_ L2 - https://dx.doi.org/10.3904/kjim.2015.30.3.354 DB - PRIME DP - Unbound Medicine ER -