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Publications

Journal Article Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. Ppublish 17 citations

PubMed: 35718113 DOI: 10.1016/j.kint.2022.05.020

Neutrophil gelatinase-associated lipocalin is elevated in children with acute kidney injury and sickle cell anemia, and predicts mortality.

Kidney Int 102(4):885-893

Authors: Anthony Batte, Sahit Menon, John M Ssenkusu, Sarah Kiguli, Robert Kalyesubula, Joseph Lubega, Zachary Berrens, Edrisa Ibrahim Mutebi, Rodney Ogwang, Robert O Opoka, Chandy C John, Andrea L Conroy

Affiliations

  • Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda.
  • San Diego School of Medicine, University of California, San Diego, California, USA.
  • Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
  • Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
  • Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
  • Division of Pediatric Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA.
  • Department of Pediatrics, Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  • Kenyan Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.
  • Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  • Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Abstract

Urine neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury that has been adapted to a urine dipstick test. However, there is limited data on its use in low-and-middle-income countries where diagnosis of acute kidney injury remains a challenge. To study this, we prospectively enrolled 250 children with sickle cell anemia aged two to 18 years encompassing 185 children hospitalized with a vaso-occlusive pain crisis and a reference group of 65 children attending the sickle cell clinic for routine care follow up. Kidney injury was defined using serial creatinine measures and a modified-Kidney Disease Improving Global Outcome definition for sickle cell anemia. Urine NGAL was measured using the NGAL dipstick and a laboratory reference. The mean age of children enrolled was 8.9 years and 42.8% were female. Among hospitalized children, 36.2% had kidney injury and 3.2% died. Measured urine NGAL levels by the dipstick were strongly correlated with the standard enzyme-linked immunosorbent assay for urine NGAL (hospitalized children, 0.71; routine care reference, 0.88). NGAL levels were elevated in kidney injury and significantly increased across injury stages. Hospitalized children with a high-risk dipstick test (300ng/mL and more) had a 2.47-fold relative risk of kidney injury (95% confidence interval 1.68 to 3.61) and 7.28 increased risk of death (95% confidence interval 1.10 to 26.81) adjusting for age and sex. Thus, urine NGAL levels were found to be significantly elevated in children with sickle cell anemia and acute kidney injury and may predict mortality.

MeSH

Kidney Diseases, Cells, Mortality, Confidence Intervals, Anemia, Sickle Cell, Anemia, Gelatinases, Lipocalin-2, Neutrophils, Kidney, Child, Hospitalized, Biomarkers, Lipocalins, Acute Kidney Injury, Child

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