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Original Article
Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy
Taek Sang Kim1, Su Hwan Kang1, Pil Moon Kang1, Hongkoo Ha2, Su Dong Kim3, Jangho Yoon4, Hyunyong Hwang5
Kosin Medical Journal 2018;33(1):20-28.
DOI: https://doi.org/10.7180/kmj.2018.33.1.20
Published online: January 21, 2018

1Department of Urology, Kosin University College of Medicine, Busan, Korea

2Department of Urology, Pusan National University College of Medicine, Busan, Korea

3Department of Urology, Dong-A University College of Medicine, Busan, Korea

4Department of Urology, Inje University College of Medicine, Busan, Korea

5Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea

Corresponding Author: Hyunyong Hwang, Department of Laboratory Medicine, Kosin University Gospel Hospital, 262, Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6279 Fax: +82-51-990-3994 E-mail: terminom@hanmail.net
• Received: September 28, 2016   • Accepted: January 16, 2017

Copyright © 2018 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress.
  • Methods
    We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery.
  • Results
    The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P = 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P = 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery.
  • Conclusions
    Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.
  • Keywords: Creatinine; Kidney; Nephrectomy
Fig. 1.
Serum creatinine levels in CKD III and non-CKD III groups. Patients were grouped into 2 groups according to the eGFR values; the patients with eGFR equal to or higher than 60 mL/min/1.73 m2 were grouped into group 1 and those with eGFR lower than 60 mL/min/1.73 m2 were grouped into group 2, respectively. Abbreviations: PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative.
kmj-33-20f1.jpg
Fig. 2.
NGAL levels in CKD III and non-CKD III groups. Patients were grouped into 2 groups according to the eGFR values; the patients with eGFR equal to or higher than 60 mL/min/1.73 m2 were grouped into group 1 and those with eGFR lower than 60 mL/min/1.73 m2 were grouped into group 2, respectively. Abbreviations: PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.
kmj-33-20f2.jpg
Fig. 3.
Receiver operating characteristic analysis of serum creatinine and NGAL. Abbreviations: POD, postoperative day.
kmj-33-20f3.jpg
Table 1.
Paired sample correlations between serum creatinine and NGAL
Time point N Pearson correlation P
PreOD1 30 -0.019 0.919
RFS 30 -0.246 0.191
SixFS 30 -0.004 0.982
POD1 30 0.082 0.668
POD3 30 0.018 0.924
POD5 30 0.170 0.370

Abbreviations: PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.

Table 2.
Area under the curve of serum creatinine and NGAL in ROC statistics
Test Result Variable(s) AUC P
Creatinine PreOD1 0.650 0.169
RFS 0.685 0.090
SixFS 0.674 0.112
POD1 0.632 0.228
POD3 0.706 0.060
POD5 0.887 0.000
NGA PreOD1 0.583 0.446
RFS 0.403 0.374
SixFS 0.743 0.026
POD1 0.676 0.108
POD3 0.588 0.421
POD5 0.704 0.063

Abbreviations: AUC, area under the curve; PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.

Table 3.
Paired sample correlations between serum creatinine and eGFR and between serum NGAL and eGFR
Pairs N Pearson correlation P
Cr and eGFR PreOD1 30 -0.292 0.118
RFS 30 -0.208 0.269
SixFS 30 -0.280 0.134
POD1 30 -0.198 0.295
POD3 30 -0.623 0.000
POD5 30 -0.712 0.000
NGAL and eGFR PreOD1 30 -0.062 0.744
RFS 30 0.084 0.661
SixFS 30 -0.193 0.306
POD1 30 -0.147 0.439
POD3 30 -0.079 0.680
POD5 30 -0.275 0.141

Abbreviations: AUC, area under the curve; PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.

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        Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy
        Kosin Med J. 2018;33(1):20-28.   Published online January 21, 2018
        DOI: https://doi.org/10.7180/kmj.2018.33.1.20
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      Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy
      Image Image Image
      Fig. 1. Serum creatinine levels in CKD III and non-CKD III groups. Patients were grouped into 2 groups according to the eGFR values; the patients with eGFR equal to or higher than 60 mL/min/1.73 m2 were grouped into group 1 and those with eGFR lower than 60 mL/min/1.73 m2 were grouped into group 2, respectively. Abbreviations: PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative.
      Fig. 2. NGAL levels in CKD III and non-CKD III groups. Patients were grouped into 2 groups according to the eGFR values; the patients with eGFR equal to or higher than 60 mL/min/1.73 m2 were grouped into group 1 and those with eGFR lower than 60 mL/min/1.73 m2 were grouped into group 2, respectively. Abbreviations: PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.
      Fig. 3. Receiver operating characteristic analysis of serum creatinine and NGAL. Abbreviations: POD, postoperative day.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy

      Paired sample correlations between serum creatinine and NGAL

      Time point N Pearson correlation P
      PreOD1 30 -0.019 0.919
      RFS 30 -0.246 0.191
      SixFS 30 -0.004 0.982
      POD1 30 0.082 0.668
      POD3 30 0.018 0.924
      POD5 30 0.170 0.370

      Area under the curve of serum creatinine and NGAL in ROC statistics

      Test Result Variable(s) AUC P
      Creatinine PreOD1 0.650 0.169
      RFS 0.685 0.090
      SixFS 0.674 0.112
      POD1 0.632 0.228
      POD3 0.706 0.060
      POD5 0.887 0.000
      NGA PreOD1 0.583 0.446
      RFS 0.403 0.374
      SixFS 0.743 0.026
      POD1 0.676 0.108
      POD3 0.588 0.421
      POD5 0.704 0.063

      Paired sample correlations between serum creatinine and eGFR and between serum NGAL and eGFR

      Pairs N Pearson correlation P
      Cr and eGFR PreOD1 30 -0.292 0.118
      RFS 30 -0.208 0.269
      SixFS 30 -0.280 0.134
      POD1 30 -0.198 0.295
      POD3 30 -0.623 0.000
      POD5 30 -0.712 0.000
      NGAL and eGFR PreOD1 30 -0.062 0.744
      RFS 30 0.084 0.661
      SixFS 30 -0.193 0.306
      POD1 30 -0.147 0.439
      POD3 30 -0.079 0.680
      POD5 30 -0.275 0.141
      Table 1. Paired sample correlations between serum creatinine and NGAL

      Abbreviations: PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.

      Table 2. Area under the curve of serum creatinine and NGAL in ROC statistics

      Abbreviations: AUC, area under the curve; PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.

      Table 3. Paired sample correlations between serum creatinine and eGFR and between serum NGAL and eGFR

      Abbreviations: AUC, area under the curve; PreOD, preoperative day; RFS, right after surgery; SixFS, 6 hours after surgery, POD, postoperative day.

      Table 1.

      Table 2.

      Table 3.

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