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Neutrophil gelatinase‐associated lipocalin accurately predicts renal tubular injury in patients with chronic hepatitis B treated with nucleos(t)ide analogs
Author(s) -
Zhang Yao,
Li Jing,
Li Fahong,
Qi Xun,
Zhang Jiming
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12908
Subject(s) - renal function , medicine , lipocalin , entecavir , gastroenterology , beta 2 microglobulin , creatinine , odds ratio , adefovir , hepatitis b , urinary system , liver function , urology , chronic hepatitis , immunology , lamivudine , virus
Aim Little is known about the impact of long‐term use of nucleos(t)ide analogs on tubular function in patients with chronic hepatitis B. Previous studies showed that neutrophil gelatinase‐associated lipocalin (NGAL) elevation was associated with renal tubular injury. We evaluated renal function markers and bone mineral density in patients treated long‐term with adefovir dipivoxil (ADV) or entecavir (ETV). Methods In this cross‐sectional study, we enrolled 78 patients (ADV, 36; ETV: 42), and 21 patients matched for age, observation time, and baseline estimated glomerular filtration rate from each group. Results Patients treated with ADV showed a significant increase in serum creatinine and urine β 2 ‐microglobulin, and decreased estimated glomerular filtration rate and bone mineral density. Furthermore, the median levels of NGAL in patients treated with ADV were significantly higher than those of ETV (12.5 ng/mL vs. 2.5 ng/mL, P = 0.020). The proportions of patients with proteinuria and phosphate <1 mmol/L in the ADV group were higher than those in the ETV group. Additionally, age, β 2 ‐microglobulin, phosphate, and ADV use were associated with altered NGAL levels on multivariate analysis. Among the commonly used biomarkers, NGAL was the most useful (odds ratio = 5.72; P = 0.005) and specific (92% specificity at 18.1 ng/mL cut‐off) in predicting low bone mass. Conclusions Patients with chronic hepatitis B treated long‐term with ADV showed elevated urinary NGAL levels. Neutrophil gelatinase‐associated lipocalin was more specific in predicting low bone mass during therapy compared with β 2 ‐microglobulin, phosphate, and creatinine. In general, this analysis examined the value of NGAL as a renal tubular injury indicator, resulting from ADV use.

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