Clinical Utility of Serum Neutrophil Gelatinase Associated Lipocalin(NGAL) as an Early Marker of Acute Kidney Injury in Asphyxiated Neonates

Acute Kidney Injury (AKI) is a common devastating problem in the NICU. Since the kidney is the second most affected organ in asphyxiated neonates (after the brain), a marker to determine kidney injury becomes important. Serum Neutrophil Gelatinase Associated Lipocalin (NGAL) determines acute kidney injury even before Blood Urea Nitrogen (BUN) or serum creatinine values rise. The aim of this study was to determine the clinical utility of NGAL as an early marker of acute kidney injury in asphyxiated neonates.Materials and Methods: This was a cohort study performed at a Level III NICU at JSS Hospital, Mysore, Karnataka, India over a period of two years. The study was conducted on30 term asphyxiated neonates and 30 term control neonates. Serum NGAL was measured within 6 hours after birth in an asphyxiated neonate using fluorescence immunoassay.Results: A highly significant increase in serum NGAL in cases group with a median of 323ng/ml as compared to control group with median of 64ng/ml was observed. Of the 30 asphyxiated neonates, 23 were positive for NGAL, and of these 3 had AKI.A cutoff value of 155 ng/ml for Serum NGAL could detect AKI in asphyxiated neonates with a sensitivity of 75% and a specificity of 23%.Conclusion: NGAL is raised in Asphyxiated neonates both with and without kidney injury. Therefore, it is not a specific marker for acute kidney injury in asphyxiated neonates.  J Nepal Paediatr Soc 2016;36(2):121-125.