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ePublished: 01 Jun 2015
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J Renal Inj Prev. 2015;4(2): 39-44.
doi: 10.12861/jrip.2015.09
PMID: 26060836
PMCID: PMC4459727
  Abstract View: 3709
  PDF Download: 1741

Original Article

Urinary neutrophil gelatinase-associated lipocalin (NGAL) might be an independent marker for anticipating scar formation in children with acute pyelonephritis

Alireza Rafiei 1, Hamid Mohammadjafari 2*, Sara Bazi 3, Araz Mohammad Mirabi 4

1 Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
2 Antimicrobial Resistant Nosocomial Infection Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3 Department of Pediatrics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
4 Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
*Corresponding Author: *Corresponding author: Hamid Mohammadjafari, , Email: hamidmjaafari@yahoo.com

Abstract

Introduction: Urinary tract infections (UTIs) are the most serious common bacterial infections among young children. It may affect kidneys that classified as acute pyelonephritis (APN) and may lead to renal parenchymal involvement and scarring with high prevalence rate (15%-60%) among children. This study aimed to assess the urinary concentration of neutrophil gelatinase-associated lipocalin (NGAL) in patients with APN to diagnose those with potency to scar formation.

Patients and Methods: Children who were admitted with a diagnosis of APN were enrolled and divided into two groups; APN with scar and APN without scar. Urinary levels of NGAL and its ratio to creatinine (Cr) levels were measured in the acute phase of infection. A receiver operating characteristic (ROC) curve was generated to allow calculation of cut-off values.

Results: Fifty-four children were enrolled across the 2 groups: group 1 consisted of 16 patients (all female); group 2 consisted of 38 children (36 female and 2 male). Urinary levels of NGAL were significantly higher in APN with scar than in APN without scar (P = 0.037). For comparison of groups 1 and 2, the cut-off values were measured as 7.32 ng/ml, sensitivity; 81.3% and specificity; 66%.

Conclusion: Evaluation of urinary NGAL levels may help us to identify children with APN who are at risk of developing renal scarring.


Implication for health policy/practice/research/medical education:

Scar formation is the most important warning in management of children with febrile urinary tract infections. Anticipating children potentially prone to scar formation in acute febrile phase, help us to better management of them. We showed here urinary levels of gelatinase-associated lipocalin (NGAL) in first days of urinary tract infection is a reliable marker to detect children prone to renal scar formation in the next future. This can be a good replacement method for Tc-99m dimercaptosuccinic acid (DMSA) if confirms by large study population.

Please cite this paper as: Rafiei A, Mohammadjafari H, Bazi S, Mirabi AM. Urinary neutrophil gelatinase-associated lipocalin (NGAL) might be an independent marker for anticipating scar formation in children with acute pyelonephritis. J Renal Inj Prev. 2015; 4(2): 39-44. DOI: 10.12861/jrip.2015.09

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