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Serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for predicting high dose methotrexate associated acute kidney injury in children with acute lymphoblastic leukemia

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Abstract

Purpose

The present study was aimed at assessing the value of serum NGAL in identifying early acute kidney injury induced by HDMTX.

Methods

Children aged 1–14 years with newly diagnosed ALL receiving MTX over 3 g/m2 were enrolled. Serum NGAL concentrations, serum creatinine (Scr) and MTX concentrations were measured. The area under the receiver-operating characteristic curve (ROC) was used for evaluating variables’ ability of early diagnosis of AKI.

Results

A total of 196 courses of 62 patients were assessed, and 22 courses (11.2%) developed AKI. Twenty-four hours serum NGAL concentrations, 24 h Scr ratio, 48 h Scr ratio, CMTX24 h, CMTX48 h, CMTX72 h were significantly higher in patients with AKI. The combination of 24 h Scr ratio and 24 h serum NGAL had higher value for detecting HDMTX induced AKI compared with the 24 h Scr ratio. And the combination had similar value for detecting HDMTX induced AKI compared with the 48 h Scr ratio. After 48 h, CMTX48 h had a satisfying accuracy in predicting AKI. The proportion of post-HDMTX sepsis in patients with AKI was significantly higher than that in patients without AKI.

Conclusions

Serum NGAL levels could be used as a marker in identifying the direct kidney tubular damage induced by HDMTX. The combination of 24 h Scr ratio and 24 h serum NGAL had higher value for early diagnosis of HDMTX associated AKI compared with the 24 h Scr ratio.

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Abbreviations

NGAL:

Neutrophil gelatinase-associated lipocalin

MTX:

Methotrexate

AKI:

Acute kidney injury

Scr:

Serum creatinine

ROC:

Receiver-operating characteristic curve

24 h Scr ratio:

24 h Serum creatinine/baseline creatinine

48 h Scr ratio:

48 h Serum creatinine/baseline creatinine

CrCl:

Creatinine clearance

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Authors and Affiliations

  1. Department of Hematology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China

    Hui Li, Kailan Chen & Jianxin Li

  2. Department of Clinical Pharmacology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiangan District, Wuhan, 430016, Hubei, China

    Qiong Xu & Yang Wang

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  1. Hui Li
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Li, H., Xu, Q., Wang, Y. et al. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for predicting high dose methotrexate associated acute kidney injury in children with acute lymphoblastic leukemia. Cancer Chemother Pharmacol 85, 95–103 (2020). https://doi.org/10.1007/s00280-019-03980-6

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