Abstract
Acute kidney injury (AKI) is a common and serious condition, currently diagnosed by functional biomarkers, such as serum creatinine measurements. Unfortunately, creatinine increase is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury has hampered our ability to translate promising experimental therapies to human AKI. The recent discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed here. NGAL may be measured by several methods both in plasma and urine for the early diagnosis of AKI and for the prediction of clinical outcomes, such as dialysis requirement and mortality, in several common clinical scenarios, including in the intensive care unit, cardiac surgery and renal damage due the exposition to toxic agent and drugs, and renal transplantation. Furthermore, the predictive properties of NGAL, may play a critical role in expediting the drug development process. A systematic review of literature data indicates that further studies are necessary to establish accurate reference population values according to age, gender and ethnicity, as well as reliable and specific decisional values concerning the more common clinical settings related to AKI. Furthermore, proper randomized clinical trials on renal and systemic outcomes comparing the use of NGAL vs. standard clinical practice are still lacking and accurate cost-benefit and/or cost-utility analyses for NGAL as biomarker of AKI are also needed. However, it is important to note that NGAL, in the absence of diagnostic increases in serum creatinine, is able to detect some patients affected by subclinical AKI who have an increased risk of adverse outcomes. These results also suggest that the concept and definition of AKI might need to be reassessed.
About the authors
Aldo Clerico graduated in Medicine at the University of Pisa in 1973. He specialized in endocrinology in 1975, in nuclear medicine in 1978, and in sport medicine in 1987 at the University of Pisa. Since 2007, he has held the position of Director of the Department of Laboratory Medicine of the Fondazione Regione Toscana Gabriele Monasterio. He is also Associate Professor of Clinical Biochemistry at the Scuola Superiore Sant’Anna of Pisa since 2005. He has published more than 290 articles in international scientific publications. He has also participated as speaker or chairman in more than 150 national or international meetings.
Claudio Galli, MD, PhD graduated in Medicine in 1980 and specialized in gastrointestinal diseases in 1984 (University of Roma “La Sapienza”). In 1988, he gained a PhD in infectious diseases with a research project on occult hepatitis B virus (HBV) infection in patients with HIV/AIDS. Main research interests: viral hepatitis A, B, C (then non-A, non-B); HIV infection; E. granulosus. From 1998–2007, he was a Professor at contract the University of Roma “La Sapienza”, specialty schools of Microbiology and Clinical Pathology. He currently holds the position of Scientific Affairs Manager at Abbott Diagnostics, Italy; principal fields of activity are: infectious diseases (viral hepatitis, retroviruses, ToRC); tumor markers; immunosuppressant drugs; markers for cardiovascular, renal and metabolic diseases. He is also a reviewer for Clinical Microbiology and Infection, Blood Transfusion, BMC Gastroenterology. He has also had 204 papers published in national and international journals and participated as a speaker in more than 100 congresses and CME courses.
Antonio Fortunato graduated in biology from the University of Padua, Italy in 1980. From 1981 to 1983 he has been co-operator for a research project supported by the National Research Council (CNR) at the Pediatric Clinic of the University of Padua. Since 1984 he has been responsible for immunoassay section of the Clinical Pathology and Haematology Laboratory at St. Bortolo Hospital, Vicenza, Italy he is known to be “highly specialized” in this area. He holds the position of “contract professor” at University of Padua and Verona, Italy. Dr. Fortunato has co-authored 250 papers, and he has delivered more than 180 lectures at national meetings. He is a council member of Italian Scientific Societies, SIBioC and ELAS.
Claudio Ronco graduated in medicine from the University of Padua, Italy in 1976. In 1979, he specialized in nephrology at the University of Padua, and in 1989, he specialized in pediatric nephrology at the University of Naples. In 1999 and 2000, he was Director of the Renal Laboratory of Research at the Renal Research Institute of New York and Professor of Medicine at the Albert Einstein College of Medicine and Beth Israel Medical Center of New York. Since 2002, he has been Director of the Department of Nephrology of St. Bortolo Hospital, Vicenza, Italy. Professor Ronco has co-authored 950 papers, 80 book chapters and 59 books, and he has delivered more than 450 lectures at international meetings and universities. He is a council member of several scientific societies. He is Editor Emeritus of the International Journal of Artificial Organs, and he is Editor-in-Chief of Blood Purification and Contributions to Nephrology. Professor Ronco has received numerous honors and awards, including, in 2004, a lifetime achievement award, honorary membership of the Spanish Society of Nephrology, and the National Kidney Foundation International Medal of Excellence.
©2012 by Walter de Gruyter Berlin Boston
