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01-12-2016 | Original Article

Predicting Severity of Acute Kidney Injury in Term Neonates with Perinatal Asphyxia Using Urinary Neutrophil Gelatinase Associated Lipocalin

Authors: Vasanthan Tanigasalam, Ballambattu Vishnu Bhat, Bethou Adhisivam, Magadi Gopalakrishna Sridhar, Kottyen Thazath Harichandrakumar

Published in: Indian Journal of Pediatrics | Issue 12-13/2016

Abstract

Objective

To evaluate the utility of urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) as a biomarker for predicting Acute Kidney Injury (AKI) and its severity among neonates with perinatal asphyxia.

Methods

This descriptive study included 120 term neonates with perinatal asphyxia. Renal parameters of neonates were monitored and AKI was ascertained as per Acute Kidney Injury Network criteria. Urinary NGAL was estimated and correlated with severity of AKI.

Results

Among the 120 neonates with perinatal asphyxia, 55(46 %) had AKI. The median urinary NGAL level was 165 ng/ml (88.8–245.8) in neonates with AKI compared to 58.97(42.8–74.7) in those without AKI. The median NGAL was 134.45(112.2–162.5), 301.2(255.5–361.2), 416.2(412.2–465.5) in AKI stages 1, 2 and 3 respectively. An NGAL cut off value of 86.82 ng/ml had 87 % sensitivity and 87.7 % specificity in predicting AKI.

Conclusions

Urinary NGAL is a useful biomarker for predicting AKI and its severity among neonates with perinatal asphyxia.

Ambalavanan N, Carlo, WA. Hypoxic ischemic encephalopathy. Nelson Text book of Pediatrics. 19th ed. In: Kleigman, RM, Geme, JW, Stanton, BF, Behrman, RE, et al editors. Philadelphia: Elsevier; 2012. p. 569–573.

Raggal NE, Khafagy SM, Mahmoud NH, Beltagy SE. Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in asphyxiated neonates. Indian Pediatr. 2013;50:459–62.CrossRefPubMed

Hjortrup PB, Haase N, Wetterslev M, Perner A. Clinical review: predictive value of neutrophil gelatinase-associated lipocalin for acute kidney injury in intensive care patients. Crit Care. 2013;17:211.CrossRefPubMedPubMedCentral

Armstrong L, Stenson BJ. Use of umbilical cord blood gas analysis in the assessment of the newborn. Arch Dis Child Fetal Neonatal Ed. 2007;92:F430–4.CrossRefPubMedPubMedCentral

Jain L. Severe perinatal asphyxia and Apgar scores. Am J Dis Child. 1987;141:1253.PubMed

Kjeldsen L, Cowland JB, Borregaard N. Human neutrophil gelatinase-associated lipocalin and homologous proteins in rat and mouse. Biochim Biophys Acta. 2000;1482:272–83.CrossRefPubMed

Soni SS, Cruz D, Bobek I, et al. NGAL: a biomarker of acute kidney injury and other systemic conditions. Int Urol Nephrol. 2010;42:141–50.CrossRefPubMed

Mishra J, Ma Q, Prada A, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol. 2003;14:2534–43.CrossRefPubMed

Sarafidis K, Tsepkentzi E, Agakidou E, et al. Serum and urine acute kidney injury biomarkers in asphyxiated neonates. Pediatr Nephrol. 2012;27:1575–82.CrossRefPubMed

10.

Askenazi D. Are we ready for the clinical use of novel acute kidney injury biomarkers? Pediatr Nephrol. 2012;27:1423–5.CrossRefPubMed

11.

Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A, NGAL Meta-analysis Investigator Group. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;54:1012–24.CrossRefPubMed

12.

Bharadwaj SK, Bhat BV. Therapeutic hypothermia using gel packs for term neonates with hypoxic ischaemic encephalopathy in resource-limited settings: a randomized controlled trial. J Trop Pediatr. 2012;58:382–8.CrossRefPubMed

13.

Tanigasalam V, Bhat V, Adhisivam B, Sridhar MG. Does therapeutic hypothermia reduce acute kidney injury among term neonates with perinatal asphyxia? – a randomized controlled trial. J Matern Fetal Neonatal Med. 2016;29:2544–7.

14.

Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? Pediatr Nephrol. 2009;24:265–74.CrossRefPubMed

15.

Mehta RL, Kellum JA, Shah SV, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefPubMedPubMedCentral

16.

Hankins GD, Koen S, Gei AF, Lopez SM, Van Hook JW, Anderson GD. Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy. Obstet Gynecol. 2002;99:688–91.PubMed

17.

Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia. J Pediatr. 2011;158:e29–33.CrossRefPubMed

18.

Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr. 2013;162:725–9.e1.CrossRefPubMed

19.

Gupta BD, Sharma P, Bagla J, Parakh M, Soni JP. Renal failure in asphyxiated neonates. Indian Pediatr. 2005;42:928–34.PubMed

20.

Aggarwal A, Kumar P, Chowdary G, Majumdar S, Narang A. Evaluation of renal functions in asphyxiated neonates. J Trop Pediatr. 2005;51:295–9.CrossRefPubMed

21.

Karlowicz MG, Adelman RD. Non oliguric and oliguric ARF in asphyxiated term neonates. Pediatr Nephrol. 1995;9:718–22.CrossRefPubMed

22.

Karlo J, Bhat BV, Koner BC, Adhisivam B. Evaluation of renal function in term babies with perinatal asphyxia. Indian J Pediatr. 2014;81:243–7.CrossRefPubMed

23.

Suchojad A, Tarko A, Smertka M, et al. Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns. Ren Fail. 2015;37:439–45.CrossRefPubMed

24.

Krawczeski CD, Woo JG, Wang Y, Benett MR, Ma Q, Deverajan P. Neutrophil gelatinase-associated lipocalin concentrations predict development of acute kidney injury in neonates and children after cardiopulmonary bypass. J Pediatr. 2011;158:1009–15.e1.CrossRefPubMed

25.

Lavery AP, Meinzen-Derr JK, Anderson E, et al. Urinary NGAL in premature infants. Pediatr Res. 2008;64:423–8.CrossRefPubMed

26.

Jayashree G, Dutta AK, Sarna MS, Saili A. Acute renal failure in asphyxiated newborns. Indian Pediatr. 1991;28:19–23.PubMed

Title: Predicting Severity of Acute Kidney Injury in Term Neonates with Perinatal Asphyxia Using Urinary Neutrophil Gelatinase Associated Lipocalin
Authors: Vasanthan Tanigasalam
Ballambattu Vishnu Bhat
Bethou Adhisivam
Magadi Gopalakrishna Sridhar
Kottyen Thazath Harichandrakumar
Publication date: 01-12-2016
Publisher: Springer India
Published in: Indian Journal of Pediatrics / Issue 12-13/2016
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI: https://doi.org/10.1007/s12098-016-2178-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predicting Severity of Acute Kidney Injury in Term Neonates with Perinatal Asphyxia Using Urinary Neutrophil Gelatinase Associated Lipocalin

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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