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Calprotectin and NGAL in the differentiation of prerenal and intrinsic acute kidney injury.
MedLine Citation:
PMID:  23336369     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Urinary calprotectin has recently been identified as a promising biomarker for the differentiation of prerenal and intrinsic acute kidney injury (AKI). The present study compares the diagnostic performance of calprotectin and neutrophil gelatinase-associated lipocalin (NGAL) in this differential diagnosis. METHODS: Urinary calprotectin and NGAL concentrations were assessed in a study population of 87 subjects including 38 cases of intrinsic AKI, 24 cases of prerenal AKI, and 25 healthy controls. Urinary tract obstruction, renal transplantation and metastatic cancer were defined as exclusion criteria. RESULTS: Mean calprotectin concentrations were significantly lower in prerenal (190.2±205.7 ng/ml) than in intrinsic AKI (6250.1±7167.2 ng/ml, p<0.001). Receiver operating characteristic (ROC) analysis provided an AUC of 0.99. Mean NGAL concentrations were significantly higher in intrinsic than in prerenal AKI as well (458.1±695.3 vs. 64.8±62.1 ng/ml, p=0.001) providing an AUC of 0.82. A combination of the present study population with the cohort of the proof of concept study led to a population of 188 subjects (58 prerenal AKI, 90 intrinsic AKI, 40 healthy controls). ROC analyses provided an AUC of 0.97 for calprotectin and 0.76 for NGAL yielding sensitivity and specificity values of 93.3% and 94.8% (calprotectin) vs. 75.3% and 72.4% (NGAL). Optimal cut-off values were 440 ng/ml (calprotectin) and 52 ng/ml (NGAL). Pyuria increased calprotectin concentrations independent of renal failure. CONCLUSION: The present study shows that both calprotectin and NGAL are able to differentiate between prerenal and intrinsic AKI after exclusion of pyuria. In the present population, calprotectin presents a higher sensitivity and specificity than NGAL. © 2013 The Authors Acta Physiologica © 2013 Scandinavian Physiological Society.
Authors:
Felix S Seibert; Nikolaos Pagonas; Robert Arndt; Frank Heller; Duska Dragun; Pontus Persson; Kai Schmidt-Ott; Walter Zidek; Timm H Westhoff
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-22
Journal Detail:
Title:  Acta physiologica (Oxford, England)     Volume:  -     ISSN:  1748-1716     ISO Abbreviation:  Acta Physiol (Oxf)     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101262545     Medline TA:  Acta Physiol (Oxf)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 The Authors Acta Physiologica © 2013 Scandinavian Physiological Society.
Affiliation:
Charité - Campus Benjamin Franklin, Dept. of Nephrology, Berlin, Germany.
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