Increased urinary neutrophil gelatinase associated lipocalin in urinary tract infections and leukocyturia

Neutrophil gelatinase associated lipocalin (NGAL) is a protein present in neutrophils. NGAL is a promising biomarker for acute kidney injury. In urinary tract infections, urinary neutrophils can be a potential source of urinary NGAL. We investigated the effects of urinary tract infection and urinary neutrophil counts on urinary NGAL values.

NGAL was assayed using an immunoassay (ARCHITECT). Urine flowcytometry was performed with the UF-1000i (Sysmex).

A correlation between the urinary white blood cell (WBC) count and NGAL concentrations was observed: log(Y) (NGAL, μg/L)=1.284+0.439 log(X) (urinary WBC, 10(9) cells/L); r=0.518. Similarly, the bacterial count correlated weakly with NGAL: log(Y) (NGAL, μg/L)=1.796+0.124 log(X) (bacterial count, 10(9) cells/L); r=0.243. Albuminuria correlated moderately with NGAL values: log(Y) (NGAL, μg/L)=1.557+0.339 log(X) (albuminuria, mg/L); r=0.368; α(1)-microglobulin (a1M) correlated weakly with NGAL: log(Y) (NGAL, μg/L)=1.631+0.360 log(X) (a1M, mg/L); r=0.381.

Leukocyte contributions to urinary NGAL concentrations can be important. In leukocyturia or tubular damage (e.g., intensive care patients), using a fixed cut-off value for interpreting urinary NGAL data can lead to false positive results. Therefore, we suggest a mathematical correction in cases with pyuria (>100×10(9) cells/L) and urinary NGAL concentration >100 μg/L: corrected NGAL (μg/L)=NGAL-0.12 (urinary WBC, 10(9) cells/L).