Using NGAL as an early diagnostic test of acute kidney injury

Neutrophil gelatinase-associated lipocalin (NGAL) has generated great interest as a novel biomarker for the timely detection of acute kidney injury (AKI). Despite the enthusiasm surrounding NGAL, the research so far details and attempts to minimize a host of limitations that substantially preclude its use as a valuable diagnostic biomarker to detect AKI and guide clinical treatment. In our review of the current research, obvious drawbacks such as variable sensitivity and specificity, even among similar patient populations were discovered. Furthermore, there are not well-defined cutoff values among various patient populations which would permit use of NGAL as a positive or negative diagnostic marker similar to troponin in cardiac injury. Moreover, due to the wide variation in baseline concentration of NGAL among patients, the added requirement of serial measurements, that may not even be accurate in at-risk or chronic kidney injury populations, further degrades the benefit of early detection.