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Rule Out Acute Kidney Injury in the Emergency Department With a Urinary Dipstick.
Jacob S Stevens1, Katherine Xu1, Alexa Corker1
1Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA.
Kidney International Reports
|November 9, 2020
Summary
A new urinary neutrophil gelatinase-associated lipocalin (NGAL) dipstick test accurately identifies patients without acute kidney injury. This rapid bedside test aids in timely clinical decisions, overcoming limitations of traditional serum creatinine measurements.
Area of Science:
- Nephrology
- Biomarker Discovery
- Diagnostic Technologies
Background:
- Serum creatinine (SCr) is a standard but limited marker for acute kidney injury (AKI) due to poor temporal resolution and low sensitivity/specificity for cellular damage.
- Urinary biomarkers offer real-time detection of kidney cellular stress and injury, providing a more dynamic assessment than SCr.
- Neutrophil gelatinase-associated lipocalin (NGAL) is a promising urinary biomarker for kidney injury.
Purpose of the Study:
- To evaluate the utility of a novel lateral flow dipstick for detecting urinary NGAL (uNGAL) in emergency department patients.
- To assess the diagnostic performance of the uNGAL dipstick in identifying acute kidney injury.
- To determine if the uNGAL dipstick can aid in the rapid triage and management of patients with suspected kidney injury.
Main Methods:
- A prospective cohort study involving 479 patients (final N=426) admitted to an emergency department.
- Urine samples were analyzed using a lateral flow dipstick assay for uNGAL.
- Results were compared with traditional serum creatinine measurements and Acute Kidney Injury Network (AKIN) criteria.
Main Results:
- The uNGAL dipstick demonstrated high interrater reliability and correlated well with ELISA measurements.
- Among patients meeting AKIN criteria for AKI, the uNGAL dipstick showed high specificity (91%) and negative predictive value (97%) for identifying those without sustained kidney injury.
- The dipstick effectively distinguished between transient and sustained elevations in SCr, indicating its potential for real-time assessment.
Conclusions:
- A bedside uNGAL dipstick test enables accurate identification of individuals without tubular kidney injury.
- This rapid diagnostic tool can facilitate efficient patient triage and decision-making in acute care settings.
- The uNGAL dipstick overcomes the retrospective, insensitive, and nonspecific nature of SCr measurements for early kidney injury detection.
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