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Plasma and Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictors of Renal Parenchymal Involvement in

Emma Baranton1, Chloé Ribet1, Emma Freyssinet1

  • 1Pediatric Emergency Department, Lenval Children's Hospital, 06200 Nice, France.

Children (Basel, Switzerland)
|September 28, 2024
PubMed

Insights

Plasma and urinary neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL) did not effectively predict kidney involvement in children with febrile urinary tract infections (UTIs). C-reactive protein (CRP) showed better predictive ability in this pediatric population.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Biomarker Research

Background:

  • Urinary tract infections (UTIs) are common bacterial infections in children, with early detection of kidney involvement crucial for effective treatment.
  • Neutrophil gelatinase-associated lipocalin (NGAL) has been investigated as a potential biomarker for acute kidney injury and pyelonephritis.

Purpose of the Study:

  • To evaluate the efficacy of plasma (pNGAL) and urinary (uNGAL) NGAL levels in predicting renal parenchymal involvement in children with febrile UTIs.
  • To compare the diagnostic performance of NGAL with established inflammatory markers like C-reactive protein (CRP) and procalcitonin (PCT).

Main Methods:

  • A prospective, single-center study involving 28 children (≥ 4 years) with a first febrile UTI episode.
  • Magnetic resonance imaging (MRI) was used as the gold standard to assess renal parenchymal involvement.
  • Automated assays measured pNGAL, uNGAL, CRP, PCT, and white blood cell counts prior to antibiotic administration.

Main Results:

  • The area under the receiver operating characteristic (ROC) curve for predicting acute pyelonephritis was 0.6 for pNGAL and 0.4 for uNGAL.
  • CRP demonstrated a higher predictive value (ROC AUC 0.8) compared to pNGAL, uNGAL, and PCT (ROC AUC 0.4).
  • An optimal pNGAL cutoff of 141.0 ng/mL yielded 54.2% sensitivity and 75.0% specificity.

Conclusions:

  • pNGAL and uNGAL, measured by an automated system, were not effective predictors of renal parenchymal involvement in febrile UTIs in children aged ≥ 4 years.
  • The study highlights the utility of MRI as a gold standard and introduces an automated method for NGAL measurement in this context.
Abstract

Keywords:
MRINGALacute pyelonephritischildrenneutrophil gelatinase-associated lipocalinurinary tract infection

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