The Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in the Differential Diagnosis of Acute Kidney Injury in Liver Cirrhosis

Abstract

Summary A cute kidney injury (AKI) is a serious complication in patients with chronic liver disease affecting about 20% hospitalized patients. AKI is a heterogeneous entity associated with various clinical presentations, treatments and procedures and is often seen in the setting of multiple organ failure and sepsis. Many potential therapeutic agents have been tried but with little success. Absence of reliable biomarkers for early detection of injury leads to delay in the introduction of treatment Causes of AKI include prerenal, HRS, ATN and post renal causes which are rare and represent less than 1% of the cases. In current clinical practice, serum creatinine level and urine output are the most frequently used indicators of renal dysfunction despite they have limited sensitivity and specificity. Serum creatinine, the commonly used marker for renal injury, is slow and insensitive. It is a marker of function and not injury and may take days after injury to increase limiting their usefulness in the early detection of AKI. An early detection of patients with kidney injury may provide the opportunity to treat and prevent the extension of kidney injury well before the serum creatinine rises resulting in fewer complications and improved outcomes. Recent advances have found the early stress response of kidney tubule cells to ischemic injury and have provided several novel biomarkers for AKI. The last decade accounted as the first steps in the new era of kidney damage biomarkers, but after a burst of enthusiasm, clinical studies seemed to bring us down to earth. The study of AKI has been revolutionized by investigation into multiple novel urinary biomarkers of kidney injury. Nearly 30 markers of acute kidney injury have been studied for early detection, differential diagnosis and prognosis of AKI. Neutrophil-gelatinase-associated lipocalin (NGAL) is a novel biomarker for diagnosing acute kidney injury (AKI). Although at first neutrophil gelatinase associated lipocalin (NGAL) was considered a promising new biomarker of renal impairment, current data revealed some limitations of its applicability in clinical practice. It is clear that NGAL can diagnose AKI, but larger studies should clarify the exact cut-off values and the best moment for determination.