The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy

  • Rhee, Harin (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Shin, Nari (Biomedical Research Institute, Pusan National University Hospital) ;
  • Shin, Min Ji (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Yang, Byung Yun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Il Young (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Song, Sang Heon (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Dong Won (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Soo Bong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kwak, Ihm Soo (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Seong, Eun Young (Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2014.08.11
  • Accepted : 2014.09.05
  • Published : 2015.05.01
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Abstract

Background/Aims: Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN. Methods: The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease. Results: There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as $T_2$ (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004). Conclusions: In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression.

Keywords

Acknowledgement

Supported by : Pusan National University Hospital

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