Comparison of urine neutrophil gelatinase-associated lipocalin to serum creatinine to assess kidney function in neonatal asphyxia
Abstract: Infants with
neonatal asphyxia have multiorgan damage, such as to the kidneys (50%), central
nervous system (28%), cardiovascular system (25%), and lungs (23%). Neonatal
asphyxia reduces kidney perfusion, often leading to acute kidney injury (AKI)
after asphyxia. Neutrophil gelatinase-associated lipocalin (NGAL) levels in the
blood, urine and kidney tissue increased rapidly in AKI. Urinary NGAL is
proposed to have better performance in diagnosing AKI than creatinine due to
its earlier, rapid level increase and it is less invasive.
Objective To compare urinary NGAL to serum creatinine as a marker to
assess kidney function in neonatal asphyxia.
Methods Diagnostic comparison study with cross-sectional design was
performed at neonatal intensive care unit (NICU) of Prof. Dr. R. D. Kandou
Hospital, Manado from November 2015 to February 2016. All subjects had neonatal
asphyxia. Data were analyzed using descriptive analysis, receiver-operator
characteristic (ROC) curve, and Z-test.
Results Urinary NGAL with cut-off point of 652.24 ng/mL can predict AKI
in neonates with asphyxia with 100% sensitivity, 75% specificity, 52.3%
positive predictive value, and 100% negative predictive value. Chi-square test
resulted in a value of x2 = 20.036, P=0.0001).This shows that urinary NGAL
levels >652,24 ng/mL can predicts AKI by 20 times in infants with neonatal
asphyxia. So, urinary NGAL performs better than serum creatinine, therefore it
can replace serum creatinine as an alternative non-invasive diagnostic test for
diagnosing AKI in infants with neonatal asphyxia.
Conclusion The diagnostic value of urinary NGAL is higher than that of
serum creatinine in assessing kidney function in neonatal asphyxia.
Keywords: Asphyxiated
neonates, urine NGAL, serum creatinine, kidney function
Author: Winston Leonardo
Tanzil, Rocky Wilar, Max Frans Josef Mantik, Adrian Umboh, Suryadi Nicolaas
Napoleon Tatura
Journal Code: jpkedokterangg160224
