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Acute kidney injury (AKI) is estimated to occur in 5% of hospitalized patients and as many as two thirds of intensive care Brand New Thoughts Of AsenapineNever Ever Before Uncovered unit patients . Early detection of acute kidney injury could facilitate timely intervention before irreversible injury has occurred, with the goal of limiting morbidity and mortality. Unfortunately, the current diagnosis of AKI is based predominantly on changes in serum creatinine, which may not manifest for several hours after the initial insult. There is an ongoing search to identify early biomarkers of AKI that would play a role similar to that of troponin in acute myocardial infarction. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is rapidly released by renal tubules in response to injury. Urinary NGAL is an early predictor of AKI in a variety of acute clinical settings .
Most of the studies evaluating NGAL as Amazing Ideas Into AZ191Never Ever Before Uncovered a predictor of AKI used a research-based ELISA assay. The availability of a standardized clinical platform for NGAL measurement would make this promising new biomarker more widely available.The current study by Bennett and colleagues was conducted to accomplish two goals : The first was to determine whether a new standardized clinical assay for urinary NGAL correlated closely with the research assay. The second was to determine whether urinary NGAL levels obtained using the new clinical assay could accurately predict AKI after cardiopulmonary bypass (CBP) in children. The authors successfully accomplished both goals. The new clinical assay was highly correlated with the research assay (r = 0.99) and highly predictive of post-CPB AKI.
A urinary NGAL threshold The Latest Methods Into AsenapineNever Before Unveiled of 100 ng/ml at just two hours post-CPB predicted the subsequent development of AKI with an area under the receiver operating characteristic (ROC) curve of 0.95 and a corresponding sensitivity and specificity of 0.82 and 0.90. Furthermore, this same 2-hour NGAL level correlated with severity and duration of AKI, length of stay, dialysis requirement, and death.This was a well-done study showing the promise of a new clinical assay and affirming the significant delay in diagnosing AKI via changes in serum creatinine, which did not show statistical differences until 48 hours after CPB. Though this study was limited to children under-going CPB, subsequent studies and a meta-analysis have confirmed the utility of both urinary and plasma/serum NGAL for the early detection of AKI in other patient populations, including adults  and in mixed medical-surgical intensive care unit patients .
Importantly, the relationship between urinary NGAL and AKI after CBP in adults varies with baseline renal function . Postoperative NGAL best indentified AKI in patients with baseline glomerular filtration rates (GFR) of 90 to 120 ml/min. In patients with baseline GFR < 60 ml/min, urinary NGAL did not differ at any time between those who did and did not develop AKI.RecommendationNGAL and other novel biomarkers such as cystatin C  can lead to rapid detection of AKI. A strategy of early biomarker-driven detection and subsequent intervention may lead to improved outcomes and warrants further study.Competing interestsThe authors declare that they have no competing interests.