NGAL Superiority to Creatinine in the Diagnosis of Renal Injury in a Pediatric Tertiary Hospital Setting
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Keywords
Acute Kidney Injur, Biomarkers, Neutrophil Gelatinase-Associated Lipocalin, Pediatrics, Serum Creatinine
Abstract
Background: Acute kidney injury (AKI) is related with higher death rates, longer hospital admissions, and an increased chance of developing chronic kidney disease (CKD). Serum creatinine, a conventional biomarker for AKI diagnosis, has limitations since it rises slowly after renal injury and is dependent on muscle mass and hydration state. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising early biomarker, appearing in urine and plasma within two hours of kidney injury. This study investigates the diagnostic accuracy of NGAL against serum creatinine in diagnosing AKI in pediatric patients. The aim of this study is to assess the sensitivity and specificity of NGAL in diagnosing AKI in pediatric patients compared to serum creatinine. By assessing the reliability of NGAL, the study aims to enhance early detection and management techniques for AKI in children.
Methodology: A cross-sectional analytic study was carried out over a 12-month period at a tertiary hospital's pediatric nephrology department. The study included 200 children aged 1 month to 18 years who had been admitted with symptoms that put them at risk for AKI, such as sepsis, dehydration, and nephrotoxic medication exposure. Blood samples were taken at admission and 24 hours later to determine serum creatinine and NGAL levels. An enzymatic colorimetric technique was used to determine serum creatinine, and an enzyme-linked immunosorbent assay (ELISA) was used to detect NGAL. Data was analyzed with SPSS software, and diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis.
Results: NGAL revealed superior diagnostic accuracy, with an area under the curve (AUC) of 0.94 against 0.72 for creatinine. NGAL demonstrated greater sensitivity (92% vs. 68%) and specificity (88% vs. 62%), especially in infants. The ROC curve demonstrated NGAL's excellent diagnostic performance in all pediatric age groups. Conclusion: This study shows that NGAL is a more reliable early biomarker for AKI in pediatric patients than serum creatinine. Its implementation in clinical practice could lead to early diagnosis and treatments, lowering the risk of severe kidney injury and improving pediatric patient outcomes.
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