Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention

Abstract

Background. Contrast-induced acute kidney injury (CI-AKI) occurs in up to 13% of patients undergoing percutaneous coronary intervention (PCI). Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for renal impairment. We investigated whether increased urinary NGAL concentrations were predictive of CI-AKI within 2 days after PCI or of a higher re-hospitalization rate within 9 months. Methods. Consecutive patients (n = 128), with stable coronary heart disease and eGFR ≥ 30 mL/min/1.73 m², undergoing PCI were included. Venous serum samples for measurement of creatinine, blood urea nitrogen, and cystatin C and urine samples for NGAL measurement were collected 4 hours and 1 and 2 days after contrast medium application. Patients were followed over 9 months to determine clinical endpoints. Results. CI-AKI was observed in 14 patients (10.9%) after PCI. NGAL concentrations before PCI were significantly higher in patients with subsequent CI-AKI (19.8 ng/mL [14.4–35.8] vs. 11.6 ng/mL [5.6–28.2]; p = 0.04). There was no significant difference in NGAL concentrations 4 h after PCI between patients with and without CI-AKI. One day after PCI, NGAL concentrations were significant higher in patients developing CI-AKI (100.1 ng/mL [41.5–129.2] vs. 16.6 ng/mL [9.1–28.1]; p < 0.001). Compared to common biomarkers, NGAL best predicted CI-AKI (AUC 0.939 [95% CI 0.89–0.99; p < 0.001]). The re-hospitalization rate due to progressive renal insufficiency within 9 months was higher in the group with CI-AKI than the group without (4 [28.6%] vs. 4 [3.5%], p < 0.01). Conclusion. Urinary NGAL is a biomarker for predicting CI-AKI when measured 1 day after PCI.

Key Words::

• Contrast-induced acute kidney injury
• contrast-induced nephropathy
• percutaneous coronary intervention
• neutrophil gelatinase-associated lipocalin
• LCN2

Acknowledgements

Abbott Diagnostics donated urinary NGAL and cystatin C assays.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

The funding sources were not involved in the design of the trial, the gathering, analysis and interpretation of data, the writing of the manuscript or the decision to publish the paper.

Notice of correction

The online version of this article published ahead of print on 5 Dec 2013 contained an error on page 6. The same image was published twice in figures 4 and 5. The error has been corrected for this version.