Significance of combined Use of Neutrophil Gelatinase-Associated Lipocalin and Natriuretic Peptides for Diagnosis and Follow up of Patients with Chronic Kidney Diseases
Departments of Chemistry and Biochemistry/ College of Medicine, Al-Nahrain University, Baghdad, Iraq
Departments of Medicine/ College of Medicine, Al-Nahrain University, Baghdad, Iraq.
Medical Research Unit, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
Departments of Chemistry and Biochemistry/ College of Medicine, Al-Nahrain University, Baghdad, Iraq.
Natriuretic peptides (NPs), are a structurally related group of hormones or paracrine factors sharing a common function of increasing renal sodium excretion and, consequently, reducing expanded extracellular volume. The principal NPs in clinical use are NT-pro BNP and NT-pro CNP. There is some evidence that using NPs tests in emergency departments could replace many expensive tests, and shorten the hospital stay and cost of treatment.
Objectives: To identify the significance of using NPs and NGAL for the diagnosis and/or follow-up of subjects with chronic kidney diseases (CKD) in comparison with routinely used markers.
Material and methods
This study involved 78 participants: 38 controls (seemingly healthy normal adults) and 40 CKD patients. They were 50.6 9.3 and 52.4 8.8 years old on average, respectively. NPs and NGAL were assessed by enzyme-linked immunosorbent assays, while assessments of renal function and serum electrolytes were performed by conventional available laboratory procedures.
There was a significant increase in NT-pro CPN, NT-pro BNP, and NGAL in the patient group compared to the control group. To discriminate between CKD and controls the ROC curve revealed excellent sensitivity and specificity after using the NGAL (90% and 100%, respectively; at a 78.5 ng/ml cutoff value). The sensitivity of NT-pro CNP and specificity were 82% and 90%, respectively, at a 4.95 pg/ml limit value. While the sensitivity of NT-pro BNP and specificity were 72% and 68%, respectively at a 565 pg/ml threshold.
Significant positive direct correlations existed between serum creatinine with each of NGAL and NT-pro BNP.
The combined clinical use of the NPs and NGAL, as adjuvant biomarkers for the CKD diagnosis and follow-up revealed a very good sensitivity and specificity.