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New Marker Allows Early Diagnosis of Acute Renal Failure

A biomarker that can detect acute renal failure (ARF) just a few hours after onset has been discovered. A major improvement over the 1 to 3 days required with standard creatinine testing. This could result in earlier treatment for the condition and improved patient outcomes.

Senior author Dr. Prasad Devarajan, from the Cincinnati Children’s Hospital Medical Center in Ohio, stated that, "We have reasonably good preventive and therapeutic measures for ARF when we know the diagnosis." Unfortunately, by the time creatinine levels rise, it is often too late to intervene effectively, he added.

"We needed a marker that would appear much earlier after ARF onset than the change in creatinine levels," Dr. Devarajan explained. "In animal studies, we identified a marker called neutrophil gelatinase-associated lipocalin (NGAL) that seemed to meet our requirements."

The researchers assessed the predictive value of NGAL in 71 children undergoing cardiopulmonary bypass, a common cause of ARF. Overall, 20 subjects (28%) developed acute renal injury. As noted, with serum creatinine testing, the diagnosis was not made until 1 to 3 days after surgery. By contrast, increased levels of NGAL were seen just 2 hours after the operation.

Multivariate analysis confirmed that the NGAL level at 2 hours was the strongest predictor of acute renal injury. Using a cutoff value of 50 micrograms/L, NGAL testing was 100% sensitive and 98% specific in detecting acute renal injury.

Although the study involved a cardiac surgery model of ARF, Dr. Devarajan said that coupled with previous research, the new findings suggest that "NGAL is an accurate marker for acute renal injury stemming from a diverse variety of insults."
Lancet 2005;365:1205-1206,1231-1238.

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