Limits...
The elusive task of biomarkers of renal injury.

Legrand M, Mari A, Mebazaa A - Crit Care (2013)

Bottom Line: Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising candidate biomarkers of renal injury, with expression in renal tissue increasing dramatically after ischemia-reperfusion injury but not in the case of pure pre-renal failure.In a recent issue of Critical Care, Di Somma and colleagues reported that NGAL could improve the classification of acute kidney injury compared with clinical assessment and showed that NGAL was associated with poor prognosis.NGAL may therefore carry different information than biomarkers of renal function.

View Article: PubMed Central - HTML - PubMed

ABSTRACT
Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising candidate biomarkers of renal injury, with expression in renal tissue increasing dramatically after ischemia-reperfusion injury but not in the case of pure pre-renal failure. In a recent issue of Critical Care, Di Somma and colleagues reported that NGAL could improve the classification of acute kidney injury compared with clinical assessment and showed that NGAL was associated with poor prognosis. NGAL may therefore carry different information than biomarkers of renal function. This study finally provides additional evidence for the highly complex relationship between renal function and renal injury.

Show MeSH

Related in: MedlinePlus

Serum/urine neutrophil-gelatinase associated lipocalin increase might outweigh renal function biomarkers for prediction of adverse outcome. Several lines of evidence suggest that a rise of serum or urine level of neutrophil-gelatinase associated lipocalin (NGAL) might outweigh biomarkers of renal function for prediction of adverse outcome (that is, mortality). Further prospective studies should confirm these findings. Dashed lines enclose potential effectors linking biomarkers of renal function (for example, serum creatinine) and renal injury (for example, NGAL) to poor outcome. These factors can affect the serum level of these biomarkers (+) but can also influence outcome (-). Further research should explore the significance of these associations and will unveil the specificity of the biomarkers toward renal injury.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3672657&req=5

Figure 1: Serum/urine neutrophil-gelatinase associated lipocalin increase might outweigh renal function biomarkers for prediction of adverse outcome. Several lines of evidence suggest that a rise of serum or urine level of neutrophil-gelatinase associated lipocalin (NGAL) might outweigh biomarkers of renal function for prediction of adverse outcome (that is, mortality). Further prospective studies should confirm these findings. Dashed lines enclose potential effectors linking biomarkers of renal function (for example, serum creatinine) and renal injury (for example, NGAL) to poor outcome. These factors can affect the serum level of these biomarkers (+) but can also influence outcome (-). Further research should explore the significance of these associations and will unveil the specificity of the biomarkers toward renal injury.

Mentions: NGAL carries risk information beyond markers of renal function and clinical assessment. In the present study NGAL did not perform better than the estimated glomerular filtration rate or clinical judgment, which share common criteria with the clinical endpoint (namely serum creatinine and estimated glomerular filtration rate) - further suggesting that these biomarkers provide different information, including a prognostic value [9]. Is it time for intensivists to operate the paradigm shift at the bedside in the way we assess AKI by using NGAL to monitor renal damage? Further exploration of the association between biomarkers of renal function, biomarkers of renal injury and prognosis appears a crucial next step before doing so. The results of an ongoing large multicenter study assessing the association between NGAL and 1-year outcome in ICU patients will provide important insights into this issue (FROG-ICU trial, ClinicalTrials.gov:NCT01367093). Exploration of the links between hits, damage and driving forces of renal failure through the sources of different biomarkers [1], identification of the NGAL pathways (that is, systemic inflammation, chronic renal injury, acute renal injury, and so forth) [10] and increased specificity of biomarkers toward renal injury is then required [11,12] (Figure 1). Most importantly, intensivists and emergency physicians should explore whether risk stratification using NGAL will translate in clinical decision-making.


The elusive task of biomarkers of renal injury.

Legrand M, Mari A, Mebazaa A - Crit Care (2013)

Serum/urine neutrophil-gelatinase associated lipocalin increase might outweigh renal function biomarkers for prediction of adverse outcome. Several lines of evidence suggest that a rise of serum or urine level of neutrophil-gelatinase associated lipocalin (NGAL) might outweigh biomarkers of renal function for prediction of adverse outcome (that is, mortality). Further prospective studies should confirm these findings. Dashed lines enclose potential effectors linking biomarkers of renal function (for example, serum creatinine) and renal injury (for example, NGAL) to poor outcome. These factors can affect the serum level of these biomarkers (+) but can also influence outcome (-). Further research should explore the significance of these associations and will unveil the specificity of the biomarkers toward renal injury.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672657&req=5

Figure 1: Serum/urine neutrophil-gelatinase associated lipocalin increase might outweigh renal function biomarkers for prediction of adverse outcome. Several lines of evidence suggest that a rise of serum or urine level of neutrophil-gelatinase associated lipocalin (NGAL) might outweigh biomarkers of renal function for prediction of adverse outcome (that is, mortality). Further prospective studies should confirm these findings. Dashed lines enclose potential effectors linking biomarkers of renal function (for example, serum creatinine) and renal injury (for example, NGAL) to poor outcome. These factors can affect the serum level of these biomarkers (+) but can also influence outcome (-). Further research should explore the significance of these associations and will unveil the specificity of the biomarkers toward renal injury.
Mentions: NGAL carries risk information beyond markers of renal function and clinical assessment. In the present study NGAL did not perform better than the estimated glomerular filtration rate or clinical judgment, which share common criteria with the clinical endpoint (namely serum creatinine and estimated glomerular filtration rate) - further suggesting that these biomarkers provide different information, including a prognostic value [9]. Is it time for intensivists to operate the paradigm shift at the bedside in the way we assess AKI by using NGAL to monitor renal damage? Further exploration of the association between biomarkers of renal function, biomarkers of renal injury and prognosis appears a crucial next step before doing so. The results of an ongoing large multicenter study assessing the association between NGAL and 1-year outcome in ICU patients will provide important insights into this issue (FROG-ICU trial, ClinicalTrials.gov:NCT01367093). Exploration of the links between hits, damage and driving forces of renal failure through the sources of different biomarkers [1], identification of the NGAL pathways (that is, systemic inflammation, chronic renal injury, acute renal injury, and so forth) [10] and increased specificity of biomarkers toward renal injury is then required [11,12] (Figure 1). Most importantly, intensivists and emergency physicians should explore whether risk stratification using NGAL will translate in clinical decision-making.

Bottom Line: Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising candidate biomarkers of renal injury, with expression in renal tissue increasing dramatically after ischemia-reperfusion injury but not in the case of pure pre-renal failure.In a recent issue of Critical Care, Di Somma and colleagues reported that NGAL could improve the classification of acute kidney injury compared with clinical assessment and showed that NGAL was associated with poor prognosis.NGAL may therefore carry different information than biomarkers of renal function.

View Article: PubMed Central - HTML - PubMed

ABSTRACT
Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising candidate biomarkers of renal injury, with expression in renal tissue increasing dramatically after ischemia-reperfusion injury but not in the case of pure pre-renal failure. In a recent issue of Critical Care, Di Somma and colleagues reported that NGAL could improve the classification of acute kidney injury compared with clinical assessment and showed that NGAL was associated with poor prognosis. NGAL may therefore carry different information than biomarkers of renal function. This study finally provides additional evidence for the highly complex relationship between renal function and renal injury.

Show MeSH
Related in: MedlinePlus