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Diagnostic accuracy of neutrophil gelatinase-associated lipocalin as a predictor of chronic kidney disease

Introduction Chronic kidney disease (CKD) is a major threat to public health problem, in terms of prevalence of disease, cost of treatment, and the comorbidities involved. To screen out the severe disease earlier and more accurately, estimated glomerular filtration rate (eGFR) and albuminuria are still regarded as the ideal markers of kidney function. Neutrophil gelatinase-associated lipocalin (NGAL) is a new biomarker for detecting early kidney damage. The aim of the study was to assess diagnostic significance of NGAL in early stages of CKD among patients. Patients and methods We measured urinary neutrophil gelatinase-associated lipocalin (uNGAL) and serum neutrophil gelatinase-associated lipocalin (sNGAL) levels in 40 patients with stages 2 and 3 CKD and 20 controls by ELISA. Results There was a highly significant increase in uNGAL and sNGAL, albumin/creatinine ratio, and eGFR on comparison of all patients and groups 1 and 2 with the control group (P < 0.001) and on comparing group 2 with group 1. We found that uNGAL and sNGAL were highly significantly and positively correlated in the patient groups (P < 0.001, r = 0.924) and in group 1 and group 2 (P < 0.001, r = 0.886 and 0.875, respectively). We also found that uNGAL and sNGAL were highly significantly correlated with albumin/creatinine ratio and C-reactive protein in the patient group and in both group 1 and group 2 (P < 0.001), and they were significantly negatively correlated with eGFR in groups 1 and 2 (P = 0.02 and P < 0.001, respectively). The area under curve for uNGAL to identify patients with CKD and those with stage 3 CKD was 0.98 and 0.909, with sensitivity of 92.5 and 85%, respectively, and specificity of 90 and 82.5%, respectively (P < 0.001). The area under curve for sNGAL was 0.937 and 0.876, with sensitivity of 85 and 95%, respectively, and specificity of 85 and 80%, respectively (P < 0.001) and for C-reactive protein was 0.774 and 0.954, with sensitivity of 72.5 and 95%, respectively, and specificity of 60 and 80%, respectively (P = 0.001 and P < 0.001, respectively).