Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug;21(4):658-664.
doi: 10.1007/s10157-016-1320-6. Epub 2016 Sep 2.

Serum NGAL and copeptin levels as predictors of acute kidney injury in asphyxiated neonates

Małgorzata Baumert  1 , Piotr Surmiak  2 , Andrzej Więcek  3 , Zofia Walencka  1
Affiliations

Serum NGAL and copeptin levels as predictors of acute kidney injury in asphyxiated neonates

Małgorzata Baumert et al. Clin Exp Nephrol. 2017 Aug.

Abstract

Background: Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that serum neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI, but there are the lacks of data about its use in term neonates with perinatal asphyxia.

Methods: A prospective cohort study was conducted on 43 term neonates. Umbilical cord blood and 24 h after birth serum NGAL, copeptin, creatinine, and molality were measured in all asphyxiated and controls neonates.

Results: During the study period, 8 of asphyxiated nenates (18.6 %) suffered from AKI, while 35 newborns have no signs of AKI and 30 healthy infants. We did not observe any differences in creatinine and copeptin levels, as well as serum osmolality in all three investigated groups (AKI, no-AKI, and controls) in cord blood, and 24 h after birth. Serum NGAL levels in umbilical cord blood were significantly higher in the AKI group (174.3 ng/mL) compared with no-AKI (88.5 ng/mL, p = 0.01) and control groups (28.5 ng/mL, p < 0.001), and 24 h after birth (respectively, AKI 152.5 ng/mL vs no-AKI 74.9 ng/mL, p = 0.02 vs controls 39.1 ng/mL, p < 0.001). NGAL concentration showed a strong negative correlation to umbilical artery pH (Rho = -0.42, p = 0.04), base excess (Rho = -0.31, p = 0.03), and Apgar score in 1st min (Rho = -0.41, p = 0.02) and 5th min of life (Rho = -0.20, p = 0.001). ROC curve analysis demonstrated a good predictive value for NGAL levels (>140.7 ng/mL) which allows to diagnose AKI in asphyxiated patients with 88.9 % sensitivity (95 % CI 75-95 %) and 95.0 % specificity (95 % CI 76-99 %).

Conclusion: NGAL seems to be a promising marker, even in subclinical AKI in neonates, due to its high specificity, but copeptin did not meet expectations.

Keywords: Acute kidney injury; Asphyxia; Copeptins; LCN2 protein; Osmolality.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted (Medical University of Silesia in Katowice no. KNW/022/KB1/35/12) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
NGAL, copeptin and creatinine levels, and serum osmolality in neonates with acute kidney injury (AKI) and newborns no-AKI in umbilical cord blood and 24 h after birth. Results are shown as medians and 95 % confidence intervals. NGAL neutrophil gelatinase-associated lipocalin, AKI acute kidney injury
Fig. 2
Fig. 2
Comparison of ROC curve analysis for prediction of AKI based on umbilical and 24-h NGAL levels in asphyxiated neonates. Comparison of ROC curves (Z statistic = 2.14). AUC area under ROC curve, SE standard error, 95 % confidence interval for SE, NGAL neutrophil gelatinase-associated lipocalin, AKI acute kidney injury
Fig. 3
Fig. 3
Comparison of ROC curve analysis for prediction of AKI based on umbilical and 24-h creatinine levels in asphyxiated neonates. Comparison of ROC curves (Z statistic = 3.50). AUC area under ROC curve, SE standard error, 95 % confidence interval for SE. NGAL neutrophil gelatinase-associated lipocalin, AKI acute kidney injury
See this image and copyright information in PMC

References

    1. Andreoli SP. Acute renal failure in the newborn. Semin Perinatol. 2004;28:112–113. doi: 10.1053/j.semperi.2003.11.003. - DOI - PubMed
    1. Gupta BD, Sharma P, Bagla J, et al. Renal failure in asphyxiaed neonates. Indian Pediatr. 2005;42:928–934. - PubMed
    1. Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? Pediatr Nephrol. 2009;24:265–274. doi: 10.1007/s00467-008-1060-2. - DOI - PMC - PubMed
    1. Cataldi L, Leone R, Morett U, et al. Potential risk factors for the development of acute failure in preterm newborn infants: a case–control study. Arch Dis Child Fetal Neonatal Ed. 2005;90:514–519. doi: 10.1136/adc.2004.060434. - DOI - PMC - PubMed
    1. Portman RJ, Carter BS, Gaylord MS, et al. Predicting neonatal morbidity after perinatal asphyxia: a scoring system. Am J Obstet Gynecol. 1990;162:174–182. doi: 10.1016/0002-9378(90)90844-W. - DOI - PubMed

MeSH terms

LinkOut - more resources