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. 2022 Jan-Feb;27(1):83-90.
doi: 10.4103/jiaps.JIAPS_334_20. Epub 2022 Jan 11.

Utility of Urinary Biomarkers Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 as a Marker for Diagnosing the Presence of Renal Scar in Children with Vesicoureteral Reflux (VUR): A Cross-Sectional Study

Prathibha B Naik  1 , Bibekanand Jindal  1 , S Kumaravel  1 , Dhanapathi Halanaik  2 , Medha Rajappa  3 , Bikash Kumar Naredi  1 , K K Govindarajan  1
Affiliations

Utility of Urinary Biomarkers Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 as a Marker for Diagnosing the Presence of Renal Scar in Children with Vesicoureteral Reflux (VUR): A Cross-Sectional Study

Prathibha B Naik et al. J Indian Assoc Pediatr Surg. 2022 Jan-Feb.

Abstract

Aim: To explore the possibility of using urinary biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) to assess the presence of renal scars in children with Vesicoureteric Reflux (VUR).

Materials and methods: This cross-sectional study was conducted in 94 children aged 0-16 years diagnosed with VUR in the Department of Pediatric Surgery, JIPMER. Urinary biomarkers were measured using the enzyme-linked immunosorbent assay kits, normalized with urinary creatinine (Cr) and compared with severity of VUR (low grade [I and II] and high grade [III, IV, and V]), presence or absence of renal scar in VUR patients and severity of renal scar. Independent Student's t-test, Mann-Whitney U-test, and analysis of variance Kruskal-Wallis test were used for comparison, and receiver operating characteristic (ROC) curve analysis for predicting the accuracy of biomarkers in detecting the presence of renal scars.

Results: The median urinary NGAL (uNGAL) value was higher in children with renal scar (1.49 ng/mL) than those without renal scar (0.58 ng/mL) and was statistically significant (<0.001). Whereas median uNGAL/Cr was higher in children with renal scar (0.07) than those without renal scar (0.03) but was not statistically significant (P = 0.06). Urinary KIM-1 and urinary KIM-1/urinary Cr (uKIM-1/Cr) was not found to be a significant predictor of renal scar. The difference of uNGAL/Cr was comparable between the grades of renal scar but was not statistically significant. On ROC curve analysis, uNGAL had area under the ROC curve (AUC) of 0.769 with 71% of both specificity and sensitivity, whereas uNGAL/Cr was found to be a poor predictor of renal scar with AUC of 0.611, 60% sensitivity, and 61.2% specificity.

Conclusion: uNGAL can serve as a noninvasive marker for diagnosing the presence of renal scar in children with VUR and a multicentric more extensive cohort study may be needed to strengthen or negate its role.

Keywords: Kidney injury molecule-1; neutrophil gelatinase-associated lipocalin; renal scar; urinary biomarkers; vesicouretericreflux.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Study population
Figure 2
Figure 2
Representation of urinary biomarkers urinary Neutrophil gelatinase-associated lipocalin/creatinine and urinary kidney injury molecule-1/creatinine to renal scar
Figure 3
Figure 3
Receiver operating characteristic curve of urinary biomarkers and estimated glomerular filtration rate to the presence or absence of renal scar
See this image and copyright information in PMC

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