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Kidney Week

Abstract: SA-OR012

Use of Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) to Rule Out AKI in Children with High Nephrotoxic Medication Exposure

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Schmerge, Alexandra, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Dill, Lynn, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Gerhardt, Bradley S., CCHMC, Cincinnati, Ohio, United States
  • Askenazi, David J., University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Nephrotoxic medication (NTMx) exposure is one of the most common causes of AKI in hospitalized children. We have demonstrated sustained reductions in NTMx exposure and associated AKI by implementation of the Nephrotoxic Injury Negated by Just in time Action (NINJA) program at our institutions. The NINJA program puts processes in place to identify high NTMx exposure and implements daily SCr assessment in exposed patients. Daily blood draws for SCr can be burdensome for the healthcare system and patients. We tested the hypothesis that daily urine NGAL assessments could be used to screen for NTMx AKI, allowing for a more limited SCr assessment.

Methods

This was a 2 center prospective study of children identified with high NTMx exposure (3 or NTMx on the same day or >3 days of IV vancomycin or an IV aminoglycoside). Patients had daily SCr drawn as standard of care for the NINJA program. Urine for NGAL measurement (The NGAL Test™, Bioporto, Denmark) was obtained for the first 7 days of high NTMx exposure. AKI was defined by the SCr based KDIGO criteria, and severe AKI (sAKI) was defined as KDIGO Stage 2 or 3 AKI.

Results

117 patients had 498 urine samples available for analysis. 27 patients had AKI; 9 patients had severe AKI. The performance of NGAL at various concentrations (ng/ml) to predict AKI and severe AKI is shown in the table.

Conclusion

Urine NGAL level < 150 ng/ml has high NPV for any AKI and sAKI. We suggest NGAL can be used to complement SCr as part of the assessment for NTMx AKI, limiting the burden on providers and patients associated with a daily blood draw.

NGAL level/AKISensitivitySpecificityPPVNPV
50/Any AKI35% (14-62%)72% (62-80%)18% (9-30%)87% (82-90%)
150/Any AKI24% (7-50%)92% (85-96%)33% (14-60%)88% (84-90%)
300/ Any AKI0% (0-20%)96% (90-99%)085% (84-85%)
50/Severe AKI50% (7-93%)71% (62-80%)6% (2-15%)98% (94-99%)
150/Severe AKI25% (0-81%)90% (83-95%)8% (2-35%)97% (95-98%)
300/Severe AKI0% (0-60%)96% (91-99%)096% (96-97%)

Values in parentheses are 95% CI

Funding

  • Commercial Support