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Abstract
Neutrophil gelatinase associated lipocalin (NGAL), a 25-kD
carrier protein, represents a novel biomarker for early identification
of acute kidney injury as reported by Brenner in 2004. It is
hypothesized as a biomarker for the quantitation of CKD
prospectively with serum cystatin C and glomerular filtration rate
(GFR). The study aimed at evaluating serum NGAL among children
with chronic kidney disease and children at high risk of developing
renal injury and correlating the results with renal function tests and
serum cystatin C.The present study was carried out at the Pediatric Nephrology
and Dialysis Unit, Children’s Hospital, Ain Shams University during
the period from April 2007 to September 2008. It included seventy
patients classified into group 1 included twenty patients with end
stage renal disease (ESRD) on regular hemodialysis, group 2
included twenty patients with chronic kidney disease on conservative
treatment, group 3 included fifteen patients with nephrotic syndrome
for more than two years duration, in remission and not on
cyclosporine A therapy, group 4 included fifteen patients with
nephrotic syndrome on cyclosporine A therapy for at least three
continuous months and group 5 included twenty healthy subjects as
control.All patients were subjected to thorough history taking and
clinical examination. The laboratory investigations included complete
blood picture, ESR, blood urea nitrogen and serum creatinine (except
group 1), calcium, phosphorus, sodium, potassium, alkaline
phosphatase, total protein and albumin. Cholesterol and creatininelearance were assayed for groups 3, 4 and 5 only. In addition, serum
cystatin C and neutrophil gelatinase associated lipocalin (NGAL)
levels were measured for all patients by the quantitative sandwich
enzyme immunoassay technique. Urine examination for groups 3, 4
and 5 included complete urine analysis, total 24-hour urinary protein
and protein/creatinine ratio.The results of the study showed highly significant difference
in the level of serum NGAL and significant difference in cystatin C
when comparing patients with ESRD on regular hemodialysis with
those suffering from chronic kidney disease on conservative
treatment, being higher in ESRD children. In patients with ESRD and
chronic kidney disease, both NGAL and cystatin C levels showed
highly significant difference in comparison with serum of control,
being higher in the former.
Serum NGAL and cystatin C were higher in the serum of
nephrotic patients on cyclosporine A therapy in comparison to serum
of nephrotic patients on steroid therapy. Both NGAL and cystatin C
in nephrotic patients on steroid therapy and those on cyclosporine A
therapy were positively correlated with serum cholesterol, protein and
albumin and negatively correlated with urinary protein/creatinineOn the other hand, NGAL was lower in the serum of
nephrotic patients on steroid and in those on cyclosporine A than in
the serum of control with significant difference, whereas cystatin C
showed no difference. However, the level of NGAL was higher in
nephrotic patients on cyclosporine A therapy for more than 12
months than in those on cyclosporine A for less than 12 months. This
proves that serum NGAL was elevated with early acute renal injur
before affection of the traditional renal function tests (serum
creatinine and blood urea nitrogen) and also creatinine clearance.