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ABSTRACT: Introduction
The identification of acute injury of the kidney relies on serum creatinine (SCr), a functional marker with poor temporal resolution as well as limited sensitivity and specificity for cellular injury. In contrast, urinary biomarkers of kidney injury have the potential to detect cellular stress and damage in real time.Methods
To detect the response of the kidney to injury, we have tested a lateral flow dipstick that measures a urinary protein called neutrophil gelatinase-associated lipocalin (NGAL). Analysis of urine was performed in a prospective cohort of 479 patients (final cohort N = 426) entering an emergency department in New York City and subsequently admitted for inpatient care.Results
Colorimetric development had high interrater reliability (88% concordance rate) and correlated with traditional enzyme-linked immunosorbent assay (ELISA) measurements (ρ = 0.732, P < .0001). Of the 14% of the cohort who met Acute Kidney Injury Network (AKIN) SCr criteria for acute kidney injury (AKI), 67% demonstrated transient (<2 days) and 33% demonstrated sustained (>2 days) elevation of SCr. Comparing the outcomes of patients with sustained versus transient or undetectable changes in SCr revealed that the urinary NGAL (uNGAL) dipstick had high specificity and negative predictive value (NPV) (high- vs. low-intermediate readings, sensitivity = 0.55, specificity = 0.91, positive predictive value = 0.24, NPV = 0.97, χ2 = 20.39, P < 0.001).Conclusion
We show that the introduction of a bedside uNGAL dipstick permits accurate triage by identifying individuals who do not have tubular injury. In an era of shortening length of stay and rapid decisions based on isolated SCr measurements, real-time exclusion of kidney injury by a dipstick will be particularly useful to overcome the retrospective, insensitive, and nonspecific attributes of SCr.
SUBMITTER: Stevens JS
PROVIDER: S-EPMC7609964 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
Stevens Jacob S JS Xu Katherine K Corker Alexa A Gopal Tejashree S TS Sayan Osman R OR Geraghty Erin P EP Yaeh Andrew M AM Kosuri Yaagnik D YD Burton John R JR Lincoln Saul V SV Callahan Miriam P MP Breheney Rebecca K RK Beenken Andrew S AS Gamino Juliana N JN Felman Ariel E AE Gehani Anjali A Giordano Hayley A HA Gozali Aileen A Guerrero Herrera Eddie F EF Hatcher Britney A BA Kheir Lena A LA Li Yuanji Y Mitsui Erika K EK Nha Jae I JI Sayan Alexander T AT Spaiser Samuel J SJ Arumugam Siddarth S Sia Samuel K SK King Kristen L KL Mohan Sumit S Barasch Jonathan J
Kidney international reports 20200918 11
<h4>Introduction</h4>The identification of acute injury of the kidney relies on serum creatinine (SCr), a functional marker with poor temporal resolution as well as limited sensitivity and specificity for cellular injury. In contrast, urinary biomarkers of kidney injury have the potential to detect cellular stress and damage in real time.<h4>Methods</h4>To detect the response of the kidney to injury, we have tested a lateral flow dipstick that measures a urinary protein called neutrophil gelatin ...[more]