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Essential nephrology for cardiologist : A new molecule scores over creatinine in predicting acute kidney injury !

Posted Oct 06 2010 9:01am

Bio-chemical diagnosis of cardiac injury or infarction is  well  documented modality for many decades. Now , acute coronary  syndrome is diagnosed  by a battery of tests  that  detects the  proteins leaking from the  injured  myocardium.

Nephrologists have long been aiming for  such a  marker for ischemic  renal injury  (Not withstanding the fact , they are already blessed with two age-old molecules  creatinine and BUN !)

Neutrophil gelatinase associated Lipocalin (NGAL)

  • This is 25 Dalton molecule  richly secreted within renal  cortical cells in response to ischemic injury .
  • It is released without  modification in the  urine  .High urinary levels  of NGAL  reflect  acute renal  injury.
  • Early experience shows it  is a  promising  investigation and could  become a regular biochemical test in the near future.
  • Urine level of  NGAL >100ng/ml 2 hours   after cardiac surgery  predicts impending renal failure  in the next 24-48 hours .The advantage is , it NGAL raises well before serum creatinine.

NGAL After cardiac surgery

Lipocalin following PCI

Bachorzewska-Gajewska H et al. Neutrophil-gelatinase-associated lipocalin and renal function after percutaneous coronary interventions. Am J Nephrol 2006; 26: 287-292.

References for  NGAL

Final message

  • Cardiologists  and cardiac surgeons  have started  performing  complex    PCIs and  CABGs in  patients with   delicately  and precariously balanced renal function.
  • While ,  cardiologists   challenge  the kidneys with high  osmolar contrast agents ,  the surgeons stress it with extra corporeal circulation.  Many of these patients also  have co- morbid conditions .
  • Often , the cardiac outcome is directly linked to pre /post procedural  renal function .Nephrologists usually  arrive  late  into the filed (Creatinine SOS calls !).By this time the full-blown ATN sets in many.

Now , we have a tool to identify impending ARF , it gives us  little more time and  flexibility in managing the issue .

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