Neutrophil Gelatinase-Associated Lipocalin: from Laboratory to Clinical Utility

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Series: Renal, Metabolic and Urologic Disorders
BISAC: MED071000

Acute kidney injury (AKI), defined as an abrupt decrease in renal function over a period of hours to days, is a common complication among hospitalized patients with different acute diseases. Its incidence has been increasing in recent years and is reported to be very high especially in the acute settings. Since clinical signs and symptoms of acute renal damage are not specific, it is difficult to promptly distinguish AKI at the time of patient presentation.

Currently the diagnosis of AKI requires serial assessment of laboratory tests over a period of several days, and is based mainly on the evaluation of serum creatinine (sCr) and decrease in urine output as supported by Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE) criteria, Acute Kidney Injury Network (AKIN) criteria, and the recent Kidney Disease: Improving Global Outcomes (KDIGO) practice guidelines for AKI. Such a need for repeated sCr evaluations and monitoring of urinary output for too long time after admission could therefore result in a diagnostic delay. With delays in diagnosis, clinicians miss opportunities to start appropriate treatment to minimize damage, and patients incur more severe AKI with subsequent greater risk of developing progression of renal damage leading to chronic kidney disease (CKD), dialysis and increased risk of severe cardiovascular diseases and death.

As a consequence, the use of biomarkers of acute kidney damage could be of great utility in order to distinguish AKI from volume responsive renal dysfunction, CKD or normal renal function. Furthermore, these biomarkers could contribute to the diagnosis of AKI by identifying a subgroup with “subclinical AKI” where there may be an injury even in the absence of sCr increase, thus leading to an earlier risk stratification of patients with prompt and specific treatment strategies. An earlier detection of acute renal damage promptly mirrored through AKI biomarkers could lead to an appropriate treatment with the aim to stop the progression of ongoing irreversible renal damage.

An ideal biomarker for AKI should distinguish prerenal AKI from apoptotic & necrotic tubular cell damage; be specific for kidney tissue lesion; be upregulated shortly after an injury in the organ tissue; predict outcome; act as surrogate end point useful for clinical interventional approaches; and be independent of glomerular filtration rate level. Among the emerging novel biomarkers of AKI, neutrophil gelatinase-associated lipocalin (NGAL) has got growing attention as the most reliable and promising AKI marker, and its clinical usefulness has been investigated in a variety of clinical settings and different acute diseases.

This specialized book is focused on lipocalin including NGAL and covers the broad aspects of this biomarker from laboratory to clinical utility. This book consists of three parts: basic information on lipocalin; laboratory consideration on NGAL; and clinical utility of NGAL. This book is unique in that it is the first comprehensive book, which provides summarized and up-to-date knowledge on NGAL and its related topics to the researchers and clinicians who are interested in this biomarker.

In particular, this book was conceived reflecting the spirit of GREAT network, an Academic Research Organization, operating as an International Network between experts in the management of acute diseases. Written and reviewed by the experts in each related filed, this book would be a valuable and practical reading for the researchers and clinicians involved in laboratory medicine, emergency medicine, cardiology, nephrology, internal medicine, geriatric and intensive care, etc. (Imprint: Nova Biomedical )

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Table of Contents

Table of Contents

Preface

Chapter 1 – Lipocalin: Sequence and Structure Relationships (pp. 1-10)
Patrizia Cardelli (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 2 – Common Molecular-Recognition Properties (pp. 11-18)
Patrizia Cardelli (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 3 – Biochemistry and Pathophysiology of NGAL (pp. 19-30)
Patrizia Cardelli (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 4 – Function of Lipocalin (pp. 31-40)
Patrizia Cardelli (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 5 – Lipocalin: Cell Regulation, Cancer Cell Interaction (pp. 41-48)
Patrizia Cardelli (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 6 – Urinary versus Plasma NGAL (pp. 49-54)
Giorgio Zampini, Benedetta De Berardinis and Salvatore Di Somma (Department of Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant’Andrea Hospital, Italy)

Chapter 7 – History of NGAL Assays (pp. 55-60)
Patrizia Cardelli and Laura Magrini (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 8 – Diagnostic Performances of NGAL Assays (pp. 61-66)
Patrizia Cardelli and Laura Magrini (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 9 – Stability and Half-Life: In Vitro, Preanalytical Factors (pp. 67-72)
Patrizia Cardelli (Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, Sapienza University, School of Medicine, Rome, Italy)

Chapter 10 – Reference Ranges and Cut-Off Values for the NGAL Assay (pp. 73-86)
Yeo-Min Yun (Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea)

Chapter 11 – NGAL vs. Creatinine (pp. 87-100)
Hee-Won Moon and Mina Hur (Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea)

Chapter 12 – Comparison of NGAL with other New Biomarkers for Kidney Disease (pp. 101-112)
Francesco Vetrone, Benedetta De Berardinis and Salvatore Di Somma (Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University, and Emergency Medicine, Sant’Andrea Hospital, Rome, Italy)

Chapter 13 – NGAL: A Marker for Acute Kidney Injury (pp. 113-118)
W. Frank Peacock, M.D., FACEP (Emergency Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA)

Chapter 14 – NGAL in Acute Heart Failure Patients (pp. 119-132)
Fatima Iqbal, Hermineh Aramin, Minal V. Patel,Matt Kawahara, Sumita Sharma and Alan S. Maisel (Veterans Affairs San Diego Healthcare System, San Diego, and Department of Medicine, University of California at San Diego, La Jolla, California, USA)

Chapter 15 – NGAL in Septic Patients (pp. 133-138)
Laura Magrini, Benedetta De Berardinis, Mina Hur and Salvatore Di Somma (Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Emergency Department Emergency Medicine Sant’Andrea Hospital, Rome, Italy and others)

Chapter 16 – NGAL in Contrast-Induced Nephropathy (pp. 139-150)
Benedetta De Berardinis, Laura Magrini and Salvatore Di Somma (Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza, and Emergency Department, Emergency Medicine, Sant’Andrea Hospital, Rome, Italy)

Chapter 17 – NGAL in Hypovolemic Patients (pp. 151-160)
Francesca Orsini, Laura Magrini, Alan Maisel and Salvatore Di Somma (Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza, and Emergency Department, Emergency Medicine, Sant’Andrea Hospital, Rome, Italy and others)

Chapter 18 – NGAL in Children and Newborns (pp. 161-168)
Laura Magrini, Benedetta De Berardinis and Salvatore Di Somma (Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza, and Emergency Department, Emergency Medicine, Sant’Andrea Hospital, Rome, Italy)

Chapter 19 – NGAL as Marker for Prognosis of Acute Kidney Injury (pp. 169-182)
Michael Haase and Anja Haase-Fielitz (Department of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Germany)

Chapter 20 – Multi-Markers Approach Including NGAL and other Biomarkers (pp. 183-190)
Salvatore Di Somma, Laura Magrini, Benedetta De Berardinis and Mina Hur (Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza, and Emergency Department, Emergency Medicine, Sant’Andrea Hospital, Rome, Italy)

Index

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