Urinary neutrophil-gelatinase associated lipocalin is a more prognostic biomarker to distinguish antenatal hydronephrosis in neonates

Background: Routine diagnostic methods of Vesicoureteral reflux (VUR) are invasive and can cause exposure to radiation and may increase risk of urinary tract infections. Therefore, introducing reliable, non invasive methods might be more interested in pediatric nephrology. The objective of this perspective case control study was to evaluate the prognostic value of urinary neutrophil-gelatinase associated lipocalin (uNGAL) on antenatal hydronephrosis (AH) with and without VUR. Materials and Methods: A total of ۵۰ patients diagnosed with AH ۷۸% males with mean age ۵.۷۱± ۲.۱ years, including ۲۷ AH with VUR and ۲۳ AH without VUR, and ۱۹ normal healthy children ۷۸.۹% males with mean age ۵.۶۳ ± ۱.۸۹ years, were enrolled in this study. Urinary NGAL levels were measured by enzyme linked immunosorbent assay (ELISA). Results: There was a significant difference in uNGAL concentration between AH patients and controls (۰.۸۰ ± ۰.۲۶ and ۰.۲۹ ± ۰.۲۷ ng/ml, p<۰.۰۰۰۱). However, the levels of uNGAL was not significantly deviated between AH patients with VUR compared to those without VUR (۰.۸۴ ± ۰.۳۴ vs. ۰.۷۵ ± ۰.۱۳, p=۰.۴۱۹). Standardization of NGAL based on urinary creatinine (uNGAL/uCr) showed a significantly difference between AH neonates with VUR compared to those without VUR (۲.۴۳±۱.۶۱ vs. ۱.۹۱±۰.۷۹, p<۰.۰۰۰۱). Receiver operator characteristic (ROC) analysis revealed higher prognostic power of uNGAL for identifying AH with a sensitivity ۹۵.۷%, and specificity ۸۴.۲%. Meanwhile, the levels of uNGAL or NGAL/uCr ratio did not correlate with reflux grade or laterality. Conclusion: The urinary level of NGAL and NGAL/uCr ratio might be a surrogate non invasive, reliable tool to distinguish hydronephrosis.

Keywords:

NGAL , Antenatal hyronephrosis , Vesicoureteral reflux , Neonate , Creatinine , Urine