Kidney NGAL is a novel early marker of acute injury following transplantation

Pediatr Nephrol. 2006 Jun;21(6):856-63. doi: 10.1007/s00467-006-0055-0. Epub 2006 Apr 14.


Acute kidney injury secondary to ischemia-reperfusion in renal allografts often results in delayed graft function. We tested the hypothesis that expression of neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of acute kidney injury following transplantation. Sections from paraffin-embedded protocol biopsy specimens obtained at approximately one hour of reperfusion after transplantation of 13 cadaveric (CAD) and 12 living-related (LRD) renal allografts were examined by immunohistochemistry for expression of NGAL. The staining intensity was correlated with cold ischemia time, peak post-operative serum creatinine, and dialysis requirement. There were no differences between the LRD and CAD groups in age, gender or preoperative serum creatinine. Using a scoring system of 0 (no staining) to 3 (most intense staining), NGAL expression was significantly increased in CAD specimens (2.3+/-0.8 versus 0.8+/-0.7 in LRD, p<0.001). There was a strong correlation between NGAL staining intensity and cold ischemia time (R=0.87, p<0.001). Importantly, NGAL staining in these early CAD biopsies was strongly correlated with peak postoperative serum creatinine, which occurred days later (R=0.86, p<0.001). Four patients developed delayed graft function requiring dialysis during the first week posttransplantation; all of these patients displayed the most intense NGAL staining in their first protocol biopsies. We conclude that NGAL staining intensity in early protocol biopsies represents a novel predictive biomarker of acute kidney injury following transplantation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / pathology
  • Acute-Phase Proteins / analysis*
  • Adolescent
  • Adult
  • Biomarkers / analysis
  • Cadaver
  • Child
  • Delayed Graft Function / diagnosis*
  • Delayed Graft Function / pathology
  • Female
  • Humans
  • Kidney / chemistry*
  • Kidney / pathology
  • Kidney Transplantation*
  • Lipocalin-2
  • Lipocalins
  • Living Donors
  • Male
  • Prognosis
  • Proto-Oncogene Proteins / analysis*
  • Reperfusion Injury / diagnosis*
  • Reperfusion Injury / pathology
  • Tissue Donors


  • Acute-Phase Proteins
  • Biomarkers
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Proto-Oncogene Proteins