Pathological and prognostic value of urinary neutrophil gelatinase-associated lipocalin in macroproteinuric patients with worsening renal function

Kidney Blood Press Res. 2008;31(4):274-9. doi: 10.1159/000151665. Epub 2008 Aug 28.


Background/aims: Persistent proteinuria is a sign of renal damage caused by several factors, but it is itself a cause of tubular injury leading to chronic renal failure. Neutrophil gelatinase-associated lipocalin (NGAL) is a stress protein released by tubular cells which urinary excretion (uNGAL) increases in response to various stimuli.

Methods: In the present study we analyzed uNGAL levels in 23 macroproteinuric patients with membranous glomerulonephritis.

Results: In these subjects, uNGAL concentrations were significantly higher than in controls, directly correlated with proteinuria and inversely related to residual renal function. Patients were further categorized into two groups, according to a cut-off baseline uNGAL value of 350 ng/ml and evaluated during a 1-year follow-up period. After 12 months, subjects with higher uNGAL levels showed a significant worsening in baseline renal function and a 3.36 risk ratio of developing a severe decrease in GFR (>or=50% of baseline values) compared with others.

Conclusions: These findings suggest that NGAL may play a key role in tubular adaptations to persistent macroproteinuria. Furthermore, a new, interesting application of NGAL measurement could be proposed in clinical nephrology as a predictor of worsening renal function in patients affected by chronic kidney disease.

MeSH terms

  • Acute-Phase Proteins / urine*
  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Glomerulonephritis, Membranous / urine
  • Humans
  • Kidney Diseases / diagnosis*
  • Kidney Diseases / urine
  • Kidney Function Tests
  • Kidney Tubules / pathology
  • Lipocalin-2
  • Lipocalins / urine*
  • Male
  • Middle Aged
  • Predictive Value of Tests*
  • Prognosis
  • Proteinuria / urine
  • Proto-Oncogene Proteins / urine*


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