Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease

Clin J Am Soc Nephrol. 2009 Feb;4(2):337-44. doi: 10.2215/CJN.03530708. Epub 2009 Jan 28.


Background and objectives: Chronic kidney disease (CKD) has recently assumed epidemic proportion, becoming a troubling emerging cause of morbidity, especially if it progresses to terminal stage (ESRD). The authors aimed to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL), a novel specific biomarker of acute kidney injury, could predict the progression of CKD.

Design, setting, participants, & measurements: Serum and urinary NGAL levels, together with a series of putative progression factors, were evaluated in a cohort of 96 patients (mean age: 57 +/- 16 years) affected by nonterminal CKD (eGFR > or =15 ml/min/1.73 m(2)) of various etiology. Progression of CKD, assessed as doubling of baseline serum creatinine and/or onset of ESRD, was evaluated during follow-up.

Results: At baseline, both serum and urinary NGAL were inversely, independently, and closely related to eGFR. After a median follow-up of 18.5 mo (range 1.01 to 20), 31 patients (32%) reached the composite endpoint. At baseline, these patients were significantly older and showed increased serum creatinine, calcium-phosphate product, C-reactive protein, fibrinogen, daily proteinuria, and NGAL levels, whereas eGFR values were significantly lower. Univariate followed by multivariate Cox proportional hazard regression analysis showed that urinary NGAL and sNGAL predicted CKD progression independently of other potential confounders, including eGFR and age.

Conclusion: In patients with CKD, NGAL closely reflects the entity of renal impairment and represents a strong and independent risk marker for progression of CKD.

MeSH terms

  • Acute-Phase Proteins / urine*
  • Adult
  • Aged
  • Biomarkers / blood
  • Biomarkers / urine
  • Chronic Disease
  • Creatinine / blood
  • Disease Progression
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Diseases / complications
  • Kidney Diseases / metabolism*
  • Kidney Diseases / physiopathology
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / etiology*
  • Kidney Failure, Chronic / physiopathology
  • Lipocalin-2
  • Lipocalins / blood*
  • Lipocalins / urine*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Proto-Oncogene Proteins / blood*
  • Proto-Oncogene Proteins / urine*
  • ROC Curve
  • Risk Assessment
  • Risk Factors


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