Factors limiting usefulness of serum and urinary NGAL as a marker of acute kidney injury in preterm newborns

Ren Fail. 2015 Apr;37(3):439-45. doi: 10.3109/0886022X.2014.996109. Epub 2015 Jan 19.


Background: Neutrophil gelatinase-associated lipocalin (NGAL) is postulated to be a highly sensitive and specific marker of acute kidney injury (AKI). The aim of this study was to assess the factors affecting serum and urine total NGAL in preterm newborns, limiting the role of this new potential marker of AKI.

Methods: Serum and urinary total NGAL concentrations were determined in 57 preterm infants admitted to the Neonatal Intensive Care Unit in the following points of time: first week of life, between 8 and 14 days of life, and after the fourth week of life. Patients' clinical conditions were evaluated based on NTISS (Neonatal Therapeutic Intervention Scoring System). Two gestational age subgroups were distinguished: ≤29 and 30 to 35 weeks of gestation. We sought correlation between total NGAL values and gestational age, birth weight, Apgar score and severity of clinical condition, with particular interest in inflammatory status.

Results: Serum and urinary total NGAL concentration correlated with inflammatory markers, such as CRP and procalcitonin, as well as with NTISS values. Birth weight and gestational age influence urinary NGAL (uNGAL) values in the first two weeks of life. In AKI (N = 8) patients uNGAL values were significantly higher than in non-AKI newborns.

Conclusions: We conclude that inflammatory status and prematurity limits the specificity of total NGAL measurement as a marker of AKI.

Keywords: Acute kidney injury; NGAL; creatinine; kidney function; perinatal asphyxia; preterm newborns; sepsis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury* / blood
  • Acute Kidney Injury* / diagnosis
  • Acute Kidney Injury* / physiopathology
  • Acute-Phase Proteins* / urine
  • Apgar Score
  • Biomarkers / blood
  • Biomarkers / urine
  • Creatinine / blood
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature / blood
  • Kidney Function Tests / methods
  • Lipocalin-2
  • Lipocalins* / blood
  • Lipocalins* / urine
  • Male
  • Proto-Oncogene Proteins* / blood
  • Proto-Oncogene Proteins* / urine
  • Regression Analysis
  • Reproducibility of Results
  • Severity of Illness Index


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