Neutrophil Gelatinase Associated Lipocalin: An Emerging Biomarker for Acute Kidney Injury in Cardiovascular Disease

Abstract

Acute kidney injury (AKI) commonly occurs in hospitalised patients resulting in short and long-term morbidity and mortality. A subset of patients especially those with cardiovascular diseases appear particularly vulnerable. The diagnosis of AKI currently depends on changes in serum creatinine and is usually made at least 24 to 48 hours after the initial renal insult. This hinders formulation of possible early therapeutic strategies which could otherwise reduce the clinical sequelae of AKI. Neutrophil gelatinase-associated lipocalin (NGAL) is released in both serum and urine, and has shown great promise in identifying AKI as early as two to four hours after renal injury. NGAL has been demonstrated to be both specific and sensitive in a variety of renal conditions associated with AKI, compared to serum creatinine. This article discusses the emerging role of NGAL in the diagnostic and prognostic evaluation of AKI secondary to cardiovascular diseases and interventions including its benefits and pitfalls. NGAL has been shown to be useful in the diagnosis of AKI particularly for contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) and renal dysfunction complicating acute and chronic heart failure. Larger prospective outcome studies with therapeutic interventions are warranted to further validate the role of NGAL in the diagnosis of AKI and in cardiorenal syndrome.