Spotting Early Signs of Kidney Injury or Failure

A novel marker that measures kidney injury earlier than current standard forms of monitoring function could help prevent more serious damage to the kidneys.

Researchers at the University of Florida College of Medicine (Gainesville, FL, USA) are evaluating neutrophil-gelatinase-associated-lipocalin (NGAL), a member of the lipocalin family, which provides evidence of subtle injury to the kidneys before creatinine levels rise. Creatinine builds up in the blood when kidney functions declines, but typically do not increases until a day or two after surgery; NGAL levels, however, rise within a few hours of surgery, hinting that there is going to be kidney injury or that the patient already has early signs of kidney injury. But while there is a commercially available testing kit for NGAL, its use as a predictor of kidney injury has not been validated so far. Findings from the initial research studies were reported at the annual clinical congress of the American College of Surgeons (ACS), held during October 2008 in San Francisco (CA, USA).

"I think maybe five years from now, we'll get an NGAL test on patients who have undergone heart surgery, and assuming we have a point-of-care test that gets immediate results as well as an effective treatment to improve kidney function, then we will be able to treat them with whatever agent we have at the time,” said lead author and study presenter Thomas M. Beaver, M.D., M.P.H, an associate professor and director of minimally invasive cardiac, thoracic, and cardiovascular surgery department.

Lipocalins are typically small, secreted proteins that are characterized by several features, the most prominent being their ability to bind small, hydrophobic molecules such as retinol. Others include their binding to specific cell-surface receptors and their ability to form macromolecular complexes. Lipocalins have been associated with many biological processes, among them immune response, pheromone transport, biological prostaglandin synthesis, retinoid binding, and cancer cell interactions.

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