Ann Lab Med 2018; 38(5): 425-430  
Plasma Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Renal Parenchymal Involvement in Infants With Febrile Urinary Tract Infection: A Preliminary Study
Bo Ae Yun, M.D., Eun Mi Yang, M.D., and Chan Jong Kim, M.D.
Department of Pediatrics, Chonnam National University Hospital and Medical School, Gwangju, Korea
Corresponding author: Eun Mi Yang
https://orcid.org/0000-0001-9410-5855
Department of Pediatrics, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
Tel: +82-62-220-6647
Fax: +82-62-222-6103
E-mail: emyang@chonnam.ac.kr
Co-corresponding author: Chan Jong Kim
https://orcid.org/0000-0001-6519-2427
Department of Pediatrics, Chonnam National University Hospital and Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
Tel: +82-62-220-6647
Fax: +82-62-222-6103
E-mail: cjkim@chonnam.ac.kr
Received: November 15, 2017; Revised: January 26, 2018; Accepted: May 4, 2018; Published online: September 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Urinary tract infection (UTI) is the most common bacterial infection in infants. Renal parenchymal involvement is an important prognostic factor; however, early detection of parenchymal involvement in UTI may be difficult during infancy. This study aimed to assess whether a recently established biomarker of UTI, neutrophil gelatinase-associated lipocalin (NGAL), can serve as a useful marker for the detection of cortical defects (CD) and to determine the appropriate diagnostic cut-off value of NGAL in infants with febrile UTI.
Methods: Infants hospitalized for febrile UTI were divided into two groups according to the presence of cortical defects on dimercaptosuccinic acid (DMSA) scintigraphy. Among 64 enrolled infants, 43 (67%) had CD (UTI-CD) and 21 (33%) had no CD (UTI-ND). The white blood cell count, C-reactive protein, and plasma NGAL (pNGAL) levels were determined before antibiotic therapy and compared between the two groups.
Results: pNGAL level was significantly higher in the UTI-CD group than in the UTI-ND group (340 μg/L vs 214 μg/L, P=0.002). Multivariate analysis showed that pNGAL level was the only independent predictor of CD (odds ratio 2.759, P=0.039). In the ROC curve analysis, pNGAL showed the highest area under the curve (0.745; 95% confidence interval, 0.561-0.821; P=0.014). The appropriate cut-off value of pNGAL was 267 μg/L (sensitivity, 72.1%; specificity, 71.4%).
Conclusions: pNGAL was found to be a useful marker for early prediction of renal parenchymal involvement in infants with febrile UTI.
Keywords: Neutrophil gelatinase-associated lipocalin, Urinary tract infection, Cortical defect, Infant



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