Ann Lab Med 2018; 38(6): 524-529  https://doi.org/10.3343/alm.2018.38.6.524
Plasma Neutrophil Gelatinase-Associated Lipocalin as a Marker of Tubular Damage in Diabetic Nephropathy
So Young Kim, M.D.1, Tae-Dong Jeong, M.D.2, Woochang Lee, M.D.3, Sail Chun, M.D.3, Sung Sunwoo, M.D.4, Soon Bae Kim, M.D.5, and Won-Ki Min, M.D.3
1Department of Laboratory Medicine, LabGenomics Clinical Laboratory, Seongnam, Korea; 2Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea; Departments of 3Laboratory Medicine, 4Family Medicine, and 5Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
Corresponding author: Sail Chun, M.D.
https://orcid.org/0000-0002-5792-973X
Department of Laboratory Medicine, Asan Medical Center and University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-4513
Fax: +82-2-478-0884
E-mail: sailchun@amc.seoul.kr
Received: July 28, 2017; Revised: January 4, 2018; Accepted: May 25, 2018; Published online: November 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

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Abstract
Background: An increase in neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular injury. Diabetic nephropathy causes typical changes in the kidney, characterized by glomerulosclerosis and eventual tubular damage. We validated the usefulness of plasma NGAL (pNGAL) as a biomarker of tubular damage in patients with diabetic nephropathy.
Methods: We included 376 patients with diabetes mellitus (260 patients with chronic renal insufficiency who had not received hemodialysis and 116 hemodialyzed due to diabetic nephropathy) and 24 healthy controls. Patients with chronic renal insufficiency were divided into three groups according to urinary albumin excretion (UAE) levels. pNGAL levels were measured using the Triage NGAL test (Alere, San Diego, CA, USA) and were compared between groups. We also examined whether pNGAL level was related to the degree of albuminuria and cystatin C-based glomerular filtration rate (GFR).
Results: Mean pNGAL levels of the healthy controls, chronic renal insufficiency patients with diabetes mellitus, and hemodialyzed patients were 61.9±5.3 ng/mL, 93.4±71.8 ng/mL, and 1,536.9±554.9 ng/mL, respectively. pNGAL level increased significantly in patients with severe albuminuria (P <0.001) and had a moderate correlation with the degree of albuminuria (r=0.467; P <0.001) and GFR (r=0.519; P <0.001). Multivariate regression analysis showed that the pNGAL level was associated with tubular damage independent of patient age, sex, and GFR.
Conclusions: pNGAL level independently reflects the degree of tubular damage in patients with diabetic nephropathy. Measurement of pNGAL, combined with UAE, would enable simultaneous, highly reliable assessments of tubular damage for such patients.
Keywords: Neutrophil gelatinase-associated lipocalin, Diabetic nephropathy, Hemodialysis, Tubular damage



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