Role of urinary NGAL and microalbuminuria in the detection of subclinical acute kidney injury in pediatric intensive care unit and diabetic children

Submitted: 24 March 2022
Accepted: 20 June 2022
Published: 15 July 2022
Abstract Views: 1487
PDF: 495
HTML: 21
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Subclinical Acute Kidney Injury (AKI) describes patients who did not fulfill the classical criteria for AKI diagnosis but showed elevated levels of new biomarkers reflecting tubular injury. One of these biomarkers is Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study is to investigate the role of urinary NGAL and microalbuminuria as non-invasive biomarkers in the detection of subclinical AKI. Analysis of urinary NGAL and microalbuminuria in 91 subjects [30 pediatric intensive care unit (PICU) patients, 31 diabetic patients and 30 healthy controls] recruited from Cairo University Pediatric Hospital was done. Our study revealed that urinary NGAL was significantly higher in the PICU group followed by the diabetic group and lowest in the controls group (p=0.022). A positive correlation was found between urinary NGAL and microalbuminuria in the PICU group (Rvalue= 0.585, p-value=0.001). In diabetic group, a positive correlation was found between urinary NGAL and fasting blood glucose, 2 hours post prandial and HbA1C (R-value=0.421; pvalue= 0.021; R-value=0.426; p-value=0.019; R-value=0.438; pvalue= 0.018 respectively). Urinary NGAL may be a potential biomarker to detect subclinical AKI before actual functional renal damage leading to early intervention and reduction of mortality.

Shoaib M, Mahmud SN, Safdar M. Early diagnosis of acute kidney injury by urinary neutrophil gelatinase-associated lipocalin in adult critically ill patients. J Ayub Med Coll Abbottabad 2019;31:12-5.

Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–R212.

Vanmassenhove J, Van Biesen W, Vanholder R, Lameire N. Subclinical AKI: ready for primetime in clinical practice? J Nephrol 2019;32:9-16. DOI:

Haase M, Kellum J, Ronco C. Subclinical AKI—an emerging syndrome with important consequences. Nat Rev Nephrol 2012;8:735–9. DOI:

Roy JP, Devarajan P. Acute kidney injury: Diagnosis and management. Indian J Pediatr 2020;87:600-7. DOI:

Zhou H, Cui J, Lu Y, et al. Meta-analysis of the diagnostic value of serum, plasma and urine neutrophil gelatinase-associated lipocalin for the detection of acute kidney injury in patients with sepsis. Experiment Therapeutic Med 2021;21:386. DOI:

Nielsen SE, Schjoedt KJ, Astrup AS, et al. Neutrophil gelatinase-associated lipocalin (ngal) and kidney injury molecule 1 (kim1) in patients with diabetic nephropathy: A cross-sectional study and the effects of lisinopril. Diabet Med 2010;27:1144-50. DOI:

Basu S, Bhattacharya M, Chatterjee TK, et al. Microalbuminuria: A novel biomarker of sepsis. Indian J Crit Care Med 2010;14:22-8. DOI:

Chin'ombe N, Msengezi O, Matarira H. Microalbuminuria in patients with chronic kidney disease at Parirenyatwa Hospital in Zimbabwe. Pan Afr Med J 2013;14:39. DOI:

World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013;310:2191-4. DOI:

Devarajan P. NGAL for the detection of acute kidney injury in the emergency room. Biomark Med 2014;8:217-9. DOI:

Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr 2011;23:194-200. DOI:

Nickolas TL, Schmidt-Ott KM, Canetta P, et al. Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study. J Am Coll Cardiol 2012;59:246-55. DOI:

Di Somma S, Magrini L, De Berardinis B, et al. Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department. Crit Care 2013;17:R29. DOI:

Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231-8. DOI:

Yuruk Yildirim Z, Nayir A, Yilmaz A, et al. Neutrophil gelatinase-associated lipocalin as an early sign of diabetic kidney injury in children. J Clin Res Pediatr Endocrinol 2015;7:274-9. DOI:

Albert C, Albert A, Kube J, et al. Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg 2018;155:2441-52.e13. DOI:

Youssef DM, Esh AM, Helmy Hassan E, Ahmed TM. Serum NGAL in critically ill children in ICU from a single center in Egypt. ISRN Nephrol 2013;2013:140905. DOI:

Bailey D, Phan V, Litalien C, et al. Risk factors of acute renal failure in critically ill children: A prospective descriptive epidemiological study. Pediatr Crit Care Med 2007;8:29-35. DOI:

Kari JA , Shalaby MA , Sofyani K, et al. Urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C measurements for early diagnosis of acute kidney injury in children admitted to PICU. World J Pediat 2018;14:134-42. DOI:

Zwiers AJ, de Wildt SN, van Rosmalen J, et al. Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: A prospective cohort study. Crit Care 2015;19:181. DOI:

Matsuura R, Srisawat N, Claure-Del Granado R, et al. Use of the renal angina index in determining acute kidney injury. Kidney Int Rep 2018;3:677-83. DOI:

Bharath G, Kumar P, Mahendra SV. Microalbuminuria can predict the development of acute kidney injury in intensive care unit admission. Int J Adv Med 2020;7:1372-5. DOI:

Papadopoulou-Marketou N, Margeli A, Papassotiriou I, et al. NGAL as an early predictive marker of diabetic nephropathy in children and young adults with type 1 diabetes mellitus. J Diabetes Res 2017;2017:7526919. DOI:

Karar T, Alniwaider RA, Fattah MA, et al. Assessment of microalbuminuria and albumin creatinine ratio in patients with type 2 diabetes mellitus. J Nat Sci Biol Med 2015;6:S89-92. DOI:

Kahdem AA, Dyab Allawi AA, Nada SZ, Turki KM. Neutrophil gelatinase-associated lipocalin (NGAL) in early detection of nephropathy in type 2 diabetic Iraqi patients. J Fac Med Bagdad 2017;59:74-8. DOI:

Nehus E, Kaddourah A, Bennett M, et al. Subclinical kidney injury in children receiving nonsteroidal anti-inflammatory drugs after cardiac surgery. J Pediatr 2017;189:175-80. DOI:

McWilliam SJ, Antoine DJ, Jorgensen AL, et al. Urinary biomarkers of aminoglycoside-induced nephrotoxicity in cystic fibrosis: Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin. Sci Rep 2018;8:5094. DOI:

Kane-Gill SL, Smithburger PL, Kashani K, et al. Clinical relevance and predictive value of damage biomarkers of drug-induced kidney injury. Drug Saf 2017;40:1049-74. DOI:

Parikh A, Rizzo JA, Canetta P, et al. Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (SCR) for acute kidney injury (AKI) diagnosis. PLoS One 2017;12:e0178091. DOI:

Ishak, S. K. I., Aguizy, F. E., Elsebaie, E. H., Youssef, M. R. L., Ismail, M. M., Abdelraouf, F. H., Ghaffar, H. A. A., & Riad, N. M. (2022). Role of urinary NGAL and microalbuminuria in the detection of subclinical acute kidney injury in pediatric intensive care unit and diabetic children. La Pediatria Medica E Chirurgica, 44(2).


Download data is not yet available.