Prevalence of acute kidney injury using urine neutrophil gelatinase associated lipocalin as an early biomarker in neonates with perinatal asphyxia
Date of Award
Master of Medicine (MMed)
Paediatrics and Child Health (East Africa)
Introduction: Perinatal asphyxia is a major cause of neonatal morbidity and mortality. Acute kidney injury (AKI) is a common complication of perinatal asphyxia occurring in up to 61% of the neonates. Currently the diagnosis of AKI is based on serum creatinine levels and clinically by oliguria, however these are late markers of the disease. More novel biomarkers are emerging that predict the diagnosis early. Current research indicates urine NGAL as an early marker for AKI, yet there is paucity of data about its use in term neonates with perinatal asphyxia.
Objectives: This study aimed to investigate the prevalence of acute kidney injury using urine NGAL and to compare it to the current gold standard, serum creatinine as an early biomarker for AKI. It also determined the association between the level of urine NGAL to the severity of asphyxia, hypoxic ischemic encephalopathy and mortality.
Methodology: This was a prospective cross-sectional study carried out in term neonates with perinatal asphyxia in Kenyatta National Hospital and Pumwani Maternity Hospital. One hundred and eight term neonates with a diagnosis of perinatal asphyxia were enrolled in the study. Serum creatinine and urine NGAL levels were measured on day 1 and 3 of life.
Results: The prevalence of AKI using urine NGAL in term asphyxiated neonates on day one of life was 56% (95% CI 46.6-65.1%) with a male to female ratio of 1.4 :1. At a cut off of 250ng/ml, urine NGAL had an acceptable discriminative capability of predicting AKI (Area under the curve – 0.724). The sensitivity, specificity, positive and negative predictive value and likelihood ratios were 88%, 56%, 30%, 95%, 2 and 0.2. The diagnostic odds ratio was at 8.9. Significantly higher median NGAL levels were associated with severe hypoxic encephalopathy death. Urine NGAL levels were significantly higher in patients with AKI compared to those without AKI.
Conclusion: the overall prevalence of AKI in neonates with perinatal asphyxia was noted to be similar to other studies. Urine NGAL is a good screening test for the early diagnosis of AKI. It is also a significant predictor of mortality and severity of HIE in asphyxiated neonates.
Essajee, F. (2013). Prevalence of acute kidney injury using urine neutrophil gelatinase associated lipocalin as an early biomarker in neonates with perinatal asphyxia (Unpublished master's dissertation). Aga Khan University, East Africa.