Background: Contrast-induced acute kidney injury (CI-AKI) particularly in high risk patients with chronic kidney\r\ndisease (CKD), increases morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein\r\nexcreted by the kidney during AKI. There are no urine (u) NGAL data as an early CI-AKI marker in CKD patients\r\nundergoing coronary procedures.\r\nMethods: This prospective study enrolled 130 patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/\r\n1.73 m2 undergoing elective coronary procedures. Serial urine samples, obtained at baseline and 3, 6, 12, 18, and 24 h\r\npost contrast administration were analyzed by NGAL ELISA kit. AKI was defined as an increase in serum creatinine (SCr)\r\nof = 0.3 mg/dl or = 1.5 times baseline SCr within 48 h per 2012 KDIGO guidelines. Receiver operator characteristic curve\r\nanalyses identified optimal uNGAL and delta of uNGAL values for diagnosing CI-AKI.\r\nResults: The uNGAL was significantly and inverse correlated with eGFR (R =0.25, P < 0.005). CI-AKI developed in 16/130\r\n(12.31%) patients: 13 and 3 in CI-AKI stages I and II, respectively. uNGAL and delta of uNGAL were significantly higher\r\nin the CI-AKI group when compared with the No CI-AKI group (P < 0.05). The best uNGAL cut-off for optimal\r\nsensitivity 94%, specificity 78%, and area under the curve 0.84 for predicting CI-AKI was 117 ng/mL at 6 h, respectively.\r\nCorresponding values for predicting CI-AKI stage II were 100%, 87% and 0.9 when using an uNGAL of 264 ng/mL\r\nat 6 h.\r\nConclusions: Monitoring of uNGAL levels not only provide the early detecting CI-AKI but also predict the severity of\r\nCI-AKI in CKD patients undergoing elective coronary procedures
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