Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH 44195, USA.
Eur J Heart Fail. 2012 Jun;14(6):597-604. doi: 10.1093/eurjhf/hfs039. Epub 2012 Apr 14.
Acute kidney injury (AKI) is a strong predictor of adverse events with an incompletely understood pathophysiology. Neutrophil gelatinase-associated lipocalin (NGAL) is proposed as an early marker of renal tubular injury. Our aim is to determine whether AKI during treatment of acute decompensated heart failure (ADHF) is accompanied by renal tubular injury.
Urinary NGAL (uNGAL) and urinary creatinine (uCreat) levels were measured in 141 consecutive patients hospitalized for ADHF and followed for 180 days for death or re-hospitalization. AKI was defined as a rise in serum creatinine ≥0.3 mg/dl in a 48 h period. Median uNGAL/uCreat levels on Day 1 (baseline) were similar between patients who did and did not develop AKI [22.8 (12.5-106.8) μg/g vs. 20.6 (12.4-52.0) μg/g, P = 0.55]. On Day 2 and beyond, the difference between the AKI and no AKI cohorts increased, but was only significant on Day 3 [36.2 (21.7-131.8) μg/g vs. 29.4 (11.4-54.6) μg/g, P = 0.02]. The area under the receiver operating characteristic curve for Day 2 uNGAL/uCreat (≥ or <32 µg/g) to predict AKI was 0.61. There was no difference in diuretic response between 'uNGAL/uCreat + ' (≥ 27 µg/g) and 'uNGAL/uCreat-' (<27 µg/g) patients. However 'uNGAL/uCreat + ' patients had more adverse events after 180 days (66% vs. 52%, P = 0.02).
In patients with ADHF who develop AKI following diuretic therapy, a minor rise in uNGAL precedes AKI. However, the degree of renal tubular insult was much lower than that observed in other forms of AKI.
急性肾损伤（AKI）是不良事件的强预测因子，其病理生理学尚不完全清楚。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）被提议作为肾小管损伤的早期标志物。我们的目的是确定在治疗急性失代偿性心力衰竭（ADHF）期间发生的 AKI 是否伴有肾小管损伤。
连续测量了 141 例因 ADHF 住院并随访 180 天以观察死亡或再入院的患者的尿 NGAL（uNGAL）和尿肌酐（uCreat）水平。AKI 的定义为在 48 小时内血清肌酐升高≥0.3mg/dl。发生 AKI 和未发生 AKI 的患者在第 1 天（基线）的 uNGAL/uCreat 中位数相似[22.8（12.5-106.8）μg/g 与 20.6（12.4-52.0）μg/g，P=0.55]。在第 2 天及以后，AKI 和非 AKI 两组之间的差异增加，但仅在第 3 天具有统计学意义[36.2（21.7-131.8）μg/g 与 29.4（11.4-54.6）μg/g，P=0.02]。第 2 天 uNGAL/uCreat（≥或<32μg/g）预测 AKI 的受试者工作特征曲线下面积为 0.61。“uNGAL/uCreat + ”（≥27μg/g）和“uNGAL/uCreat-”（<27μg/g）患者的利尿剂反应没有差异。然而，“uNGAL/uCreat + ”患者在 180 天后的不良事件更多（66%比 52%，P=0.02）。
在 ADHF 患者中，利尿剂治疗后发生 AKI 时，uNGAL 略有升高先于 AKI。然而，肾小管损伤的程度远低于其他形式的 AKI。
