Kumar Rakesh, Shekhar Ravi, Gupta Anand K, Kumar Amit, Prasad Nidhi, Kumar Santosh, Sinha Seema R, Prakash Jayant
Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Diabetes and Endocrinology, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Cureus. 2023 Feb 1;15(2):e34503. doi: 10.7759/cureus.34503. eCollection 2023 Feb.
Urinary Neutrophil Gelatinase Associated Lipocalin (uNGAL) has been demonstrated to be a powerful marker of progression in chronic kidney disease. The present study was done to find out the ability of uNGAL as a biomarker to differentiate steroid-sensitive nephrotic syndrome (SSNS), steroid-dependent nephrotic syndrome (SDNS), and steroid-resistant nephrotic syndrome (SRNS) from each other.
The cross-sectional study included 45 patients with Idiopathic Nephrotic Syndrome (INS) (15 each of SSNS, SDNS, and SRNS). uNGAL was measured by ELISA. Demographic profile of patients with INS, lab parameters including Serum albumin, cholesterol, urinary albumin, creatinine, etc., were estimated using standard laboratory methods. Various statistical methods were used to assay the usefulness of NGAL as a diagnostic marker.
Among the three groups, the median value of uNGAL was 8.68 ng/ml in SSNS, higher in SDNS (32.8 ng/ml), and highest in the SRNS group (50 ng/ml). The receiver operating curve (ROC) was generated for uNGAL to differentiate between SDNS and SSNS. Cut-off 13.26 ng/ml had a sensitivity of 86.7% and specificity of 97.4%, PPV 92.9%, and NPV 87.5 % with an area under the curve (AUC) of 0.958. Another ROC was generated for uNGAL to differentiate between SRNS and SDNS, and cut-off 40.02 ng/ml had a sensitivity of 80% and specificity of 86.7% with an AUC of 0.907. A similar result was observed when ROC was generated to differentiate SRNS from SSNS and SDNS combined.
uNGAL can distinguish between SSNS, SDNS, and SRNS.
尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）已被证明是慢性肾脏病进展的有力标志物。本研究旨在探究uNGAL作为生物标志物区分激素敏感型肾病综合征（SSNS）、激素依赖型肾病综合征（SDNS）和激素抵抗型肾病综合征（SRNS）的能力。
横断面研究纳入45例特发性肾病综合征（INS）患者（SSNS、SDNS和SRNS各15例）。采用酶联免疫吸附测定法（ELISA）检测uNGAL。使用标准实验室方法评估INS患者的人口统计学特征、实验室参数，包括血清白蛋白、胆固醇、尿白蛋白、肌酐等。采用多种统计方法分析NGAL作为诊断标志物的有效性。
三组中，SSNS组uNGAL的中位数为8.68 ng/ml，SDNS组（32.8 ng/ml）较高，SRNS组最高（50 ng/ml）。绘制uNGAL区分SDNS和SSNS的受试者工作特征曲线（ROC）。截断值为13.26 ng/ml时，灵敏度为86.7%，特异性为97.4%，阳性预测值为92.9%，阴性预测值为87.5%，曲线下面积（AUC）为0.958。绘制uNGAL区分SRNS和SDNS的另一ROC，截断值为40.02 ng/ml时，灵敏度为80%，特异性为86.7%，AUC为0.907。当绘制ROC区分SRNS与SSNS和SDNS合并组时，观察到类似结果。
uNGAL可区分SSNS、SDNS和SRNS。
