Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Acute Kidney Injury and Its Relation to Troponin T in cardiac and renal patients.

Background: Neutrophil gelatinase-associated lipocalin (NGAL) might be investigated as a potential early and sensitive marker of kidney impairment/injury in order to select the appropriate strategy for reducing the risk in the setting of cardiorenal syndrome (CRS). NGAL is a 25 kDa protein covalently bound to matrix metalloproteinase-9 (MMP-9) from neutrophils .which has been shown to be highly increased in patients with acute and chronic renal injury in different clinical stages. Aim of the work: study the relation between NGAL, Troponin and AKI in cardiac non renal patients and renal non cardiac patients. Subject and method :50 subjects classified into five groups: Group 1: 10 healthy control subjects. Group II:10 patients with Acute Decompensated Heart failure (ADHF). Group III:10 patient with acute myocardial infarction (ACS). GroupIV:10 patients with hypertensive encephalopathy (HTN). GroupV:10 patients with acute kidney injury due to toxic exposure (AKI). Methods: Routine investigations: Complete blood picture, Fasting and post prandial plasma glucose level, liver function tests, Lipid profile, serum urea and creatinine and urine analysis Specific investigations: Measurement of NGAL (ELISA). Measurement of Troponin by ELFA (Enzyme-Linked-Fluorescent-Assay. Results : in AKI (acute kidney injury) high statistical significant difference betweenall studied parameter(NGAL1,NGAL2,Troponin1,Troponin2) among the different groups. NGAL1was significantly higher in AKI group versus all other groups, also NGAL1 was significantly higher in ADHF than in control group. NGAL2 was significant higher in AKI and ADHF groups. Troponin1 and 2 was significantly higher in ACS versus all other groups. no significant correlation between NGAL1and all other parameters in Control group and AKI group . Also there was non significant correlation between NGAL and Troponin i.e no relation between cardiac troponin and renal troponin . no statistical significant difference between NGAL1 and the different parameters in ACS group, HTN encephalopathy group, ADHF group, and control group. in AKI group NGAL1 positive correlate with NGAL2, and this prove high sensitivity of serum NGAL due to kidney affection although non significant correlation between NGAL and creat.1,2 and –ve correlation with GFR .no statistically significant difference between NGAL2 and the different parameters In ADHF group , in ACS group and in HTN encephalopathy group . except between NGAL2 and NGAL1where there is positive correlation in ADHF patients. in AKI group no significant correlation was found between NGAL 2 and other parameters except that NGAL2 positive correlate with NGAL1.That explain NGAL is the early marker of (AKI ) and not Troponin . Conclusion: NGAL 1&2 are good indicators of early renal affection in ADHF and AKI patients, but neither in ACS nor in HTN encephalopathy patients. NGAL had no relation to Troponin serum values in renal non cardiac patients and also in cardiac non renal patients.