The Value Of Combined Detection Of Urinary NGAL And KIM-1in The Diagnosis Of Acute And Chronic Kidney Injury

Objective To investigate the correlation between the urinary neutrophilgelatinase-associated lipocalin(NGAL), kidney injury molecule-1(KIM-1), cystatin-C(Cys-C) andequation to estimate glomerular filtration rate (eGFR), serum creatinine (Scr) by observingthe changes of NGAL, KIM-1, Cys-C in acute and chronic kidney injury and healthypeople. Meanwhile, to explore the value of combined detection of urinary NGAL andKIM-1in the diagnosis of acute and chronic kidney injury.Methods76cases of patients who matched for age and gender were selected in thenephrology and Intensive Care Unit of the First Affiliated Hospital of Suzhou Universityfrom January2013to December2013, including46cases of acute kidney injury,40chronic kidney injury. At the same period,30healthy volunteers of medical center in thesame hospital as normal control group. Clinical presentations and urinary samples werecollected when the patients were enrollment into our study. The levels of urinary NGAL,KIM-1, Cys-C were analyzed by enzyme-linked immunosorbent assay(ELISA) in urinarysamples. To analyze the correlation between urinary urinary NGAL, KIM-1, Cys-C andScr, eGFR, and evaluate the diagnostic value of urinary NGAL, KIM-1, Cys-C in acutekidney injury.Results1. Compared with the CKD group, the levels of urinary NGAL, KIM-1, Cys-C andScr in the AKI group increased obviously, and the levels of eGFR reduced(P<0.05). Inaddition, compared with the CKD group, the levels of urinary NGAL, KIM-1, Cys-C andScr in the AKI group increased more obviously, and the levels of eGFR reduced moresignificantly(P<0.051).2. In the one period, two period and three period of AKI group, urinary NGAL,KIM-1, Cys-C and Scr were gradually increased, but the eGFR was gradually declined, thedifference was statistically significant (all P <0.01). 3. Correlation analysis showed that in the AKI group the levels of urinary NGALwere positive correlated with the levels of urinary KIM-1, Cys-C and Scr, correlationcoefficients were R=0.784, R=0.674, R=0.479, respectively. But the levels of urinaryNGAL were negatively correlated with eGFR, correlation coefficient was R=-0.485.(all P<0.05)4. Correlation analysis showed that in the AKI group the levels of urinary KIM-1andCys-C were both positive correlated with the levels of Scr, correlation coefficients wereR=0.499, R=0.641, respectively. At the same time, the levels of urinary KIM-1and Cys-Cwere both negatively correlated with eGFR, correlation coefficient were R=-0.579,R=-0.589, respectively.(all P <0.05)5. Correlation analysis showed that in the CKD group the levels of urinary NGALwere positive correlated with the levels of urinary KIM-1, Cys-C and Scr, correlationcoefficients were R=0.489, R=0.589, R=0.434, respectively. But the levels of urinaryNGAL were negatively correlated with eGFR, correlation coefficient was R=-0.389.(all P<0.05)6. Correlation analysis showed that in the CKD group the levels of urinary NGALwere positive correlated with the levels of urinary KIM-1, Cys-C and Scr, correlationcoefficients were R=0.489, R=0.589, R=0.434, respectively. But the levels of urinaryNGAL were negatively correlated with eGFR, correlation coefficient was R=-0.389.(all P<0.05)7. Receiver operator characteristic curve (ROC) analysis showed that the area underthe curve (AUC) of urinary NGAL, KIM-1and Cys-C were0.698,0.641,0.579,respectively. The AUC of combined detection of urinary NGAL and KIM-1was0.934.The AUC of combined detection of urinary NGAL and Cys-C was0.901. The AUC ofcombined detection of urinary KIM-1and Cys-C was0.895. If the three markers werecombined, the AUC was0.945.Conclusion1. The levels of urinary NGAL, KIM-1, Cys-C were significantly different in AKIgroup, CKD group and CON group, and increased in AKI and CKD group, has certaindiagnostic value, but for the early diagnosis of AKI higher sensitivity and specificity.2. The levels of urinary NGAL, KIM-1, Cys-C were positive correlated with theseverity of AKI. 3. The levels of urinary NGAL, KIM-1, Cys-C were positive correlated with thelevels of serum creatinine and negative correlated with eGFR in AKI and CKD group, hadsynergistic effect on diagnosis of AKI and CKD.4. For AKI diagnosis, combined detection of urinary NGAL, KIM-1and Cys-C hadhigher sensitivity and specificity than single detection. Combined detection of urinaryNGAL and KIM-1had more advantages.