Predictive Accuracy of Urinary neutrophil gelatinase associated lipocalin (NGAL) for renal parenchymal involvement in Children with Acute Pyelonephritis

Abstract

INTRODUCTION: Urinary tract infections (UTIs) are among the most prevalent infections in children and infants. Early and accurate detection of renal parenchymal involvement in UTI is necessary for decision making and determining treatment strategies. The aim of this study was to determine the predictive accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) for renal parenchymal involvement in children with acute pyelonephritis. METHODS: This descriptive, cross-sectional study was conducted in 2014 on children who had been diagnosed with UTI. Children who were admitted to Koodakan Hospital in Bandar Abbas, Hormozgan Province, Iran, and whose ages ranged from two months to 14 years were enrolled in the study. Urine samples were taken to conduct urinary NGAL tests, urine cultures, and urinalyses. In addition, some blood samples were collected for the purpose of determining leukocyte count and C-reactive protein (CRP) and to conduct erythrocyte sedimentation rate (ESR) tests. All patients underwent a dimercaptosuccinic acid (DMSA) scan. SPSS software was used to analyze the data. RESULTS: Among the participants in the study, 29 were male (32), and 60 were female (68). The mean age of the children who participated in the study was 2.99 +/- 2.94 years. The results of the Kruskal-Wallis test showed a significant increase in the urinary NGAL level, an increase in the CRP level, and higher DMSA scan grades (p < 0.001). The cutoff point amounted to > 5 mg/l, having the negative predictive value (NPV) of 76.3, the specificity of 97.83, the positive predictive value (PPV) of 96.7, and the sensitivity of 67.4. CONCLUSION: Urinary NGAL is not sensitive enough for the prediction of renal parenchymal involvement, but it is a specific marker.