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Neutrophil gelatinase-associated lipocalin (u-NGAL) in the assessment of renal function in patients after kidney allotransplantation


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BACKGROUND: Early dysfunction of transplanted kidney is a serious complication that can lead to the premature loss of transplant. Ischemic and reperfusion injury of donor kidney leads to the disturbance of the function of the graft, which is a form ofpost-transplantation acute kidney injury that causes the relevance of search of early markers for diagnosis. OBJECTIVE: Evaluation of the diagnostic value of determination in the urine neutrophil gelatinase-associated lipocalin (u-NGAL) in patients in the early period after kidney transplantation. METHODS: An open, randomized, retrospective comparative study of 80 patients, who underwent kidney transplantation from a living human-related donor (group 1,50 patients) and from donor with brain death documentation (group 2, 30 patients) was carried out. In 20 patients of the second group (group 2a) rapid recovery of graft function was observed, and in 10 patients (group 2b) - delayed graft recovery as a result of postischemic acute kidney injury. During the first five post-transplantation days investigated biochemical analysis of blood and urine, as well as the marker u-NGAL. RESULTS: Because of kidney transplantation was performed to the patients with end-stage chronic renal failure, high values of urea and creatinine in the blood samples during the first postoperative days were noted, that reflected the severity of the preoperative state of the patients. In the patients, who underwent human-related kidney transplantation, a more favorable picture of the investigated laboratory parameters was seen. Values of u-NGAL in this group in the early post-transplant period were normal, which attested to the absence of significant ischemic injury of transplanted kidney. In 30 patients with cadaver kidney transplantation average u-NGAL value during the first post-transplant day was 14-times fold exceeded normal range (160 ng/ml), while in 50 patients of the group with human-related transplantation - only 2 times. In the first day in group 2a average u-NGAL value decreased to normal, while in group 2b, where renal replacement therapy was carried out from the first day, remained extremely high (more than 2000 ng/ml, p<0.001 to compare with other two groups) during all 5 days of investigation. Conducting of hemodialysis sessions during the first week was required in 10 patients of group 2b, on the 2nd week - 9 patients, on the 3 and 4 week in 5 patients 5, and on the fifth week - in 3 patients. CONCLUSIONS: Due to prolonged period of ischemia in kidney transplantation from a donor with established brain death the level of u-NGAL in these patients was significantly higher than in the kidneys transplantation from living human-related donor. In patients after transplantation dynamics of u-NGAL allows to identify patients with delayed graft function recovery and the need for renal replacement therapy already in the early postoperative period.

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