Journal of Pediatric Research (Dec 2022)

Urine Neutrophil Gelatinase-associated Lipocalin as a Prognostic Biomarker in the First Episode of Idiopathic Nephrotic Syndrome in Children

  • Geethanjali Pradeepchandran,
  • Susy Joseph,
  • Susan Uthup,
  • Geetha Saradakutty

DOI
https://doi.org/10.4274/jpr.galenos.2022.00008
Journal volume & issue
Vol. 9, no. 4
pp. 376 – 382

Abstract

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Aim:Idiopathic nephrotic syndrome (NS) is the most common glomerular disorder of childhood. Its prognosis is correlated with treatment responsiveness and not renal histopathology. Most of the children who suffer from NS experience multiple relapses and there is a risk of long-term drug dependence with possible side effects. Hence, there is always a need for markers to assess its long-term outcome even in steroid responders. Urine neutrophil gelatinase-associated lipocalin (uNGAL) is an early risk marker of acute kidney injury and also a marker of progression of chronic kidney disease. Our aim was to determine if urine NGAL could predict steroid responsiveness at the onset of NS, which would help in the planning and monitoring of the treatment in idiopathic NS. The aims of this study were to determine the levels of uNGAL in children who were having their first episode of NS and to study its relation with steroid resistance at 3 months.Materials and Methods:A prospective observational study was conducted in children diagnosed with their first episode of idiopathic NS in a tertiary care teaching hospital from January, 2019 to July, 2020. Urinary NGAL measurements were conducted before starting steroids.Results:Seventy-nine children satisfying the inclusion criteria were included in this study. Their mean age was 7.18 (±2.86) years. The male to female ratio was 1.25:1. All 63 children who had urine NGAL less than 10 ng/mL responded to the standard dose of steroids at 8 weeks and attained remission. Out of the 16 children with NGAL over 10 ng/mL, 56.3% (n=9) responded to steroids within 8 weeks (intermediate or late steroid responders) and 43.8% (n=7) were steroid resistant NS (SRNS). Urine NGAL below 10 ng/mL was associated with steroid responsiveness in the first episode of NS at 3 months (p<0.001).Conclusion:Urine NGAL below 10 ng/mL is an early predictive biomarker of steroid responsiveness in the first episode of idiopathic NS.

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