Bio-chemical diagnosis of cardiac injury or infarction is well documented modality for many decades. Now , acute coronary syndrome is diagnosed by a battery of tests that detects the proteins leaking from the injured myocardium.
Nephrologists have long been aiming for such a marker for ischemic renal injury (Not withstanding the fact , they are already blessed with two age-old molecules creatinine and BUN !)
Neutrophil gelatinase associated Lipocalin (NGAL)
- This is 25 Dalton molecule richly secreted within renal cortical cells in response to ischemic injury .
- It is released without modification in the urine .High urinary levels of NGAL reflect acute renal injury.
- Early experience shows it is a promising investigation and could become a regular biochemical test in the near future.
- Urine level of NGAL >250 ng/ml , 2 hours after cardiac surgery predicts impending renal failure in the next 24-48 hours .The advantage is , it NGAL raises well before serum creatinine.
NGAL After cardiac surgery
Lipocalin following PCI
References for NGAL
- Cardiologists and cardiac surgeons have started performing complex PCIs and CABGs in patients with delicately and precariously balanced renal function.
- While , cardiologists challenge the kidneys with high osmolar contrast agents , the surgeons stress it with extra corporeal circulation. Many of these patients also have co- morbid conditions .
- Often , the cardiac outcome is directly linked to pre /post procedural renal function .Nephrologists usually arrive late into the filed (Creatinine SOS calls !).By this time the full-blown ATN sets in many.
Now , we have a tool to identify impending ARF , it gives us little more time and flexibility in managing the issue .