| Abstract: |
Background: In recent years, Chronic Kidney Disease (CKD) is a rapidly increasing devastating illness. The worldwide epidemic of CKD will double the incidence of End-Stage Renal Disease (ESRD) over the next 10 years whereas the number of patients with earlier stages of CKD exceed those reaching ESRD by more than 50 folds. Early identification of CKD and timely detection of its progression are crucial and extremely valuable, especially after the innovation of a number of kidney function preservation therapies. Neutrohpil Gelatinase Associated Lipocalin (NGAL), a small 25-KD lipocalin protein, is heavily released from renal tubular cells after various injuring stimuli. Patients with higher baseline NGAL were vulnerable to a considerable higher risk fo worsening residual renal function within one year. NGAL structure is defined by a calyx that modulates local iron channeling and serves as growth and differentiation factor for renal tubular epithelium.Objectives: This study measured serumNGAL on 60 subjects with chronic kidney disease stages 2-4 and 20 apparently healthy controls. All patients gave written informed consent. The patients were classified according to occurrencse of chronic kidney injury into 2 groups: Control group: It included 20 healty individuals. Patient group: It included 60 patients subdivided into 3 subgroups: Group I: It included 20 patients with chronic kidney disease stage II. Group II: It included 20 patients with chronic kidney disease stage III. Group III: It included 20 patients with chronic kidney disease stage IV. Patients with hepatic, thyroid, malignant diseases, infectious diseases, severe proteinuria (> 3.5 mg/dl), inflammatory states and alterations in leukocyte count or formula, patients with serum creatinine above 6 mg/dl and/or estimated Glomerular Filtration Rate (eGFR) ≤ 15 ml/minute (CKD stage 5) and patients treated with steroids or immunosuppressors were excluded from the study. All patients have been subjected to: full history taking and thorough clinical examination, laboratory investigations and specific investigations including MDRD, NGAL and CRP.Results: Our results showed that there are significantly higher levels of creatinine,associated with significantly lower levels of CG and MDRD formulas of eGFR in all patients groups(I, II, III)compared to control group. there are a significantly higher levels of urea,CRP,protein in blood in all patients groups(I, II, III) compared to the control group. There is a highly significant levels of serum NGAL levels in all patients groups (I, II, III) compared to the control group. There are highly significant positive correlations between serumNGAL and creatinine, urea, CRP and protein in blood associated with highly significant negative correlations between serumNGAL and CG and MDRD formulas of eGFR in all patients groups(I, II, III) compared to the control group.Conclusion: The potential use of serumNGAL measurements among CKD patients may be of great potential, but the findings made in the present study are only preliminary. Therefore, no clinical application can be contemplated without, for instance, specifically evaluating the real effect of chronic inflammation on circulating NGAL levels, and making an effective cost-to-benefits analysis since rapid NGAL measurement incurs considerable economic costs.
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