Serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for predicting high dose methotrexate associated acute kidney injury in children with acute lymphoblastic leukemia.

Li, Hui; Xu, Qiong; Wang, Yang; Chen, Kailan; Li, Jianxin

Purpose: The present study was aimed at assessing the value of serum NGAL in identifying early acute kidney injury induced by HDMTX. Methods: Children aged 1–14 years with newly diagnosed ALL receiving MTX over 3 g/m2 were enrolled. Serum NGAL concentrations, serum creatinine (Scr) and MTX concentrations were measured. The area under the receiver-operating characteristic curve (ROC) was used for evaluating variables' ability of early diagnosis of AKI. Results: A total of 196 courses of 62 patients were assessed, and 22 courses (11.2%) developed AKI. Twenty-four hours serum NGAL concentrations, 24 h Scr ratio, 48 h Scr ratio, CMTX24 h, CMTX48 h, CMTX72 h were significantly higher in patients with AKI. The combination of 24 h Scr ratio and 24 h serum NGAL had higher value for detecting HDMTX induced AKI compared with the 24 h Scr ratio. And the combination had similar value for detecting HDMTX induced AKI compared with the 48 h Scr ratio. After 48 h, CMTX48 h had a satisfying accuracy in predicting AKI. The proportion of post-HDMTX sepsis in patients with AKI was significantly higher than that in patients without AKI. Conclusions: Serum NGAL levels could be used as a marker in identifying the direct kidney tubular damage induced by HDMTX. The combination of 24 h Scr ratio and 24 h serum NGAL had higher value for early diagnosis of HDMTX associated AKI compared with the 24 h Scr ratio.

ACUTE kidney failure; LYMPHOBLASTIC leukemia; ACUTE leukemia; LIPOCALIN-2; PROXIMAL kidney tubules; METHOTREXATE

Cancer Chemotherapy & Pharmacology, 2020, Vol 85, Issue 1, p95

0344-5704

Academic Journal

10.1007/s00280-019-03980-6