Affiliations: Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Correspondence:
[*]
Corresponding author: Min Hu, Department of Clinical Laboratory, Second Xiangya Hospital, Central South University, Changsha, Hunan, China. Tel.: +81 0731 85292145; Fax: +81 0731 85292145; E-mail:minhu013@sina.com
Abstract: OBJECTIVES: Neutrophil gelatinase-associated lipocalin (NGAL) has been proved as a
sensitive biomarker in acute and chronic renal injury. Renal impairment is a
common complication of multiple myeloma (MM). We attempt to assess the value
of NGAL for the early and accurate diagnosis of renal injury in MM patients. METHODOLOGY: Forty-five MM patients with CKD stage I to V(MM-renal group), 20 MM
patients with normal kidney function (MM-non-renal group), and 37 healthy
volunteers (healthy control) were compared for serum and urinary NGAL and
other renal injury biomarkers (Creatinine[CRE]; Cystatin-C [CysC];
N-acetyl-beta-D-glucosaminidase [NAG]). Other biomarkers reflect the
inflammation and tumor burden like high-sensitivity C-reactive
protein(hs-CRP) and urine free light chain were also detected. RESULTS: Among the biomarkers of renal injury, the assessment of serum CysC, CRE
and NGAL was a reliable tool to distinguish MM-renal from MM-non-renal. Both
serum and urinary NGAL levels were higher in MM-renal patients than in
MM-non-renal or healthy controls (187.10 (45.60-699.60) vs 136.70
(47.70-216.50) vs 117.7 (69.3-192.3), P< 0.01; 37.50 (6.30-412.10) vs 18.00
(0.50-66.50) vs 11.2 (0.9-69.1), P< 0.01). Univariate analysis showed that
both serum (Odds Ratio = 1.009; 95%CI 1.002-1.017; P= 0.018) and urinary
NGAL (Odds Ratio = 1.038; 95%CI 1.003-1.073; P= 0.031) as well as serum
CysC (Odds Ratio = 9.875; 95%CI 1.685-57.882; P= 0.011) were strong
predictors for the risk of renal injury in MM patients. Moreover, the
urinary NGAL level was negatively correlated with estimated glomerular
filtration rate (eGFR) (r= -0.586, P= 0.00003) and has a tendency towards
positive correlation with urine free light chain (r = 0.235, P = 0.124) and
hs-CRP (r = 0.379, P = 0.074). CONCLUSIONS: The present study demonstrated that urinary NGAL was not superior to serum
NGAL in distinguishing MM-renal group from MM-non-renal group. And it could
be considered an independent predictor of renal injury from multiple myeloma
reflecting active kidney damage, tumor burden, and inflammation.
