Clinical research Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery Fatina I. Fadel1, Azza M.O. Abdel Rahman2, Mohamed Farouk Mohamed1, Sonia A. Habib2, Mona H. Ibrahim3, Zeinab S. Sleem1, Hafez M. Bazaraa1, Mohamed M.A. Soliman2 1Department of Pediatrics, Cairo University, Egypt 2Department of Pediatrics, National Research Centre, Egypt 3Department of Clinical Pathology, National Research Centre, Egypt Submitted: 27 July 2011 Accepted: 23 September 2011 Arch Med Sci 2012; 8, 2: 250-255 DOI: 10.5114/aoms.2012.28552 Copyright © 2012 Termedia & Banach A b s t r a c t Introduction: Cardiopulmonary bypass (CPB) surgery is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) represents a frequent and serious complication. The aim of the present study was to eval- uate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in pediatric cardiac surgery. Material and methods: The study included forty children aged 2 to 78 months undergoing CPB. They were divided into group I: patients who suffered AKI grades II and III; and group II: patients who did not develop AKI or at risk. Periph- eral venous blood was withdrawn pre- and post-operatively for serial measure- ments of NGAL and creatinine. Statistical analysis was performed using Statis- tical Package for Social Sciences version 14. Results: Mean plasma NGAL levels showed highly significant elevations in group I patients at 2, 12, and 24 h after surgery (p < 0.0001) compared to group II. Sig- nificant correlations were found between NGAL and creatinine at different time intervals. Highly significant correlations (p < 0.0001) were found between plasma NGAL and AKI at 2, 12 and 24 h after surgery. A cut-off level of 100 ng/ml at 2 h, and 125 ng/ml at 12 h post-operatively both recorded the highest accu- racy, being 95% accurate, with sensitivity of 100% and 89.5% respectively, and specificity of 90.5% and 100% respectively. Conclusions: This study showed that plasma NGAL could be used as an early biomarker for detection of AKI following CPB. We recommend further studies on a wider scale to validate the current study results. Key words: neutrophil gelatinase-associated lipocalin, biomarker, acute kidney injury, cardio-pulmonary bypass, pediatrics. Introduction Acute kidney injury (AKI) is a term proposed to reflect the entire spec- trum of acute renal failure (ARF), a complex disorder that occurs in a wide variety of settings with clinical manifestations ranging from minimal ele- vation in serum creatinine to anuric renal failure [1]. In 2004, a consensus definition for AKI was proposed by the Acute Dialysis Quality Initiative: the RIFLE criteria (risk, injury, failure, loss, end-stage renal disease) [2]. The adult-derived RIFLE definition was modified, and then applied and vali- Corresponding author: Dr. Azza M.O. Abdel Rahman Department of Pediatrics National Research Centre Dokki, Egypt Phone: +202 26366932 E-mail : azzaomar_74@yahoo.com