Biomarkers NGAL, IL 18 as Predictors of Acute Kidney Injury in Renal Transplant Recipients
Condition: Kidney Transplant; Complications; Acute Kidney Injury
MeSH terms: Acute Kidney Injury; Wounds and Injuries
Study type: Observational

Summary: 
      New markers of AKI including plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) and
      Interleukin 18(IL-18) may form a biomarker panel that may help predict AKI earlier in the
      course of disease than creatinine.

      Biomarkers for renal injury decreases following successful Renal transplantation. The level
      of decrease in biomarkers, correlates with the renal graft function, and this fall occurs
      earlier than the fall in creatinine and/or increase in the Urine output. Should graft
      dysfunction occurs, investigating the fall in biomarkers could provide a window of
      opportunity for therapeutic interventions and also guide in evaluating the effectiveness of
      such interventions. NGAL is a 25 kilo Dalton(kDa) ligand-binding protein of the lipocalin
      family, present in human tissues including kidney. NGAL is induced early in ischemic or
      nephrotoxic injury to the kidney. It has also been evaluated as a biomarker of acute injury
      in kidney transplantation. Interleukin (IL)-18 is synthesized as an inactive 23 kDa precursor
      by several tissues including monocytes, macrophages, and proximal tubular epithelial cells.
      Urine IL-18 is elevated in patients with acute tubular necrosis and in urinary tract
      infection, chronic renal insufficiency, and prerenal azotemia.

      Delayed graft function and slow graft function are associated with poor graft survival at one
      year. Early prediction of graft dysfunction could help prognosticate and initiate
      renoprotective measures. Urine biomarkers including NGAL and IL 18 have shown promise in this
      regard, but it may be fraught with risk of biomarker dilution, an effect of urinary flow rate
      on biomarker levels. The investigators hypothesized that plasma NGAL and plasma IL-18 can
      detect reduced renal graft function in renal transplant recipients within the first 2
      postoperative days.
    

Detailed description: 
      Creatinine is widely used as a marker of kidney function. The use of Creatinine has many
      confounding factors, and it rises only after loss of 50% of renal function. This time lost in
      rise of serum creatinine gives rise to the risk of missing time window that may be used to
      prevent progress of Acute Kidney Injury (AKI).

      NGAL and IL 18 are a panel of new biomarkers associated with acute kidney injury, and their
      levels correlate with an improvement of graft function in renal transplant recipients.
      Precise and early detection of a failing graft can prompt multiple investigations and
      interventions which may ultimately aid in maintaining the graft.

      The serum levels were measured to avoid the dilution effect and output variability of urine
      samples.

      The investigators measure the serum NGAL and IL-18 for the first 2 post-operative days after
      renal transplantation, and check if the trends correlate with long term graft survival and
      function.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population is patients undergoing renal transplantation
      
Biospecimen description: 
      Blood samples collected in Ethylenediaminetetraacetic Acid(EDTA) vials