Neutrophil gelatinase-associated lipocalin as an early predictor of contrast-induced nephropathy following endovascular therapy for arteriosclerosis obliterans

Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) are standard biomarkers of contrast-induced nephropathy (CIN). However, recent studies suggest that serum neutrophil gelatinase-associated lipocalin (sNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) may be better predictors, particularly within 24 hours of contrast medium exposure. We conducted a prospective, observational cohort study of 107 consecutive patients diagnosed with arteriosclerosis obliterans between February 2016 and October 2018. We divided the patients into 2 groups: CIN (n = 22) and non-CIN (n = 85). We assessed the correlation between sNGAL and uNGAL concentrations and standard renal markers at baseline, 6, 24, and 48 hours post-procedure. We constructed conventional receiver operating characteristic (ROC) curves and calculated the area under the curve to assess the performance of SCr, eGFR, sNGAL, and uNGAL. We derived biomarker cutoff levels from ROC analysis to maximize sensitivity and specificity. The incidence of CIN within our cohort was 20.6%. sNGAL levels correlated significantly with SCr and eGFR at baseline, 6, 24, and 48 hours post-contrast medium exposure. Similarly, uNGAL levels correlated with SCr and eGFR at baseline, 24, and 48 hours post-exposure. sNGAL and uNGAL were significantly elevated as early as 6 hours post-catheterization in the CIN group, whereas only minor changes were observed in the non-CIN group. SCr was also significantly elevated in the CIN group, but not until 24 hours post-catheterization. Both sNGAL and uNGAL may be superior to SCr and eGFR as early biomarkers of CIN in patients with peripheral vascular disease undergoing endovascular therapy.