1887
Volume 2025, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Acute gastroenteritis (AGE) is a common disease observed in emergency departments (ED). Most cases of AGE are of viral causes and are self-limiting; however, in some patients, this can lead to acute kidney injury (AKI), which can lead to serious complications. Several variables have been studied to diagnose and measure the extent of morbidity due to these conditions, with neutrophil gelatinase-associated lipocalin (NGAL) being important. The present study was conducted with the aim to ascertain whether plasma NGAL levels can be used as a marker for diagnosing AKI in patients with dehydration due to AGE.

A prospective cohort study was conducted among patients admitted to the ED of a tertiary healthcare centre between the years 2015 and 2017. Patients aged between 15 and 65 years who were diagnosed with AGE were included in the study. Patients with known major comorbidities or drug use were excluded from this study. The classification of dehydration was calculated in conjunction with measurements of plasma NGAL, serum creatinine (SCr), and blood urea nitrogen.

Of the 50 selected patients, most participants (72%) reported a SCr < 1.1 (normal). Plasma NGAL levels >100 ng/mL were observed among 44% patients, while 28% had plasma NGAL <100. There was a significant difference ( < 0.001) between the mean plasma NGAL levels in patients with mild dehydration (104.88 ± 51.38 ng/mL) when compared to those with moderate dehydration (243.83 ± 120.62 ng/mL). SCr also showed a similar trend with < 0.002, with mean SCr of mild and moderately dehydrated groups being 0.78 ± 0.23 and 1.03 ± 0.30, respectively. Plasma NGAL and SCr levels showed a significant positive correlation ( = 0.486; < 0.001), whereas plasma NGAL and glomerular filtration rate showed a significant negative correlation ( = −0.428; < 0.002).

Mild and moderately dehydrated AGE patients had significantly higher plasma NGAL concentrations, even in the early stages, with normal SCr values. Plasma NGAL levels may be used as an early biomarker to identify adults with mild or moderate dehydration who are at increased risk for developing AKI.

© 2025 Subramani, Vasnaik. licensee HBKU Press.
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2025-08-08
2025-12-05

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References

  1. Senderovich H, Vierhout M. Is there a role for bismuth in diarrhea management?. Rambam Maimonides Med J. 2021Jan;12:(1):e0002. https://doi.org/10.5041/RMMJ.10422
     [Google Scholar]
  2. Al Jassas B, Khayat M, Alzahrani H, Asali A, Alsohaimi S, ALHarbi H, et al. Gastroenteritis in adults. Int J Community Med Public Health. 2018Oct;5:(11):4959. https://doi.org/10.18203/2394-6040.ijcmph20184250
     [Google Scholar]
  3. Behera DK, Mishra S. The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: evidence from the global burden of disease study. BMC Public Health. 2022Jan;22:(1):92. https://doi.org/10.1186/s12889-022-12515-3
     [Google Scholar]
  4. Dawoodi S, Dawoodi I, Dixit P. Gastrointestinal problem among Indian adults: evidence from longitudinal aging study in India 2017–18. Front Public Health. 2022Sep; 10:911354. https://doi.org/10.3389/fpubh.2022.911354
     [Google Scholar]
  5. Bogari MH, Munshi A, Almuntashiri S, Bogari A, Abdullah AS, Albadri M, et al. Acute gastroenteritis-related acute kidney injury in a tertiary care center. Ann Saudi Med. 2023Mar-Apr; 43:(2):82–9. https://doi.org/10.5144/0256-4947.2023.82
     [Google Scholar]
  6. Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders H-J. Acute kidney injury. Nat Rev Dis Primers. 2021Jul;7:(1):52. https://doi.org/10.1038/s41572-021-00284-z
     [Google Scholar]
  7. Eskandarifar A, Naghshizadian R, Tari A. Assessment of urinary level of neutrophil gelatinaseassociated lipocalin (NAGL) in children with renal scar due to vesicoureteral reflux. Iran J Kidney Dis. 2023Jan;1:(1):14-9.
    [Google Scholar]
  8. Moon JH, Yoo KH, Yim HE. Urinary neutrophil gelatinase-associated lipocalin: a marker of urinary tract infection among febrile children. Clin Exp Pediatr. 2021Jul;64:(7):347-54. https://doi.org/10.3345/cep.2020.01130
     [Google Scholar]
  9. Marakala V. Neutrophil gelatinase-associated lipocalin (NGAL) in kidney injury - a systematic review. Clin Chim Acta. 2022Nov;536:135-41. https://doi.org/10.1016/j.cca.2022.08.029
     [Google Scholar]
  10. Albert C, Zapf A, Haase M, Röver C, Pickering JW, Albert A, et al. Neutrophil gelatinase-associated lipocalin measured on clinical laboratory platforms for the prediction of acute kidney injury and the associated need for dialysis therapy: a systematic review and meta-analysis. Am J Kidney Dis. 2020Dec;76:(6):826-41.e1. https://doi.org/10.1053/j.ajkd.2020.05.015
     [Google Scholar]
  11. Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM. Biomarkers in acute kidney injury - pathophysiological basis and clinical performance. Acta Physiol (Oxf). 2017Mar;219:(3):554-72. https://doi.org/10.1111/apha.12764
     [Google Scholar]
  12. Khawaja S, Jafri L, Siddiqui I, Hashmi M, Ghani F. The utility of neutrophil gelatinase-associated Lipocalin (NGAL) as a marker of acute kidney injury (AKI) in critically ill patients. Biomark Res. 2019Feb; 7:4. https://doi.org/10.1186/s40364-019-0155-1
     [Google Scholar]
  13. Gupta B, Tiwari P, Subramanian A, Mahajan S, Kalaivani M, Bindra A, et al. Evaluation of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) as an early diagnostic marker of acute kidney injury (AKI) in critically ill trauma patients. J Anaesthesiol Clin Pharmacol. 2023Apr-Jun; 39:(2):292–301. https://doi.org/10.4103/joacp.joacp_284_21
     [Google Scholar]
  14. Nath CK, Rajkhowa P, Barman B, Barman H, Dutta A, Pala S, et al. Plasma neutrophil gelatinase-associated lipocalin (NGAL): A candidate biomarker to detect early acute kidney injury (AKI) for at-risk intensive care admissions. J Family Med Prim Care. 2022Jul;11:(7):3681-6. https://doi.org/10.4103/jfmpc.jfmpc_2316_21
     [Google Scholar]
  15. Güzel C, Yeşiltaş S, Daşkaya H, Uysal H, Sümer I, Türkay M. The effect of gender on acute kidney injury developing in the intensive care unit. Hippokratia. 2019Jul-Sep; 23:(3):126–30.
    [Google Scholar]
  16. Harris RC, Zhang M-Z. The role of gender disparities in kidney injury. Ann Transl Med. 2020Apr;8:(7):514. https://doi.org/10.21037/atm.2020.01.23
     [Google Scholar]
  17. Prisco A, Capalbo D, Guarino S, Miraglia del Giudice E, Marzuillo P. How to interpret symptoms, signs and investigations of dehydration in children with gastroenteritis. Arch Dis Child Educ Pract Ed. 2021Apr;106:(2):114-9. https://doi.org/10.1136/archdischild-2019-317831.
    [Google Scholar]
  18. Krzemien GJ, Pańczyk-Tomaszewska M, Turczyn A, Demkow U, Kotuła I, Szmigielska A. Serum neutrophil gelatinase-associated lipocalin for predicting anemia of inflammation in children with urinary tract infection. Cent Eur J Immunol. 2021;46:4456–62. https://doi.org/10.5114/ceji.2021.112450
     [Google Scholar]
  19. Córdova-Sánchez, Herrera-Gómez Á, Ñamendys-Silva SA. Acute kidney injury classified by serum creatinine and urine output in critically ill cancer patients. Biomed Res Int. 2016; 2016:6805169. https://doi.org/10.1155/2016/6805169
     [Google Scholar]
  20. Engström J, Koozi H, Didriksson I, Larsson A, Friberg H, Frigyesi A, et al. Plasma neutrophil gelatinase-associated lipocalin independently predicts dialysis need and mortality in critical COVID-19. Sci Rep. 2024Mar;14:(1):6695. https://doi.org/10.1038/s41598-024-57409-z
     [Google Scholar]
  21. Raman M, Middleton RJ, Kalra PA, Green D. Estimating renal function in old people: an in-depth review. Int Urol Nephrol. 2017Nov;49:(11):1979-88. https://doi.org/10.1007/s11255-017-1682-z
     [Google Scholar]
  22. Wen Y, Parikh CR. Current concepts and advances in biomarkers of acute kidney injury. Crit Rev Clin Lab Sci. 2021Aug;58:(5):354-68. https://doi.org/10.1080/10408363.2021.1879000
     [Google Scholar]
  23. Ali H, Abu-Farha M, Alshawaf E, Devarajan S, Bahbahani Y, Al-Khairi I, et al. Association of significantly elevated plasma levels of NGAL and IGFBP4 in patients with diabetic nephropathy. BMC Nephrol. 2022Feb11; 23:(1):64. https://doi.org/10.1186/s12882-022-02692-z
     [Google Scholar]
  24. Danquah M, Owiredu WKBA, Jnr BAE, Serwaa D, Odame Anto E, Peprah MO, et al. Diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for detection of renal failure in hypertensives: a case–control study in a regional hospital in Ghana. BMC Nephrol. 2023Apr;24:(1):114. https://doi.org/10.1186/s12882-023-03120-6
     [Google Scholar]
  25. Wołyniec W, Ratkowski W, Renke J, Renke M. Changes in novel AKI biomarkers after exercise. A systematic review. Int J Mol Sci. 2020Aug;21:(16):5673. https://doi.org/10.3390/ijms21165673
     [Google Scholar]
/content/journals/10.5339/jemtac.2025.34
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Assessing neutrophil gelatinase-associated lipocalin as an early indicator for AKI among gastroenteritis patients with dehydration
Journal of Emergency Medicine, Trauma and Acute Care 2025, 34 (2025); https://doi.org/10.5339/jemtac.2025.34
/content/journals/10.5339/jemtac.2025.34
/content/journals/10.5339/jemtac.2025.34
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  • Article Type: Research Article
Keyword(s): acute kidney injury, dehydration, diarrhoea and Gastroenteritis

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