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April 1, 2012

Neutrophil gelatinase-associated lipocalin

NGAL has beta pleated sheets?
We just had a ground rounds from Dr. Alan Maisel of UCSD on the fascinating topic of biomarkers. He was the lead author of the Breathing Not Properly trial, which helped launch BNP into the world.

Two great points from his lecture:

1. Some patients with sky-high BNPs who look clinically eu- to hypovolemic are just super sick and will be diuretic intolerant. I think many of us see a really high BNP in people with a hx of heart failure and nearly-automatically order diuretics; this is probably not the right strategy.

2. There is a novel biomarker for pts who are at risk to develop kidney injury: NGAL has been studied in pediatric cardiopulm bypass, toxicology, heart failure, kidney transplantation, and in other cases.

It seems to be very sensitive and specific for development of AKI. Serum creatinine pretty much sucks, and may often give you a false sense of security. Think of toxic alcohols, when the Cr starts to rise you're already in big trouble. This molecule seems ready for prime-time, ED decision-making. Dr. Maisel's lecture presaged a time (probably not far off) when we will be getting biomarkers for renal risk in the ED.
If you think of renal function as a forest and AKI as a forest fire, creatinine tells you which trees are dead. NGAL tells you which trees are on fire.
Dr. Maisel (paraphrased)

1 comment:

  1. Interesting and perhaps promising new biomarker. Matt and I disagree about this, but I think the utility of BNP is near-zero in the ED -- there are very few situations where it adds to the clinical assessment.
    See this recent Annals editorial by David Newman and David Schriger (specifically about biomarkers for TBI):