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Vol. 108, No. 3, 2008
Issue release date: April 2008
Nephron Clin Pract 2008;108:c176

Urinary IL-18 and NGAL as Early Predictive Biomarkers in Contrast-Induced Nephropathy after Coronary Angiography

Ling W. · Zhaohui N. · Ben H. · Leyi G. · Jianping L. · Huili D. · Jiaqi Q.
aRenal Division and bCardiology Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Background/Aims: Contrast-induced nephropathy (CIN) is at present the third leading cause of hospital-acquired acute kidney injury (AKI). Traditionally, it is diagnosed by measuring the increase of the serum creatinine concentration. However, in patients with acute changes in their glomerular filtration rate, serum creatinine is an insensitive marker. This clinical study was designed to investigate whether human urinary interleukin-18 (IL-18) and neutrophil gelatinase-associated lipocalin (NGAL) are early predictive markers for AKI after coronary angiography and their correlation with later cardiac events. Methods: Patients undergoing coronary angiography using low-osmolar contrast medium were enrolled and then followed up for at least 17 months. Urine samples were collected before and 24 h after coronary angiography and IL-18 and NGAL levels measured by using an ELISA kit. Results: CIN was diagnosed in 13 of 150 (8.7%) patients (CIN group); 27 patients without CIN served as control group. At 24 h after the procedure, the urinary IL-18 and NGAL levels were significantly increased in the CIN group, but not in the control group (p < 0.05). The predictable time of AKI onset determined by IL-18 was 24 h earlier than determined by serum creatinine (p < 0.01). Receiver operating characteristic curve analysis showed that both IL-18 and NGAL showed a good performance in early diagnosis of CIN as compared with serum creatinine (p < 0.05). We also found that IL-18 is an independent predictive marker for later major cardiac events: relative risk = 2.09 (p < 0.01). Conclusions: We conclude that urinary IL-18 or NGAL could be early biomarkers of CIN and that urinary IL-18 is well associated with the later cardiac outcomes in patients after coronary angiography.

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  1. McCullough PA, Sandberg KR: Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med 2003;4(Suppl 5):S3–S9.

    External Resources

  2. McCullough PA, Soman SS: Contrast- induced nephropathy. Crit Care Clin 2005;21:261–280.
  3. McCullough PA: Outcomes of contrast-induced nephropathy: experience in patients undergoing cardiovascular intervention. Catheter Cardiovasc Interv 2006;67:335–343.
  4. Rihal CS, Textor SC, Grill DE, et al: Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002;105:2259–2264.
  5. Mehran R, Nikolsky E: Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl 2006(100):S11–S15.
  6. Rabb H: Novel urinary markers for early diagnosis of ARF. Am J Kidney Dis 2003;42:599–600.
  7. Parikh CR, Abraham E, Ancukiewicz M, et al: Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit. J Am Soc Nephrol 2005;16:3046–3052.
  8. Parikh CR, Mishra J, Thiessen-Philbrook H, et al: Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int 2006;70:199–203.
  9. Mishra J, Dent C, Tarabishi R, et al: Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231–1238.
  10. Parikh CR, Jani A, Mishra J, et al: Urine NGAL and IL-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant 2006;6:1639–1645.
  11. Ma YC, Zuo L, Chen JH, et al: Modified glomerular filtration rate estimating equation for Chinese patients with chronic disease. J Am Soc Nephrol 2006;17:2937–2944.
  12. Star RA: Treatment of acute renal failure. Kidney Int 1998;54:1817–1831.
  13. Melnikov VY, Ecder T, Fantuzzi G, et al: Impaired IL-18 processing protects caspase-1-deficient mice from ischemic acute renal failure. J Clin Invest 2001;107:1145–1152.
  14. Cowland JB, Borregaard N: Molecular characterization and pattern of tissue expression of the gene for neutrophil gelatinase-associated lipocalin from humans. Genomics 1997;45:17–23.
  15. Mishra J, Ma Q, Prada A, et al: Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003;14:2534–2543.
  16. Tumlin J, Stacul F, Adam A, et al: Pathophysiology of contrast-induced nephropathy. Am J Cardiol 2006;98:14K–20K.
  17. Heyman SN, Rosenberger C, Rosen S: Regional alterations in renal haemodynamics and oxygenation: a role in contrast medium-induced nephropathy. Nephrol Dial Transplant 2005;20(Suppl 1):i6–i11.
  18. Zager RA, Johnson AC, Hanson SY: Radiographic contrast media-induced tubular injury: evaluation of oxidant stress and plasma membrane integrity. Kidney Int 2003;64:128–139.
  19. Whitman SC, Ravisankar P, Daugherty A: Interleukin-18 enhances atherosclerosis in apolipoprotein E–/– mice through release of interferon-gamma. Circ Res 2002;90:E34–E38.

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