Neutrophil Gelatinase-Associated Lipocalin Serum as a Predictor of Acute Kidney Injury in Pediatric Acute Lymphoblastic Leukemia with Induction Phase Chemotherapy

Abstract

AKI is more common in hematological cancers than in other forms of cancer caused by underlying malignancy or subsequent consequences of treatment. AKI affects 68.5% of people. AKI diagnostic criteria rely on creatinine and urine output, which cannot detect early kidney impairment. Neutrophil gelatinase-associated lipocalin has been studied as a marker for the early detection of AKI. This study aimed to evaluate serum NGAL as a predictor of AKI in pediatric ALL treated with induction-phase chemotherapy. This study was designed as an observational analysis in a prospective cohort from April to December 2022. 77 patients with induction chemotherapy met the inclusion and exclusion criteria at Dr. Moewardi Surakarta. A multivariate analysis with logistic regression was conducted to determine the relative risk and 95% confidence interval (CI) for each variable. The prevalence of AKI in this study was 40.3%. Haemoglobin, creatinine, and serum NGAL significantly differed (p = 0.381, 0.044, 0.000). The NGAL cut-off was 187.5 ng/mL, with a sensitivity of 80.6% and a specificity of 84.8%. Age, anemia, leukocytosis, and NGAL had an adjusted RR with CI of 95%, respectively 1.22 (95% CI 0.31-4.82; p=0.799), 2.07 (95% CI) 0.50-8.68; p=0.318), 7.45 (95% CI 1.26-44.09; p=0.027) and 33.10 (95% CI 7.64-143.40; p<0.001). In ALL children receiving induction-phase chemotherapy, serum NGAL levels of more than 187.5 ng/mL are an independent predictor of AKI. Follow-up research was conducted at different examination facilities to identify the diagnosis of AKI based on the completion of supporting exams and the timing of creatinine collection.