SERUM NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AND URINARY NGAL EXCRETION AS A BIOMARKER OF RENAL INJURY IN CHILDREN WITH BETA THALASSEMIA MAJOR

Abstract

Background Frequent blood transfusions among patients with beta thalassemia major leads to iron overload state and leads to damage of various organs including kidney. Very few studies have explored on Serum and urinary NGAL as a biomarkers of renal injury in thalassemia major children. Therefore, this study is planned to investigate the renal injury in beta thalassemic children by measuring serum and urinary NGAL levels and correlating it with cystatin c and creatinine clearance. Methods: The study was a cross-sectional conducted among 25 patients with β thalassemia major, aged 1-18 years, having undergone regular blood transfusion and chelation therapy. Levels of plasma and urinary NGAL were measured and compared to the standard values of the normal range. Linear regression analysis was done. Results: Mean(SD) serum NGAL value in 1- 5 years of age was 1.6(0.26) , in 5-10 years was 2.15(0.23), in 10- 15 years was 2.6 (0.11) and > 15 years it was 18.11(33.76). ( p value <0.005).Mean (SD) urine NGAL value in 1- 5 years of age was 0.66 (0.11) , in 5-10 years was 1.13(0.13), in 10- 15 years was 1.38 (0.18) and > 15 years it was 1.94(0.25). ( p value <0.005).The mean values of plasma N-GAL, and Urinary N-GAL were significantly higher in our patients as compared to that of standard population values(p<0.05). Conclusions: Serum and urine NGAL values are found to be much higher in those with longer duration of transfusion and chelation. Positive correlation was found between urine NGAL levels and cystatin C. Serum and urine NGAL values are fair markers of renal injury in thalassemia major patients on multiple transfusions.