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

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Palgunadi, Dian Ariningrum, Mas Aditya Senaputra


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.

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