Background: Neutrophil gelatinase-associated lipocalin (NGAL) is a marker of acute kidney injury (AKI), but is also released from neutrophils as part of the inflammatory response and on phagocytosis of bacteria. It has been reported that the injured kidney releases NGAL in its monomer form. In contrast, neutrophils have been claimed to release NGAL primarily as homodimer,i.e.two NGAL monomers linked by a disulfide bridge. Patients with severe sepsis have both an elevated release of NGAL from neutrophils and a high risk of AKI. We have measured the levels of NGAL monomer and homodimer in urine and plasma samples from patients suffering from severe sepsis..
Methods: NGAL monomer and homodimer were measured in sets of urine and EDTA plasma samples from 151 ICU patients suffering from severe sepsis with monomer and dimer specific ELISAs and compared with NGAL measured with a fully automated NGAL assay, The NGAL Test™, BioPorto Diagnostics A/S, Denmark. AKI was defined as a 50% increase in plasma creatinine levels.
Conclusion: The monomer is the major form of NGAL found in urine and plasma from patients suffering from severe sepsis. The occasional presence of low levels of NGAL homodimer has little impact on the interpretation of results obtained with monomer-reactive, homodimer cross-reactive NGAL assays in samples from patients suffering from severe sepsis.
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