Massive proteinuria (more than 40 mg/m^2 per hour) causes hypoalbuminemia (less than 30 g/L), which leads to hyperlipidemia, edema, and other problems. Nephrotic syndrome is a clinical illness characterized by this condition. Although patient response varies, corticosteroids are usually used as the first line of treatment.
Early in the course of the disease, it's critical to distinguish between steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS), as the latter is linked to a higher risk of unfavorable long-term consequences. One possible non-invasive indicator of renal impairment is neutrophil gelatinase-associated lipocalin (NGAL), a biomarker generated in response to tubular injury. Therefore, this systematic review and meta-analysis attempted to establish if urine NGAL values change between patients with SRNS, SSNS, and healthy controls.
Following the PRISMA standards, this research performed a systematic review and meta-analysis of papers that reported NGAL levels in SSNS and SRNS. Using PubMed, Web of Science, Scopus, ScienceDirect, and the WHO Virtual Health Library Regional, a thorough literature search was carried out. A random-effects model was used for the statistical analysis in order to determine the standardized mean difference (SMD) with a 95% confidence range.
There were 16 investigations in all. Both SSNS and SRNS patients had much greater urine NGAL levels than healthy controls, according to meta-analyses. In comparison to healthy controls, SSNS and SRNS patients had substantially higher urinary NGAL levels (SMD = 0.78 (95% CI: 0.434–1.128, P <.001) and SMD = 2.56 (95% CI: 1.152–3.971, P <.001), respectively.
Urinary NGAL levels were significantly greater in SRNS patients than in SSNS patients (SMD = 1.889, 95% CI: 0.819–2.959, P <.001). Urinary NGAL has a moderate to great discriminative power in differentiating between SRNS and SSNS, according to ROC analysis from many investigations.
Overall, urinary NGAL showed great promise as a non-invasive, early indicator of steroid resistance in nephrotic syndrome. Its incorporation in clinical evaluation processes is supported by its relevance across populations, biological plausibility, and diagnostic accuracy. With more research, NGAL may be crucial in helping children patients with nephrotic syndrome achieve better results, reduce needless steroid exposure, and customize treatment plans.
Source:
Abdalla, A., Ali, A., Abufatima, I. O., Majzoub, S., Elbasheer, T. A. E., Ahmed, S. M. A. O., Osman, S., Khalid, Y. K. K., Elamir, A., Khalid, H. K. K., Abdelmutalib, N. M. A., & Mohamed, S. O. O. (2025). Use of urinary NGAL in steroid-resistant vs. steroid-sensitive nephrotic syndrome: a systematic review and meta-analysis. BMC Nephrology, 26(1). https://doi.org/10.1186/s12882-025-04420-9
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