Neutrophil gelatinase-associated lipocalin and Hs CRP may detect AKI in diabetic children

A recent study found that levels of Neutrophil gelatinase-associated lipocalin and highly sensitive C reactive protein can be used to detect early acute kidney injury in children with type 1 diabetes. The study results were published in the journal BMC Pediatrics.  

The most common cause of morbidity and mortality in diabetic patients is infection. In high glucose concentrations, few microorganisms become more virulent. Asymptomatic and symptomatic bacteriuria is most likely seen in diabetics. Literature shows that Neutrophil gelatinase-associated lipocalin (NGAL) is one of the earliest and the most indicative biomarkers of acute kidney injury (AKI and it is secreted in high concentrations into the blood and urine within two hours of AKI. Hence researchers conducted a study to detect UTI in type1diabetic children through screening of their urine samples and measurement of NGAL urinary levels in cases with asymptomatic bacteriuria for early detection of AKI to prevent serious complications. 

A prospective study was carried out on 1022 known diabetic children with regular follow-up in the endocrine outpatient clinic at Minia Children's University hospital by screening for UTI. Three groups were formed with 52 children in each. Group, I had 52 diabetic children diagnosed with asymptomatic bacteriuria, group II had 52 diabetic children with normal urine analysis and group III had age and sex-matched controls with 52 healthy children. CBC, Renal function test, HbA1c, hsCRP, Albumin/creatinine ratio, urine examination, urine culture, Gon, and urinary NGAL were done to all children. 

Results

• Thirty-seven females (71.2%) had asymptomatic bacteriuria, Hs CRP and urinary NGAL were significantly higher, while GFR was significantly lower in diabetic children with bacteriuria than in the other two groups.
• For diabetic children with bacteriuria, (AUC) for NGAL was 1 with an optimal cutoff value of > 44.1 while AUC for hsCRP was 0.887 with an optimal cutoff value of > 1 (Sensitivity of 82.69% and Specificity of 90.38%). 

Even if a child has no symptoms, all diabetic children should have their urine analyzed regularly. Since NGAL and hsCRP are non-invasive tests that can detect early renal injury in these patients, proper treatment of UTIs should be started as soon as possible to avoid renal injury.

Further reading: Bebars, G.M., Mostafa, A.N., Moness, H.M. et al. Assessment of early kidney injury caused by asymptomatic bacteriuria in children with type 1 diabetes. BMC Pediatr 22, 643 (2022). https://doi.org/10.1186/s12887-022-03689-1