Potential of Neutrophil Gelatinase-Associated Lipocalin and N-Acetyl-Beta-D-Glucosaminidase Biomarkers in Diagnosing Acute Kidney Injury in Pediatric Cases of Severe Malaria

Abstract

Background: Acute kidney injury (AKI) constitutes a severe complication of malaria in the context of severity, often contributing to higher rates of morbidity and mortality in children. Traditional biomarkers, such as serum urea, creatinine, and estimated glomerular filtration rate (eGFR), remain too insensitive to detect very early renal impairments. Objectives: The present study investigated the potential of N-acetyl-beta-D-glucosaminidase (NAG) and neutrophil gelatinase-associated lipocalin (NGAL) to serve as alternative markers for AKI detection in malaria-infected children. Methods: A comparative cross-sectional study involving 85 children (30 severe malaria, 25 mild malaria, and 30 controls) aged 1–15 years was performed in a Nigerian tertiary healthcare facility. Renal function markers (urea, serum creatinine, and eGFR) and electrolytes were analyzed. NAG and NGAL assays were performed as well. Finally, ANOVA, correlation, and receiver operating characteristic curve analysis were employed for data analysis. Results: Significant hyponatremia (P<0.05) and metabolic acidosis were noted among the malaria-infected children. There were significantly elevated levels of NAG and NGAL in severe malaria cases compared with controls (P<0.05). NAG was highly correlated with creatinine (r=0.478, P=0.007), while NGAL distinguished between conditions with excellent accuracy (AUC: 0.975 and 0.855 for mild and severe malaria). Conclusion: NAG and NGAL are superior to the traditional renal markers since they are sensitive and specific biomarkers for AKI in children with malaria. Routine use of these parameters could facilitate the early detection of AKI in the clinical setting, leading to improved patient outcomes in resource-poor environments.