Serum neutrophil gelatinaseassociated lipocalin in children with b-thalassemia major as a promising marker for predicting renal tubular impairment

Abstract

To assess the usefulness of serum neutrophil gelatinase-associated lipocalin (NGAL) in children with b-thalassemia major as an early indicator of kidney damage. A case-control study was conducted on 140 children. Two main groups were identified: 70 patients with transfusion-dependent beta thalassemia major and 70 ageand gender-matched healthy controls. All the participants were evaluated for medical history and underwent a thorough physical examination, clinical assessments, and laboratory tests for complete blood count, serum ferritin, renal function, and serum NGAL. A significant increase in serum NGAL levels was observed in the patients compared to the controls (p = 0.001). Moreover, NGAL showed a positive correlation with serum urea (r = 0.257; p 0.001), creatinine (r = 0.389; p 0.001), and ferritin levels (r = 0.635; p 0.001), and a negative correlation with hemoglobin level (r = –0.608; p 0.001), MCV (r = –0.0480; p 0.001), MCH (r = –0.433; p 0.001), and eGFR (r = –0.346; p 0.001). NGAL had an AUC of 0.914, a cut-off value of 1370 ng/mL, 86.7% sensitivity, and 90% specificity. The Ethical Committee of the Faculty of Medicine, Menoufia University, reviewed the study protocol and gave approval (No. 191219 PEDI 28). Written informed parental consent was obtained in all cases. Renal dysfunction in thalassemia can start as a hidden damage with no apparent symptoms or complaints. Hence, NGAL may serve as an early indicator of renal tubular and glomerular dysfunction in patients with beta-thalassemia.