CORRELATION OF URINARY NEUTROPHIL GELATINASE ASSOCIATED LIPOCALIN WITH ERYTHROPOIETIN IN ACUTE KIDNEY INJURY
DOI:
https://doi.org/10.69656/pjp.v22i1.1891Keywords:
Acute kidney injury, Biomarkers, Erythropoietin, Nephrotoxicity, NGAL, Renal failureAbstract
Background: Neutrophil gelatinase-associated lipocalin (NGAL) and erythropoietin (EPO) are emerging biomarkers in acute kidney injury (AKI). While both markers are elevated independently in AKI, their correlation has not been explored. This study aimed to evaluate the correlation between urinary NGAL and serum EPO levels in patients with AKI. Methods: This comparative cross-sectional study was conducted at a tertiary care hospital in Peshawar. A total of 106 AKI patients (58 males, 48 females) aged over 18 years were enrolled through purposive sampling. Patients with chronic kidney disease, diabetes mellitus, hypertension, autoimmune diseases, or on long-term medications were excluded. AKI was staged using RIFLE criteria. Urinary NGAL and serum EPO levels were measured and compared across the severity stages. Results: Among stage 1 AKI patients, NGAL levels were 126±43 ng/mL in females and 138±37 ng/mL in males (p=0.29), while EPO levels were 82.8±32 mIU/mL in females and 139±74 mIU/mL in males (p=0.002). In stage 2 AKI, NGAL values were 116.1±30 ng/mL in females, 135±36 ng/mL in males (p=0.15), and EPO was 99±65 mIU/mL in females and 102±35 mIU/mL in males (p=0.87). Stage 3 AKI cases had NGAL 117.5±41 ng/mL in females and 126±42 ng/mL in males (p=0.52), and EPO 131±69 mIU/mL in females and 117±57 mIU/mL in males (p=0.50). Conclusion: Except in stage 1 AKI, no significant correlation was found between urinary NGAL and serum erythropoietin levels. Disease history and duration, glomerular filtration rate, or lack of serial biomarker measurements may cause results variability.
Pak J Physiol 2026;22(1):6–8, DOI: https://doi.org/10.69656/pjp.v22i1.1891
Downloads
References
Mercado MG, Smith DK, Guard EL. Acute kidney injury: diagnosis and management. Am Fam Physician 2019;100(11):687–94.
Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders HJ. Acute kidney injury. Nat Rev Dis Primers 2021;7(1):52.
Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G. Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol 2015;26(9):2231–8.
Ravn B, Prowle JR, Mårtensson J, Martling CR, Bell M. Superiority of serum cystatin C over creatinine in prediction of long-term prognosis at discharge from ICU. Crit Care Med 2017;45(9):e932–40.
Elliott S, Busse L, Swift S, McCaffery I, Rossi J, Kassner P, et al. Lack of expression and function of erythropoietin receptors in the kidney. Nephrol Dial Transplant 2012;27(7):2733–45.
van Duijl TT, Ruhaak LR, de Fijter JW, Cobbaert CM. Kidney injury biomarkers in an academic hospital setting: where are we now? Clin Biochem Rev 2019;40(2):79–97.
Zhang WR, Parikh CR. Biomarkers of acute and chronic kidney disease. Annu Rev Physiol 2019;81(1):309–33.
Clerico A, Galli C, Fortunato A, Ronco C. Neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of acute kidney injury: a review of the laboratory characteristics and clinical evidences. Clin Chem Lab Med 2012;50(9):1505–17.
AL-Sallami AS, Kadhim RA. Assessment of some biochemical markers in chronic kidney disease patients in Al-Najaf Al-Ashraf Governorate. Int J Pharm Tech Res 6;9(6):473–82.
Nishiwaki H, Abe Y, Suzuki T, Hasegawa T, Levack WM, Noma H, et al. Erythropoiesis?stimulating agents for preventing acute kidney injury. Cochrane Database Syst Rev 2024;9(9):CD014820.
Yang Y, Song M, Liu Y, Liu H, Sun L, Peng Y, et al. Renoprotective approaches and strategies in acute kidney injury. Pharmacol Ther 2016;163:58–73.
Kusirisin P, Thanapongsatorn P, Chaikomon K, Lumlertgul N, Yimsangyad K, Leewongworasingh A, et al. The role of erythropoietin levels in predicting long-term outcomes following severe acute kidney injury. Blood Purif 2023;52(9–10):793–801.
Curtis LM. Sex and gender differences in acute kidney injury. Kidney360 2024:5(1).160–7.
Soranno DE, Awdishu L, Bagshaw SM, Basile D, Bell S, Bihorac A, et al. The role of sex and gender in acute kidney injury—consensus statements from the 33rd Acute Disease Quality Initiative. Kidney Int 2025;107(4):606–16.
Ma HY, Chen S, Du Y. Estrogen and estrogen receptors in kidney diseases. Ren Fail 2021;43(1):619–42.
Liu H, Gu Q, Zhao Y, Wang H, Liu F. Linear correlation between white blood cell counts and the progression and prognosis of acute kidney injury. J Int Med Res 2025;53(8):03000605251369843.
Yamashita T, Noiri E, Hamasaki Y, Matsubara T, Ishii T, Yahagi N, et al. Erythropoietin concentration in acute kidney injury is associated with insulin?like growth factor?binding protein?1. Nephrology (Carlton) 2016;21(8):693–9.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aamir Asmatullah, Ayesha Sardar, Maham Khalid, Rashid Mahmood, Aslam Khan Mohmand, Fatima Munir
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The author(s) retain the copyrights and allow their publication in Pakistan Journal of Physiology, Pak J Physiol, PJP to be FREE for research and academic purposes. It can be downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.
