Associations of Plasma Neutrophil Gelatinase-associated Lipocalin, Anemia, and Renal Scarring in Children with Febrile Urinary Tract Infections

Background: Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs). Methods: We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR). Results: Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard beta= -0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio (OR), 2.37; 95% confidence interval (CI] , 1.07-5.27; P< 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P< 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591-0.843) was higher than that of post-treatment CRP (0520; 95% CI, 0.395-0.643; P< 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring. Conclusion: Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.