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Open Access Highly Accessed Research article

Plasma neutrophil gelatinase associated lipocalin (NGAL) is associated with kidney function in uraemic patients before and after kidney transplantation

Nils E Magnusson*, Mads Hornum, Kaj Anker Jørgensen, Jesper Melchior Hansen, Claus Bistrup, Bo Feldt-Rasmussen and Allan Flyvbjerg

BMC Nephrology 2012, 13:8  doi:10.1186/1471-2369-13-8

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Immunosuppressive therapies, serum creatinine and NGAL

Mehmet Agilli   (2012-08-09 16:53)  Gulhane School of Medicine

We read with great interest your article. You have shown that plasma NGAL levels were markedly higher in patients prior to transplantation compared to the levels measured at three and twelve months after transplantation. And you have found that NGAL paralleled measures of kidney function and correlated to serum creatinine and leukocyte count. This study is important because it provides scientific information on this clinically relevant condition. However, we think that some points should be discussed.

NGAL is a protein belongs to the lipocalin family. NGAL is released to circulation by activated neutrophils and epithelial cells, and is also produced by renal tubular cells in response to injury. NGAL have been considered good markers of neutrophil activity. It has known that NGAL is also a novel and early marker of acute kidney injury [2]. Generally, a high NGAL level reflects increased neutrophil activity. There is a significant correlation between plasma NGAL levels and leukocyte counts. In this study, transplanted patients were given immunosuppressive therapies including methylprednisolone, prednisolone, basiliximab, daclizumab and antithymocyte globulin. Induction therapy using these agents causes a drastic and rapid reduction of the number of leukocyte. Therefore, decreased NGAL levels in transplanted patients may be due to induction therapies because of decreased leukocyte counts. This condition should be reevaluated.

On the other hand, in figure 1, it has been shown the relationship between serum creatinine and plasma NGAL levels in the kidney allograft recipient. In this figure, in the group of before transplantation serum creatinine levels appears to be below 1.5 mg/dl. These levels of serum creatinine are not suitable for patients awaiting transplant. For this reason, unit of creatinine or the results of creatinine should be revised. This would certainly provide the readers clearer information about the relationship between NGAL and with kidney function in uraemic patients before and after kidney transplantation.
Thank you
Sincerely

Competing interests

This comment is not only mine. I and my colleagues have roles for occurence of this comment. They are;
Halil Yaman, Emin Ozgur Akgul, Tuncer Cayci, Yasemin Gulcan Kurt, Irfan Sener, Mehmet Agilli, Tevfik Honca.
Gulhane Military Medical Academy, School of Medicine, Department of Clinical Biochemistry, Etlik, Ankara, Turkey
Thank you
Sincerely

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