Prevalence of Acute Kidney Injury (AKI) in Children with Severe Malaria Using a Novel Biomarker: Serum Neutrophil Gelatinase Associated Lipocalin (NGAL) in Enugu.

Abstract

OBJECTIVES: This study aims to determine the prevalence of Acute Kidney Injury (AKI) among children with severe malaria who present to the emergency room, using serum creatinine and NGAL levels as biomarkers. It also aims to ascertain which biomarker (serum creatinine and NGAL) detects AKI earliest, especially at day 0. The study is also aims to determine the relationship between parasite density and levels of serum NGAL. METHODS: This was a cross-sectional and observational study carried out in the Children's emergency room (CHER) of two tertiary institutions which also served as referral centres for children with renal disease in Enugu metropolis. RESULTS: The prevalence of AKI using NGAL at day 0 was 74.4% while with NGAL at day 2, it was 35.9%. The prevalence of AKI using serum creatinine at day 0 was 7.7% while with that at day 2 was 5.1%. There was a very weak negative correlation between parasite density count and serum creatinine at 48 hours but this was not found to be statistically significant, (n=38, r=-0.156, p=0.499). There was a moderate positive correlation between creatinine at 0 hours and NGAL at day 2, r = 0.483; p = 0.017). There was also a moderate positive correlation between creatinine at 48 hours and NGAL at day 2, (r (21) = 0.565; p = 0.005). A significant regression equation was found F (1, 21) = 5.844, p < 0.025 with an adjusted R2 of 0.180. Participants predicted serum creatinine at day 2 was equal to - 1.96 + 0.179 x (serum NGAL at day 48). Serum creatinine at day 2 increased by 0.179 for every unit increase in NGAL. CONCLUSION: This study has documented a high prevalence of AKI using NGAL. It also showed the importance of NGAL in predicting AKI earlier than creatinine at day zero and 48 hours.