65 Not surprisingly, NGAL measurements as an outcome variable are currently included in several ongoing clinical trials formally listed in ClinicalTrails.gov. The approach of using NGAL as a trigger to initiate and monitor novel therapies, and as a safety biomarker when using potentially nephrotoxic agents, is expected to increase. It is also hoped that the use of predictive and sensitive biomarkers such as NGAL as endpoints in clinical

trials will result in a reduction in required sample sizes, and hence the cost incurred. A number of studies have demonstrated the utility of early NGAL measurements for predicting the severity and clinical outcomes of AKI. In children undergoing cardiac surgery, early post-operative plasma NGAL levels strongly correlated with duration and severity of AKI, length Selleckchem Acalabrutinib of hospital stay

and mortality.66 In a similar cohort, early urine NGAL levels highly correlated with duration and severity of AKI, length of hospital stay, dialysis requirement and death.67 In a multicentre study of children with diarrhoea-associated haemolytic uraemic syndrome, urine NGAL obtained early during the hospitalization predicted the severity of AKI and dialysis requirement with high sensitivity.68 Early urine NGAL levels were also predictive of duration of AKI (AUC 0.79) selleck screening library in a heterogeneous cohort of critically ill paediatric subjects.51 In adults undergoing cardiopulmonary bypass, those who subsequently required renal replacement therapy (RRT) were found to have the highest

urine NGAL values soon after Selleck Fludarabine surgery.30–37 Similar results were documented in the adult critical care setting.53–59 Collectively, the published studies revealed an excellent overall AUC-ROC of 0.78 for prediction of subsequent dialysis requirement, when NGAL was measured within 6 h of clinical contact.41 Furthermore, a number of studies conducted in the cardiac surgery and critical care populations have identified early NGAL measurements as a very good mortality marker,30–32,54,55,59 with an overall AUC-ROC of 0.71 in these heterogeneous populations.41 Furthermore, there is now evidence for the utility of subsequent NGAL measurements in critically ill adults with established AKI. Serum NGAL measured at the inception of RRT was an independent predictor of 28-day mortality, with an AUC of 0.74.69 With respect to the sample source, the majority of AKI biomarkers described thus far have been measured in the urine. Urinary diagnostics have several advantages, including the non-invasive nature of sample collection, the reduced number of interfering proteins, and the potential for the development of patient self-testing kits.