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Neutrophil gelatinase-associated lipocalin for urinary tract infection and pyelonephritis: a systematic review

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Abstract

Background

The sensitivity and specificity of the leukocyte esterase test are relatively low for a screening test for urinary tract infection (UTI). More accurate tests could reduce both overtreatment and missed cases. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) can replace leukocyte esterase in the diagnosis of UTI and/or whether NGAL accurately identifies children with acute pyelonephritis.

Methods

Data sources—MEDLINE and EMBASE. We only considered published studies that evaluated the results of an index test (NGAL) against the results of urine culture (for UTI) or against the results of dimercaptosuccinic acid (for acute pyelonephritis) in children aged 0 to 18 years. Two authors independently applied the selection criteria to all citations and independently extracted the data.

Results

A total of 12 studies met our inclusion criteria. Four studies (920 children) included data on NGAL for UTI; eight studies (580 children) included data on NGAL for pyelonephritis. We did not pool accuracy values because the included studies used different cutoff values. For the diagnosis of UTI, urinary NGAL appeared to have better accuracy than the leukocyte esterase test in all included studies. For the diagnosis of pyelonephritis, neither plasma NGAL nor urinary NGAL had high sensitivity and/or specificity. The number of studies was the main limitation of this systematic review.

Conclusions

Urinary NGAL appears promising for the diagnosis of UTI; however, larger studies are needed to validate this marker as a replacement for leukocyte esterase. The use of NGAL for diagnosing acute pyelonephritis requires further study.

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Abbreviations

UTI:

Urinary tract infection

NGAL:

Neutrophil gelatinase-associated lipocalin

pNGAL:

Plasma neutrophil gelatinase-associated lipocalin

uNGAL:

Urine neutrophil gelatinase-associated lipocalin

APN:

Acute pyelonephritis

PCT:

Procalcitonin

CRP:

C-reactive protein

DMSA:

Dimercaptosuccinic acid

WBC:

White blood cell

CFU:

Colony-forming unit

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

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Authors and Affiliations

  1. Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, 3414 Fifth Ave, Pittsburgh, PA, 15213-2583, USA

    Kai Shaikh, Vinod Rajakumar, Victor A. Osio & Nader Shaikh

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  1. Kai Shaikh
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  2. Vinod Rajakumar
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  3. Victor A. Osio
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  4. Nader Shaikh
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Contributions

Dr. Nader Shaikh is responsible for the study concept and design, acquisition of data, analysis and interpretation of data, drafting the manuscript, and statistical analysis. He had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Kai Shaikh, Victor Osio, and Vinod Rajakumar are responsible for the acquisition of data, analysis and interpretation of data, and drafting of the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Nader Shaikh.

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Shaikh, K., Rajakumar, V., Osio, V.A. et al. Neutrophil gelatinase-associated lipocalin for urinary tract infection and pyelonephritis: a systematic review. Pediatr Nephrol 36, 1481–1487 (2021). https://doi.org/10.1007/s00467-020-04854-3

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