American Journal of Clinical Medicine Research
ISSN (Print): 2328-4005 ISSN (Online): 2328-403X Website: Editor-in-chief: Dario Galante
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American Journal of Clinical Medicine Research. 2018, 6(2), 48-52
DOI: 10.12691/ajcmr-6-2-5
Open AccessArticle

The Difference of Urinary Neutrophil Gelatinase-Associated Lipocalin Levels in Moderate Malnutrition and Well-Nutrition in School-age Children

Asri Rachmawati1, , Nanan Sekarwana1 and Susi Susanah1

1Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung. Indonesia

Pub. Date: August 13, 2018

Cite this paper:
Asri Rachmawati, Nanan Sekarwana and Susi Susanah. The Difference of Urinary Neutrophil Gelatinase-Associated Lipocalin Levels in Moderate Malnutrition and Well-Nutrition in School-age Children. American Journal of Clinical Medicine Research. 2018; 6(2):48-52. doi: 10.12691/ajcmr-6-2-5


Background. The prevalence of school-age children with moderate malnutrition in Indonesia is high enough that growth monitoring and nutritional intervention in school-aged children are required. Moderate malnutrition in school-age children who are not well managed might reduce the quality of human resources in the productive age. Malnutrition can affects reduced protein synthesis, hypoalbuminemia, and decreased oncotic pressure, in addition to decrease in glomerular filtration rate and impaired tubular function. If the renal tubules damage, the level of Neutrophil gelatinase-associated lipocalin (NGAL) excreted in the urine will increase because NGAL can not be properly reabsorbed. NGAL is expressed by the tubules and passes through the urine quickly after the kidney is injured and inflamed. Methodology/Principal Findings. This was a cross-sectional study conducted from November-December 2017 in children aged 6–13 years old at Garuda Elementary School in Bandung. Subjects were selected through stratified random sampling. We got 39 children with moderate malnourished and 39 well-nourished children who met the study criterias. Weight, height and urine NGAL of subjects were measured. Nutritional status were determined using WHO Child Growth Standards. Urine sampling was done by collecting 10 ml of midstream urine in a sterile container, labeled with name, study registry number and date of material collection. The samples were then immediately sent to Hasan Sadikin Hospital laboratory. Urinary NGAL level was examined using ELISA method. Data analysis using Mann Whitney test. There was significant difference in urinary NGAL levels between well-nourished and moderate malnourished children (p<0.05). Median of urinary NGAL levels in moderate malnourished group were higher than in the well-nourished group with a difference of 43.6 and 95% CI between 38.3-50.1. Conclusions. The level of urinary NGAL (uNGAL) in moderately malnourished children were higher than in well-nourished children.

moderate malnutrtion children urinary NGAL

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[1]  Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan Republik Indonesia. Riset kesehatan dasar, RISKESDAS 2013. In: Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan Republik Indonesia, (Eds). Jakarta; 2013.
[2]  Thakur B, Mehrotra R, Nigam JS. Correlation of various techniques in diagnosis of tuberculous lymphadenitis on fine needle aspiration cytology. Hindawi. 2013.
[3]  WHO. Technical note: Supplementary foods for the management of moderate acute malnutrition in infants and children 6-59 months of age. Geneva: World Health Organization; 2012 Contract No.: Document Number|.
[4]  Blössner M, Onis Md. Malnutrition: Quantifying the health impact at national and local levels. World Health Organization. 2005.
[5]  Syahrul S, Kimura R, Tsuda A, Susanto T, Saito R, Ahmad F. Prevalence of underweight and overweight among school-aged children and it's association with children's sociodemographic and lifestyle in indonesia. Int J Nurs Stud. 2016; 3: 169-77.
[6]  Yeasmin S, Islam K. Prevalence and determinants of undernutrition among school age slum children in dhaka city, bangladesh. J Nutr Health Sci. 2016; 3(2): 1-8.
[7]  Black RE, Victora CG, Walker SP, Bhutta ZqA, Christian P, Onis Md, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013: 1-25.
[8]  WHO. WHO child growth standards and the identification of severe acute malnutrition in infants and children. World Health Organization. 2009: 1-11.
[9]  Ece A, Gözü A, Bükte Y, Tutanç M, Kocamaz H. The effect of malnutrition on kidney size in children. Pediatr Nephrol. 2007; 22: 857-63.
[10]  Dharnidharka V, Ortur AS, Kandoth R, Tiyeh B, Bbagh S. Effect of body size and malnutrition on renal size in childhood. Nephrology. 1998; 4: 361-5.
[11]  Benabe JE, Martinez-Maldonado M. The impact of malnutrition on kidney function. Miner Electrolyte Metab. 1998; 24: 20-6.
[12]  Alleyne GAO. The effect of severe protein calorie malnutrition on the renal function of jamaican children. Pediatrics. 1967; 39(3): 400-11.
[13]  Bolignano D, Donato V, Coppolino G, Campo S, Buemi A, Lacquaniti A, et al. Neutrophil gelatinase–associated lipocalin (NGAL) as a marker of kidney damage. Am J Kidney Dis. 2008; 52: 595-605.
[14]  Soni SS, Cruz D, Bobek I, Chionh CY, Nalesso F, Lentini P, et al. NGAL: A biomarker of acute kidney injury and other systemic conditions. Int Urol Nephrol. 2010; 42: 141-50.
[15]  Yim HE. Neutrophil gelatinase-associated lipocalin and kidney diseases. Child Kidney Dis. 2015; 19: 79-88.
[16]  Devarajan P. Neutrophil gelatinase-associated lipocalin (NGAL): A new marker of kidney disease. Scand J Clin Lab Invest Suppl. 2008; 241: 89-94.
[17]  Schmidt-Ott KM, Mori K, Li JY, Kalandadze A, Cohen DJ, Devarajan P, et al. Dual action of neutrophil gelatinase–associated lipocalin. J Am Soc Nephrol. 2007; 18: 407-13.
[18]  Mishra A, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol. 2003; 14: 2534-43.
[19]  Lisowska-Myjak B. Serum and urinary biomarkers of acute kidney injury. Blood Purif. 2010; 29: 357-65.
[20]  Noto A, Cibecchini F, Fanos V, M.Mussap. NGAL and metabolomics: The single biomarker to reveal themetabolome alterations in kidney injury. BioMed Research International. 2013: 1-6.
[21]  Chakraborty S, Kaur S, Tong Z, Batra SK, Guha S. Neutrophil gelatinase associated lipocalin: Structure, function and role in human pathogenesis. In: Veas F, (Eds). Acute phase proteins - regulation and functions of acute phase proteins. InTech Europe; 2011. hlm. 345-68.
[22]  Atta H, Bakry S, Obaia E, Gengehy SE, Mohamed W. Serum and urinary NGAL in acute and chronic kidney disease. JPBMS. 2011; 4(13): 1-6.
[23]  Bennett MR, Nehus E, Haffner C, Ma Q, Devarajan P. Pediatric reference ranges for acute kidney injury biomarkers. Pediatr Nephrol. 2015; 30(4): 677-85.
[24]  Klahr S, Tripathy K. Evaluation of renal function in malnutrition. Arch Intern Med. 1966; 118 (322-325).
[25]  Kartawinata Y, Hilmanto D, Nataprawira HM. Kadar serum kreatinin dan cystatin-c pada kelompok anak status gizi kurang serta gizi normal. J Indon Med Assoc. 2012; 62(12): 471-4.
[26]  Yazdani M, Merrikhi A, Beni ZN, Baradaran A, Soleimani N, Musazade H. Association between neutrophil gelatinase-associated lipocalin and iron deficiency anemia in children on chronic dialysis. J Res Med Sci. 2014; 19: 624-8.
[27]  Basu RK, Wong HR, Krawczeski CD, Wheeler DS, Manning PB, Chawla LS, et al. Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. J Am Coll Cardiol. 2014; 64(25): 2753-62.
[28]  Luyckx VA, Brenner BM. Birth weight, malnutrition and kidney associated outcomes-a global concern. Nat Rev Nephrol. 2015; 11: 135-49.
[29]  Gopal G, R.Premalatha. Effect of malnutrition on kidney size and incidence of urinary tract infection in malnourished children. Int J Pharm Biomed Res. 2014; 5(1): 29-35.