The role of serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in detecting acute kidney injury in preterm neonates exposed to nephrotoxic drugs

Acute kidney injury (AKI) is a serious complication in neonates, especially among those exposed to nephrotoxic medications. Serum neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a potential early biomarker for AKI, but its utility in neonates remains unclear. We aimed to assess the diagnostic performance of serum NGAL as an early predictor of AKI in preterm neonates receiving nephrotoxic drugs in the NICU. This prospective observational study included 70 preterm neonates admitted to the NICU at Kafr Elsheikh University Hospital between September 2023 and April 2024. Neonates receiving nephrotoxic drugs were enrolled, and serum NGAL and creatinine were measured on days 3 and 8 of admission. AKI was defined using modified KDIGO criteria. Comparative statistical analyses were conducted to assess NGAL's predictive value. AKI occurred in 30% of neonates. Serum creatinine and NGAL levels significantly increased after nephrotoxic drug exposure. However, no significant difference was observed between the AKI and non-AKI groups. While serum NGAL levels increased following nephrotoxic drug exposure, a single post-exposure measurement did not reliably predict AKI in preterm neonates. NGAL may have limited utility as a standalone biomarker for early AKI detection in this population.