Plasma NGAL-detected kidney injury following paediatric spine surgery: role of intraoperative hypotension

Although 12% of the children developed clinical AKI, approximately one-third had subclinical AKI detectable only by NGAL. Plasma NGAL at the 6th hour demonstrated excellent sensitivity for predicting AKI, with a threshold of 86 ng/mL. Intraoperative hypotension was a major predictor, with a MAP < 70 mmHg linked to tubular damage whereas deeper hypotension (MAP < 60 mmHg) was linked to clinical AKI. This study is the first to define NGAL cut-off values and intraoperative MAP thresholds for postoperative AKI in paediatric non-cardiac surgery.