Assessment of urinary neutrophil gelatinase-associated lipocalin for the early detection of renal dysfunction among children with beta thalassemia major

Background Thalassemia results in ineffective erythropoiesis, chronic anemia, and hemolysis, often requiring transfusions that lead to secondary iron overload. the renal damage is a common complication in beta thalassemia due to Tubular dysfunction. Conventional renal markers such as serum creatinine (SCr) and proteinuria lack sensitivity for early detection of kidney injury. Novel noninvasive biomarkers, particularly neutrophil gelatinase-associated lipocalin (NGAL), show promise for the timely identification of renal dysfunction in this population. Aim To detect the early renal impairment in children with beta thalassemia major (β-TM). Patients and methods The current case-control study was performed in Port Said hospitals, included 56 patients, 36 β-thalassemia children, 20 age- and sex-matched healthy controls. Key history and physical examination were done on both groups. Laboratory data include complete blood counts, serum biochemical analyses including serum urea (s. urea) SCr, serum potassium, serum ferritin, also urine samples were collected and analyzed to measure the level of NGAL in all groups. Results The results showed a statistically significant increase in urinary NGAL in the β-TM patients group compared with the control group ( P <0.001) and a significant increase in serum s. urea in β-TM patients compared with the control group ( P =0.043). In addition, the study showed a significant increase of s. ferritin in β-TM patients compared with the control group ( P <0.001). NGAL had an area under the curve=0.691, at a cutoff point of 525 showing the best specificity (85%) and accuracy (71.7%), compared with sensitivity of SCr (35%) and s. urea (70%). Conclusion The urinary NGAL has strong potential as an early biomarker for detecting early renal injury in β-TM.