Serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for predicting high dose methotrexate associated acute kidney injury in children with acute lymphoblastic leukemia

  • Hui Li
  • Qiong XuEmail author
  • Yang Wang
  • Kailan Chen
  • Jianxin Li
Original Article



The present study was aimed at assessing the value of serum NGAL in identifying early acute kidney injury induced by HDMTX.


Children aged 1–14 years with newly diagnosed ALL receiving MTX over 3 g/m2 were enrolled. Serum NGAL concentrations, serum creatinine (Scr) and MTX concentrations were measured. The area under the receiver-operating characteristic curve (ROC) was used for evaluating variables’ ability of early diagnosis of AKI.


A total of 196 courses of 62 patients were assessed, and 22 courses (11.2%) developed AKI. Twenty-four hours serum NGAL concentrations, 24 h Scr ratio, 48 h Scr ratio, CMTX24 h, CMTX48 h, CMTX72 h were significantly higher in patients with AKI. The combination of 24 h Scr ratio and 24 h serum NGAL had higher value for detecting HDMTX induced AKI compared with the 24 h Scr ratio. And the combination had similar value for detecting HDMTX induced AKI compared with the 48 h Scr ratio. After 48 h, CMTX48 h had a satisfying accuracy in predicting AKI. The proportion of post-HDMTX sepsis in patients with AKI was significantly higher than that in patients without AKI.


Serum NGAL levels could be used as a marker in identifying the direct kidney tubular damage induced by HDMTX. The combination of 24 h Scr ratio and 24 h serum NGAL had higher value for early diagnosis of HDMTX associated AKI compared with the 24 h Scr ratio.


Neutrophil gelatinase-associated lipocalin High-dose methotrexate Acute kidney injury 



Neutrophil gelatinase-associated lipocalin




Acute kidney injury


Serum creatinine


Receiver-operating characteristic curve

24 h Scr ratio

24 h Serum creatinine/baseline creatinine

48 h Scr ratio

48 h Serum creatinine/baseline creatinine


Creatinine clearance


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Hematology, Wuhan Children’s Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
  2. 2.Department of Clinical Pharmacology, Wuhan Children’s Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina

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