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Urine neutrophil gelatinase-associated lipocalin predicts kidney support therapy duration and liberation in critically ill children

Pediatric Research (2025)Cite this article

Abstract

Background

Early identification of kidney recovery in critically ill children and young adults undergoing continuous kidney support therapy (CKST) is essential to optimize care and minimize complications. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker of acute kidney injury, but its utility in predicting CKST duration and guiding timely liberation remains unclear.

Methods

We retrospectively analyzed urinary uNGAL levels in pediatric intensive care unit (PICU) patients (aged 2 months to 25 years) who received CKST between July 2018 and April 2024. We evaluated two outcomes: (1) the ability of peak uNGAL levels during the first four days of CKST to predict prolonged therapy (>7 days), and (2) the performance of uNGAL measured during KST liberation attempts in predicting successful liberation.

Results

Among 57 patients, early peak uNGAL predicted CKST duration >7 days with good accuracy (AUC-ROC 0.85 [95% CI, 0.73–0.97], optimal cutoff 2600 ng/mL). uNGAL also showed excellent performance in predicting successful KST liberation (AUC-ROC 0.95 [95% CI, 0.89–1.00], optimal cutoff 900 ng/mL).

Conclusions

uNGAL may be useful for predicting prolonged CKST duration and guiding KST liberation in critically ill children. Larger prospective studies are needed to confirm its role in personalized CKST management.

Impact statement

  • Peak uNGAL levels within the first four days of CKST are strongly associated with treatment duration >7 days, showing good predictive accuracy.

  • uNGAL demonstrates excellent performance in identifying patients likely to achieve successful KST liberation.

  • uNGAL measured during KST may support clinical decision-making by providing timing insights, potentially optimizing treatment duration in critically ill pediatric patients.

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Fig. 1: uNGAL kinetics from two days before to 7 days after CKST start by CKST duration (≤7 vs. >7 days).

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Giovanni Ceschia, Kelli A. Krallman, Ana C. Navarro & Stuart L. Goldstein

  2. Department for Women’s and Children’s Health, University-Hospital of Padua, Padua, Italy

    Giovanni Ceschia

  3. University of Colorado Anschutz Medical Campus, School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA

    Katja M. Gist

  4. Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Imogen Clover-Brown

  5. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Stuart L. Goldstein

Authors
  1. Giovanni Ceschia
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  2. Katja M. Gist
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  4. Kelli A. Krallman
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  5. Ana C. Navarro
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  6. Stuart L. Goldstein
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Contributions

G.C., I.C.B., K.A.K., and A.C.N. collected the clinical data. G.C. drafted the manuscript, while G.C. and S.L.G. conducted the data analysis and interpretation, serving as the primary authors. K.M.G., I.C.B., A.C.N., and S.L.G. contributed to the critical revision and editing of the manuscript.

Corresponding author

Correspondence to Giovanni Ceschia.

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Competing interests

SLG reports receiving personal fees from Baxter Healthcare, BioPorto Diagnostics, Calcimedica, Fresenius, Novartis, Nuwellis, MediBeacon, Medtronic, Otsuka and SeaStar Medical. KMG reports receiving funding from the Gerber Foundation for the MINI-ROCKET study and is a consultant for Bioporto Diagnostics. She is a member of the Medical Advisory Board for SeaStar Medical and received speaker honoraria from Fresenius. None of these entities had any input into the study or manuscript, and these relationships are not relevant to the manuscript. No other disclosures were reported.

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Ceschia, G., Gist, K.M., Clover-Brown, I. et al. Urine neutrophil gelatinase-associated lipocalin predicts kidney support therapy duration and liberation in critically ill children. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04430-1

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