Medición del NGAL urinario en el donante para detectar función retardada del injerto renal en el receptor

John Fredy Nieto-Ríos, Lina María Serna Higuita, Catalina Ocampo Kohn, Arbey Aristizabal-Alzate, Sandra Lopera, Ana Maria Bedoya-Londoño, Carlos Mario Merchan-Ospina, John Bairo Palacio-Garces, Alex Mauricio Garzón-Muñoz, Maria Eugenia Nieves-Posada, Nelson Darío Giraldo, Gustavo Adolfo Zuluaga-Valencia

Resumen


Introducción: en el trasplante renal de donante fallecido es importante tener marcadores tempranos que ayuden a predecir la funcionalidad adecuada del injerto renal. La medición de creatinina continúa siendo el marcador de elección para definir si los riñones de un posible donante son aptos para ser trasplantados. La lipocalina asociada a la gelatinasa del neutrófilo urinaria (NGALu) es un biomarcador que ha sido utilizado para el diagnóstico temprano de lesión renal aguda, pero su comportamiento es incierto en el donante fallecido. Este estudio tiene como objetivo determinar si los niveles de NGALu del donante pueden predecir la función retardada del injerto (FRI) en los receptores. Metodología: cohorte prospectiva en la que se evaluaron los niveles de NGALu del donante al momento de la extracción renal; se aplicó estadística descriptiva y pruebas no paramétricas. Se exploró el comportamiento de este biomarcador en el donante del injerto renal para determinar si es un factor predictivo de función retardada del injerto. Resultados: se evaluaron 27 donantes de criterios óptimos; el 74,1 % eran hombres, la edad tuvo una mediana de 27 años (rango: 18,8-43,3); la principal causa de muerte fue trauma encefalocraneano, seguido por el accidente cerebrovascular. La creatinina tuvo una mediana de 0,8 mg/dl y los valores de NGALu tuvieron una mediana de 11,1ng/ml (4,2-33,6). En total se realizaron 46 trasplantes, de los cuales el 15,2 % presentaron función retardada del injerto y dos pacientes necesitaron terapia de reemplazo renal en la primera semana luego del trasplante. Los valores de NGALu agrupados de acuerdo a presencia o no de función retardada del injerto fueron de 11,1 (3-17,3) ng/ml en los pacientes sin función retardada del injerto y 11,2 ng/ml en los pacientes con dicha función (7,7-39,4) (p=0,40). En el análisis multivariado no se encontró ningún factor asociado al desarrollo de función retardada del injerto. Conclusión: en este estudio la medición de uNGAL en donantes fallecidos de criterios óptimos no predijo función retardada del injerto.

DOI: http://dx.doi.org/10.21615/cesmedicina.30.2.2


Palabras clave


Función retardada del injerto renal; lipocalina asociada a la gelatinasa del neutrófilo urinaria; trasplante renal; creatinina sérica

Citas


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