TY - JOUR T1 - Neutrophil gelatinase-associated lipocalin: primary care diagnostic technology update JF - British Journal of General Practice JO - Br J Gen Pract SP - 542 LP - 543 DO - 10.3399/bjgp16X687505 VL - 66 IS - 651 AU - Roya Hassanzadeh AU - Daniel Lasserson AU - Christopher P Price AU - Carl Heneghan AU - Ann Van den Bruel AU - Annette Plüddemann Y1 - 2016/10/01 UR - http://bjgp.org/content/66/651/542.abstract N2 - Clinical QuestionIn the primary care setting, what is the accuracy and utility of neutrophil gelatinase-associated lipocalin tests to predict, diagnose, and manage acute kidney injury?In current clinical practice, the consensus diagnosis of acute kidney injury (AKI) depends on the detection of an acute rise in serum creatinine and/or oliguria.1 Recognition of AKI in the community is important, as it is relatively common and associated with excess mortality and morbidity.1 In a primary-care-based cohort of around 61 000 patients, 7% had an episode of AKI over a 6-month period.2 However, detection is difficult on clinical grounds alone. In a population-based study among patients retrospectively diagnosed with AKI from laboratory samples using the NHS England AKI algorithm, those who were managed at home by GPs had a higher risk of death than those admitted to hospital.3 Improving the recognition of AKI in the community is a national priority, but the optimal strategy to achieve this is unclear. This horizon scanning article explores the potential for neutrophil gelatinase-associated lipocalin (NGAL) to detect AKI and how this could translate to community settings.The traditional biomarker of creatinine has several important limitations. Creatinine is a product of muscle breakdown and therefore several non-renal factors also influence its concentrations, compromising its performance as a surrogate marker, including age, sex, muscle mass, muscle disease, metabolism, and diet. Further, creatinine is a suboptimal indicator of acute changes in kidney function as studies have shown that >50% of renal function may be lost before creatinine rises are detectable above the upper reference limit. And it is of particular concern that it may not … ER -