Serum neutrophil gelatinase-associated lipocalin and cystatin C as markers of renal function in patients with stages 2–5 chronic kidney disease

Individuals with reduced glomerular filtration rate (GFR) are at greater risk for cardiovascular disease and other comorbidities. Creatinine-based equations are used to estimate GFR, identify patients with potential kidney disease, and classify them into different stages since serum creatinine is insensitive to changes in the GFR. The aim of our work was to evaluate diagnostic performance of serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) as markers of kidney function in patients with reduced GFR. Fifty cases at different stages of renal impairment and 30 healthy control subjects were tested. Only serum NGAL and cystatin C were higher in stage 2 chronic kidney disease (CKD) when compared to the control group (p < 0.05). For stages 3–5 the median levels of cystatin C, NGAL, and creatinine were found to be significantly higher than the control group. ROC curve constructed to differentiate stage 2 patients from the controls showed AUC for NGAL 0.795, sensitivity 86%, and specificity 63.3%; AUC for cystatin C 0.957, sensitivity 86%, and specificity 90%; and AUC for creatinine 0.738. Frequency of cases that tested positive for NGAL and cystatin C in stage 2 was higher than those in control group (p < 0.05) with an OR of 10.364 (95% CI 1.099–97.686) for NGAL and OR 54 (95% CI 4.7–613) for cystatin C. NGAL and cystatin C exhibited higher sensitivity than creatinine for diagnosis of stage 2 CKD. Their use as adjunctive diagnostic tools in patients with mildly reduced GFR may be justified on the long term to diagnose early renal insult.