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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2026323.6996
Published online: 06 August 2026
Original article
J of IMAB. 2026 Jul-Sep;32(3):6996-7001
CHANGES IN SERUM LEVELS OF NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AND THEIR RELATIONSHIP WITH THE PROGRESSION OF CHRONIC KIDNEY DISEASE
Borislav Ignatov1
, Krasimir Kostov1, Tsvetelina Eftimova2, Alexander Blazhev3, Tatyana Simeonova1
,
1) Department of Physiology and Pathophysiology, Faculty of Medicine, Medical University – Pleven, Bulgaria.
2) Department of Dialysis, University Hospital "Saint Marina" – Pleven, Bulgaria.
3) Department of Anatomy, Histology, Cytology and Biology, Faculty of Medicine, Medical University – Pleven, Bulgaria.
ABSTRACT:
Chronic kidney disease (CKD) affects over 10% of the global population, posing significant challenges due to its asymptomatic nature in early stages and progressive deterioration of renal function. The identification of reliable biomarkers for early diagnosis and monitoring of disease progression is crucial for improving prognosis and treatment. Neutrophil gelatinase-associated lipocalin (NGAL) is a promising candidate, already validated as a marker for acute kidney injury.
Purpose: This study aimed to evaluate the potential of serum NGAL levels as a biomarker for diagnosis and monitoring the progression of CKD.
Material/Methods: Seventy-one adult Caucasian patients at CKD stages G1–G4 according to the KDIGO criteria were divided into three groups: Group 1 (eGFR ≥90 mL/min/1.73m²), Group 2 (eGFR 45–89 mL/min/1.73m²), and Group 3 (eGFR 15–44 mL/min/1.73m²). Blood samples were collected and analyzed via standard biochemical and immunological techniques. Serum NGAL levels were measured using ELISA.
Results: NGAL levels increased significantly with disease progression and strongly correlated with declining eGFR. Higher NGAL levels were linked to elevated serum creatinine and inflammatory markers, indicating progressive damage to the kidney tissue against the backdrop of persistent systemic inflammation.
Conclusions: As a biomarker, NGAL has significant potential for identifying and monitoring kidney damage. Its application in clinical settings could complement and improve existing methods for diagnosing and observing CKD.
Keywords: chronic kidney disease (CKD), neutrophil gelatinase-associated lipocalin (NGAL), biomarkers of kidney disease progression, chronic systemic inflammation,
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Please cite this article as: Ignatov B, Kostov K, Eftimova T, Blazhev A, Simeonova T. Changes in serum levels of neutrophil gelatinase-associated lipocalin (NGAL) and their relationship with the progression of chronic kidney disease. J of IMAB. 2026 Jul-Sep;32(3):6996-7001. [Crossref - 10.5272/jimab.2026323.6996]
Correspondence to: Tatyana Simeonova, Department of Physiology and Pathophysiology, Medical University-Pleven; 1, St. Kliment Ohridski Str., Pleven, 5800, Bulgaria. E-mail: dr_tsimeonova@abv.bg
REFERENCES:
1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022 Apr;12(1):7-11. [PubMed]
2. Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024 Jul;20(7):473-485. [PubMed]
3. Rocco MV, Berns JS. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012 Nov;60(5):850–886.[PubMed]
4. Shefket S. [Predictive role of NGAL – neutrophil gelatinase-associated lipocalin as an early marker for renal injury in patients with diabetes mellitus type 1 and type 2.] [dissertation] Varna (Bulgaria): Medical University Varna. 2022; p.81. [in Bulgarian] [Internet]
5. Bourgonje AR, Abdulle AE, Bourgonje MF, Kieneker LM, la Bastide-van Gemert S, Gordijn SJ, et al. Plasma Neutrophil Gelatinase-Associated Lipocalin Associates with New-Onset Chronic Kidney Disease in the General Population. Biomolecules. 2023 Feb 9;13(2):338. [PubMed]
6. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41. [PubMed]
7. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006 Aug 15;145(4):247–254. [PubMed]
8. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May 5;150(9):604-12. [PubMed]
9. Di Somma S, Magrini L, De Berardinis B, Marino R, Ferri E, Moscatelli P, et al. Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department. Crit Care. 2013 Feb 12;17(1):R29. [PubMed]
10. Romejko K, Markowska M, Niemczyk S. The Review of Current Knowledge on Neutrophil Gelatinase-Associated Lipocalin (NGAL). Int J Mol Sci. 2023 Jun 21;24(13):10470. [PubMed]
11. Kaul A, Behera MR, Rai MK, Mishra P, Bhaduaria DS, Yadav S, et al. Neutrophil gelatinase-associated lipocalin: as a predictor of early diabetic nephropathy in type 2 diabetes mellitus. Indian J Nephrol. 2018 Jan-Feb;28(1):53-60. [PubMed]
12. Prashant P, Dahiya K, Bansal A, Vashist S, Dokwal S, Prakash G. Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a potential early biomarker for diabetic nephropathy: a meta-analysis. Int J Biochem Mol Biol. 2024 Feb 15;15(1):1-7. [PubMed]
13. Bolignano D, Lacquaniti A, Coppolino G, Donato V, Fazio MR, Nicocia G, et al. Neutrophil gelatinase-associated lipocalin as an early biomarker of nephropathy in diabetic patients. Kidney Blood Press Res. 2009;32(2):91–98. [PubMed]
14. Ding H, He Y, Li K, Yang J, Li X, Lu R, et al. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for renal tubulointerstitial injury in IgA nephropathy. Clin Immunol. 2007 May;123(2):227–234. [PubMed]
15. Rhee H, Shin N, Shin MJ, Yang BY, Kim IY, Song SH, et al. High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy. Korean J Intern Med. 2015 May;30(3):354-361. [PubMed]
16 Chen W, Li W, Zhang Z, Tang X, Wu S, Yao G, et al. Lipocalin-2 exacerbates lupus nephritis by promoting Th1 cell differentiation. J Am Soc Nephrol. 2020 Oct;31(10):2263-2277. [PubMed]
17. Viau A, El Karoui K, Laouari D, Burtin M, Nguyen C, Mori K, et al. Lipocalin 2 is essential for chronic kidney disease progression in mice and humans. J Clin Invest. 2010 Nov;120(11):4065-4076. [PubMed]
18. Danquah M, Owiredu WKBA, Jnr BAE, Serwaa D, Odame Anto E, Peprah MO, et al. Diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for detection of renal failure in hypertensives: a case–control study in a regional hospital in Ghana. BMC Nephrol. 2023 Apr 26;24(1):1–10. [PubMed]
19. Song E, Fan P, Huang B, Deng HB, Cheung BM, Félétou M, et al. Deamidated lipocalin-2 induces endothelial dysfunction and hypertension in dietary obese mice. J Am Heart Assoc. 2014 Apr 10;3(2):e000837. [PubMed]
20. Courbon G, Francis C, Gerber C, Neuburg S, Wang X, Lynch E, et al. Lipocalin 2 stimulates bone fibroblast growth factor 23 production in chronic kidney disease. Bone Res. 2021 Aug 2;9(1):35. [PubMed]
21. Han M, Li Y, Wen D, Liu M, Ma Y, Cong B. NGAL protects against endotoxin-induced renal tubular cell damage by suppressing apoptosis. BMC Nephrol. 2018 Jul 6;19(1):168. [PubMed]
22. Steflea RM, Stoicescu ER, Aburel O, Horhat FG, Vlad SV, Bratosin F, et al. Evaluating neutrophil gelatinase-associated lipocalin in pediatric CKD: correlations with renal function and mineral metabolism. Pediatr Rep. 2024 Dec 9;16(4):1099-1114. [PubMed]
Received: 31 March 2026
Published online: 06 August 2026