Neutrophil gelatinase associated lipocalin as biomarker in predicting acute renal tubular injury following general anesthesia with sevoflurane on low-flow anesthesia

The administration of general anesthesia through inhalation is a frequently employed method. The volatile anesthetic substance known as sevoflurane is believed to possess nephrotoxic properties due to its metabolites, including fluoroacetic acid and molecule A. The combination of low fresh gas flow and elevated concentrations of sevoflurane within the respiratory circuit, along with its passage via the CO2 absorbent, results in heightened degradation of sevoflurane, hence increasing the risk of renal tubule injury. NGAL expression in healthy kidneys is mostly produced by proximal tubular epithelial cells and is primarily located in the loop of Henle and distal tubules of the kidney. NGAL is crucial in controlling cell proliferation, facilitating healing processes, and promoting tubular re-epithelialization following kidney injury. Increased NGAL levels are indicative of acute renal injury. Segrepsis, chronic obstructive pulmonary disease, and cardiac failure are conditions that can disrupt the performance, sensitivity, and specificity of NGAL as a biomarker for renal tubular injury. Age seems to have an impact on the performance of the NGAL biomarker. The NGAL examination can be conducted using either urine or plasma samples, yielding comparable outcomes. The receiver operating characteristic (ROC) curve for urine NGAL in predicting acute renal injury was 0.998, while for plasma NGAL it was 0.91. The NGAL examination is based on the utilization of monoclonal antibodies. The ELISA approach is commonly employed in the majority of NGAL testing conducted for research purposes. One of the benefits associated with NGAL is its non-invasive nature, rapidity, and sensitivity in facilitating early detection.