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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Urinary neutrophil gelatinase -associated lipocalin (uNGAL) is a well-established marker of tubular injury, particularly in the setting of acute kidney injury (AKI). Emerging evidence also supports its prognostic value in certain forms of chronic kidney disease (CKD), such as diabetic nephropathy and IgA nephropathy. Recognized as a tubular injury marker, we hypothesized that uNGAL could enhance risk stratification for all-cause mortality when combined with glomerular injury markers, including the urinary albumin-to-creatinine ratio (uACR) and urinary protein-to-creatinine ratio (uPCR), as well as their derived indices, uAPR (urinary albumin-to-protein ratio) and uNAP (non-albumin protein), thereby modeling the continuum from glomerular to tubular injury.
Among 5,625 participants aged 21 to 75 years in the Chronic Renal Insufficiency Cohort (CRIC), we excluded those with over-diluted (urine creatinine <30 mg/dL), over-concentrated (urine creatinine >300 mg/dL), or implausible (urine albumin > urine protein) urine samples. We retrospectively analyzed 3,341 participants with concurrently measured uNGAL, uACR, and uPCR from the same urine specimen. The uAPR was calculated as uACR divided by uPCR, and uNAP as uPCR minus uACR. Associations of uNGAL with all-cause mortality were evaluated using multivariable Cox proportional hazards models. A 3×3 risk matrix was constructed by cross-classifying tertiles of uNGAL with tertiles of uNAP and further stratified by median uAPR.
The median age was 60 years (interquartile range [IQR], 52.0–66.0), and 43.8% were female. During 37,860.4 person-years of follow-up, 1,392 deaths occurred. The median levels (IQR) of uNCR, uNAP, and uAPR were 21.2 (9.3-53.7) mg/g, 80.7 (44.1-248.4) mg/g, and 37.9% (14.4-58.7), respectively. The Spearman correlation coefficient between uNCR and uNAP was 0.495 (Figure). For each doubling in uNCR and uNAP, the adjusted hazard ratios (aHRs) for mortality were 1.15 (95% confidence interval [CI], 1.12–1.19) and 1.17 (95% CI, 1.13–1.20), respectively. Linear dose–response associations with mortality were observed for both uNCR and uNAP. The 3×3 risk matrix showed that participants in the severe concordant category of uNCR and uNAP had the highest mortality risk (aHR, 2.34; 95% CI, 1.90–2.87; Table). Among patients with non–albumin-predominant proteinuria (uAPR <40%), those in the highest tertiles of uNCR and uNAP exhibited the greatest mortality risk (aHR, 2.68; 95% CI, 1.97–3.65).
Table. Risk matrices presenting adjusted hazard ratios (aHRs) for all-cause mortality across combined tertiles of uNCR and uNAP. Models were stratified by age at entry and exit and adjusted for sex, diabetes, hypertension, cardiovascular disease, cancer, use of ACE inhibitors, ARBs, antiplatelet agents, baseline eGFR, hemoglobin, and glucose.
uNGAL and uNAP levels each showed independent and mutually reinforcing positive associations with all-cause mortality, particularly among patients with uAPR <40%, highlighting the role of tubulointerstitial injury in mortality risk assessment in CKD. These findings suggest that integrated evaluation of uNGAL, uNAP, and uAPR may provide practical clinical utility in the routine management of CKD.
