In patients with chronic hepatitis B on long-term nucleotide analogue therapy, serum neutrophil gelatinase-associated lipocalin (NGAL) can act as a surrogate marker of early renal injury, according to results published in the Journal of Viral Hepatology.

Patients with high baseline serum NGAL concentrations may warrant closer renal monitoring or an early switch to treatments with lower renal toxicity.

The study included treatment-naïve participants with chronic hepatitis B (n=192) who were treated with nucleotide analogue therapy for ≥5 years (median 8.34 years). The researchers compared estimated glomerular filtration rates (eGFR) and urinary protein/creatinine ratio (uPCR) at baseline and last clinical visit. Serum NGAL concentrations were measured at the same time points.

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Participants’ baseline and last-visit eGFR were similar (median: 78 vs 84 ml/min). However, participants’ serum NGAL concentrations increased during therapy (median: 9.4 vs 16.4 ng/ml, P <.05).

The percentage of participants with proteinuria (uPCR>15) increased between baseline and last visit (4.6% vs 21.4%, P <.05), with 30 (16%) participants having de-novo non-albumin proteinuria at last visit.

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Only participants with de-novo non-albumin proteinuria had high baseline NGAL concentrations (median: 31.7 vs. 7.8ng/ml, P <.01). Baseline NGAL levels >25mg/ml were predictive of non-albumin proteinuria at last visit (area under receiver operator curve, 0.813).


Carey I, Byrne R, Childs K, et al. Serum NGAL can act as an early renal safety biomarker during long-term nucleos(t)ide analogue antiviral therapy in chronic hepatitis B [published online April 16, 2018]. J Viral Hepat. doi:10.1111/jvh.12916