Microalbuminuria, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) as predictors of preeclampsia and gestational diabetes mellitus

Background: The health of young women of reproductive age is a key factor that directly influences the health of future generations. Therefore, early detection of chronic diseases, including chronic kidney disease, in this category of patients is one of the primary objectives of healthcare services. From an obstetric perspective, preventing chronic kidney disease can be linked to the early detection and prediction of preeclampsia and gestational diabetes mellitus. In the literature, there are studies that investigate microalbuminuria, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) as predictors of these obstetric complications.

Aim: The aim of this study was to evaluate microalbuminuria, KIM-1, and NGAL as markers for the development of gestational diabetes mellitus and preeclampsia.

Materials and methods: This prospective study was conducted at the Department of Obstetrics and Gynecology, Academician I.P. Pavlov First Saint Petersburg State Medical University (Saint Petersburg, Russia) and involved 280 pregnant women during the first trimester at 6-13 weeks of gestation. The concentrations of microalbuminuria, KIM-1, and NGAL were measured. The second stage involved assessing the course of pregnancy and the development of obstetric complications in the participants. ROC analysis was performed to assess biological markers as predictors of preeclampsia, and predictive value was evaluated by the area under the ROC curve.

Results: The urinary KIM-1 levels in all patients were within the reference values. Microalbuminuria in the range from 30 to 300 mg/L was detected in 20 patients (7.14%). Gestational diabetes mellitus was more common in patients with microalbuminuria above 30 mg/L (p = 0.0358). Elevated serum NGAL levels above the reference values (106 ng/L) were observed in 96 patients (34.2%). Urinary NGAL levels exceeded 9.8 ng/L in 203 patients (72.5%). Moderate or severe preeclampsia developed in 63 (22.5%) pregnant women. ROC analysis of NGAL’s predictive ability showed high sensitivity and specificity for preeclampsia prediction (sensitivity 95.24%, specificity 93.09%, area under the ROC curve 0.93).

Conclusions: The data obtained suggest that the assessment of albuminuria, serum NGAL, and urinary NGAL levels in the blood serum and urine of pregnant women during the first trimester of gestation may serve as early prognostic biomarkers for gestational diabetes mellitus and preeclampsia.