Serum FGF23 and Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) Correlation with Glomerular Filtration Rate, Measured with a Reference Technique in Children with CKD
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Bibliographic record
Abstract
Background: Prognosis of chronic kidney disease (CKD) is closely related to early diagnosis and initiation of nephroprotective measures. Current kidney injury biomarkers are suboptimal for predicting kidney disease progression. Fibroblast Growth Factor 23 (FGF23) is well described as an early marker that increases proportionally to worsening CKD stages in adults. Neutrophil gelatinase-associated lipocalin (NGAL) is known to increase early after acute kidney injury, as a marker of AKI severity, however, it has not been validated as an early marker in CKD. The aim of this study is to investigate the association between FGF23, NGAL and glomerular filtration rate (GFR) in children and evaluate their role in ascertaining moderate to severe CKD. Methods: Children aged 5 to 20 years old requiring kidney function assessment following primary nephropathy, solid organ transplantation or secondary nephropathy were recruited prospectively in a tertiary hospital of Switzerland for a reference measure of their GFR, with simultaneous measurement of plasma FGF23 and urinary NGAL. Results: 123 clearances were analyzed, in children mostly post solid organ transplantation (46%) or with primary nephropathy (37%). 42% had stage I CKD, 40% had stage II CKD and 12% had stage III or IV CKD. FGF23 was significantly higher in stage III or IV CKD (mean: 282.02 UI/ml ± 174.71) compared to stage I (mean: 143.76 UI/ml ± 178.61 ; p<0.001) or stage II (mean: 104.61 UI/ml ± 63.52; p<0.001). The area under the ROC curve for FGF23 to discriminate CKD stages I-II versus III-IV was 0.864 (95% confidence interval (CI): 0.780-0.947). NGAL values were more elevated in stage III or IV CKD (mean: 103.65 UI/ml ± 129.43) compared to stage I (mean: 36.19 UI/ml ± 100.36 ; p=0.016) or stage II (mean: 44.86 UI/ml ± 104.66; p=0.082). The area under the ROC curve for NGAL to discriminate CKD stages I-II versus III-IV was 0.688 (95% CI: 0.512-0.864). Conclusions: FGF23 is significantly associated with decreasing GFR in children and discriminates for the presence of moderate to severe CKD in children. NGAL was not as strongly associated to decreasing GFR. Further studies are needed to evaluate FGF23 and NGAL as markers of CKD progression.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it