Neutrophil Gelatinase-associated Lipocalin in the Cardio–Renal Axis – Pathogenic Factor or Just a Risk Biomarker?

The kidney and the heart are strictly and reciprocally connected in health as well as in disease. The discovery of new factors involved in the pathogenesis and complications of cardiovascular and renal disease is mandatory to improve our knowledge and clinical management of the so-called cardio–renal syndromes. Neutrophil gelatinase-associated lipocalin (NGAL), a small 25 kDa protein mainly produced by damaged tubular cells, is emerging as one of the most promising biomarkers for the early diagnosis of acute kidney injury and chronic kidney disease progression. Recent studies have underlined that NGAL also has a central role in the pathogenesis of atherosclerosis, myocardial infarction, heart failure and even anaemia. Future studies are thus eagerly awaited to ascertain whether NGAL can be considered a true pathogenic factor of both renal and cardiac disease, or whether it is just a useful risk marker.