Urinary Lipocalin-2 Levels in Pregnant Women with Asymptomatic Fungal Urinary Tract Infection: A Cross-sectional Study from Enugu Metropolis, Nigeria
Ogechukwu Calista Dozie-Nwakile
Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
Ebere Adaeze Onyebueke
Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
Ferdinand Chinwetalu Onwuka
Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
Oluchi Mary Okeh
Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
Aghatise Kevin Erhamwonyi
Department of Medical Laboratory Science, Igbinedion University, Okada, Edo State, Nigeria.
Seto Tunrayo Aladenika *
Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Fungal urinary tract infection (UTI) during pregnancy is an under-appreciated clinical challenge, with most cases presenting asymptomatically and therefore often undetected. Lipocalin-2 (neutrophil gelatinase-associated lipocalin; NGAL) is an acute-phase protein and an established urinary biomarker of renal tubular stress and urinary tract infection. Its utility in detecting asymptomatic fungal UTI in pregnancy remains unexplored.
Aim: The purpose of this study was to assess urinary Lipocalin-2 concentrations in pregnant women with asymptomatic fungal UTI (funguria) and to examine associations between Lipocalin-2 levels and key obstetric variables.
Materials and Methods: A hospital-based cross-sectional study was conducted among 72 pregnant women attending antenatal clinics in Enugu metropolis, Nigeria. Participants were allocated to a funguria group (n = 39) and a non-funguria control group (n = 33). Mid-stream urine specimens were analysed for Lipocalin-2 concentration by enzyme-linked immunosorbent assay (ELISA), urinary pH, and specific gravity.
Results: Mean urinary Lipocalin-2 did not differ significantly between the funguria (4.19 ± 0.42 ng/mL) and non-funguria groups (4.38 ± 0.62 ng/mL; p = 0.799). Urinary pH and specific gravity were similarly comparable between groups (p = 0.524 and p = 0.452, respectively). Within the funguria group, gestational age was the only variable significantly associated with Lipocalin-2 level (p < 0.001), with the highest concentrations observed in the second trimester (6.85 ± 0.60 ng/mL). Age, parity, and history of UTI did not significantly influence Lipocalin-2 levels.
Conclusion: Urinary Lipocalin-2 does not appear to be significantly elevated in asymptomatic fungal UTI during pregnancy compared to non-infected controls, suggesting limited utility as a standalone diagnostic biomarker for this condition. The observed gestational age-related variation in Lipocalin-2 warrants further investigation. Routine antenatal funguria screening using culture-based methods remains recommended in this population.
Keywords: Lipocalin-2, NGAL, funguria, candiduria, asymptomatic urinary tract infection, pregnancy, antenatal care, Enugu, Nigeria, biomarker