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Background Acute Kidney Injury (AKI) is a common and serious complication of cardiovascular surgery.There is a need to find biomarkers that are involved in the etiology of cardiac surgery-associated acute kidney in jury (CSA-AKI) and have an earlier response to acute kidney injury.The association between urine neutrophil gelatinase-associated lipocalin (NGAL) concentrations and AKI progression is not well established.Methods The prospective-cohort study included 1631 consecutive adult patients undergoing cardiac surgery at Fuwai Hospital between September 2012 and November 2013.AKI defined by Acute Kidney Injury Network (AKIN) criteria with a postoperative increase in plasma creatinine ≥50％ baseline or ≥0.3 mg/dL.Urine NGAL was measured using latex particle-enhanced turbidimetric immunoassay.Associations between Urine NGAL levels and AKI were determined by estimating areas under receiver operating characteristic curves (AUC).Results A total of 438 (26.9％) patients developed CSA-AKI.And the patients were divided into four groups:1193 non-AKI patients,368(22.6％) patients with AKIN stage 1 AKI,49(3.0％) with AKIN stage 2 AKI and 21(1.3％) with AKIN stage 3 AKI.urine NGAL concentrations at surgical intensive care unit (SICU) admission were significantly related to AKI severity.The AUCs for urine NGAL were for AKIN stage 1 (0.54±0.02),AKIN stage 2 (0.67±0.04),and AKIN stage 3 (0.76±0.06),respectively.Conclusions Urinary NGAL is associated with CSA-AKI and its progression,indicating their potential use as prognostic markers.Urine NGAL level measured at SICU admission predicts the development of severe AKI after cardiac surgery.