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Introduction: We assessed the urinary level of L-FABP in patients with APN and compared between patients with scar versus normal kidneys.Methods: We enrolled children aged 2 months to 12 years old with APN. The urine concentration of L-FABP and L-FABP/Cr were measured. Patients divided into three groups; patients with scarring APN as group 1, patients with non-scarring APN as group 2, and controls.Results: 79 children (aged 57.4 ± 40.5 months, (87.5%) female) enrolled in the study. Group 1 was composed of 19 (16 female) cases, group two 35 (32 female) cases, and group three 26 (2 female) healthy controls. There was no significant difference in absolute urinary level of L-FABP between APN groups and controls. Group 1 patients had a significantly higher concentration than group 2 (P < .05). The UL-FABP /Cr was significantly higher in group 1, than groups 2 and 3 [(0.28 ± 0.39 pg/mg, 0.08 ± 0.08 pg/mg, and 0.10 ± 0.09 pg/mg; respectively), (P < .05, P < .05)]. The difference between group 2 and 3 was not significant (P > .05). The sensitivity and specificity of UL-FABP32 /Cr ratio in prediction of scar was 50% to 72% and 44% to 56%, respectively.Conclusion: The urinary ratio of L-FABP to creatinine is not a useful tool for diagnosis of APN or VUR but could be helpful in prediction of long-term potency to renal parenchymal scar formation. [ABSTRACT FROM AUTHOR]