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Abdelhafez MO, Alhroob AA, Abu Hawilla MO, Rjoob AA, Abualia NM, Gorman EF, Hamadah AM, Gharaibeh KA. Utility of fractional excretion of urea in acute kidney injury with comparison to fractional excretion of sodium: A systematic review and meta-analysis. Am J Med Sci 2024:S0002-9629(24)01220-5. [PMID: 38768779 DOI: 10.1016/j.amjms.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/28/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Differentiating between intrinsic and prerenal acute kidney injury (AKI) presents a challenge. Here, we assessed the performance of the fractional excretion of urea (FEUrea) and compared it to the fractional excretion of sodium (FENa) in distinguishing intrinsic from prerenal AKI. METHODS A thorough search was conducted in several databases until January 16, 2024. We included studies evaluating FEUrea, with or without FENa, for differentiating AKI etiologies in adults. We assessed the methodological quality using the QUADAS-2 and QUADAS-C tools. We performed a meta-analysis using the bivariate random effects model, with subgroup analyses to explore the impact of diuretic therapy on FEUrea, and direct statistical comparisons between FEUrea and FENa involving the subgroups with and without diuretics. RESULTS We included 11 studies with 1108 hospitalized patients. Among eight studies (915 patients) evaluating FEUrea >35% for distinguishing intrinsic from prerenal AKI, the pooled sensitivity and specificity were 66% (95% CI, 49%-79%) and 75% (95% CI, 60%-85%), respectively. In a subset of six studies (302 patients) comparing FEUrea at 35% to FENa at 1% in patients not receiving diuretics, there were no significant differences in sensitivity (77% versus 89%, P = 0.410) or specificity (80% versus 79%, P = 0.956). In four studies, 244 patients on diuretics, FEUrea demonstrated lower sensitivity (52% versus 92%, P < 0.001) but higher specificity (82% versus 44%, P < 0.001) compared to FENa for the diagnosis of intrinsic AKI. CONCLUSIONS FEUrea has limited utility in differentiating intrinsic from prerenal AKI. FEUrea does not provide a superior alternative to FENa, even in patients receiving diuretics.
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Affiliation(s)
- Mohammad O Abdelhafez
- Department of Internal Medicine, Al-Quds University, Abu Dis, Jerusalem, State of Palestine
| | - Asil A Alhroob
- Department of Internal Medicine, Al-Quds University, Abu Dis, Jerusalem, State of Palestine
| | - Mustafa O Abu Hawilla
- Department of Internal Medicine, Al-Quds University, Abu Dis, Jerusalem, State of Palestine
| | - Asmaa A Rjoob
- Department of Internal Medicine, Al-Quds University, Abu Dis, Jerusalem, State of Palestine
| | - Nasser M Abualia
- Department of Internal Medicine, Al-Quds University, Abu Dis, Jerusalem, State of Palestine
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA
| | | | - Kamel A Gharaibeh
- Department of Internal Medicine, Al-Quds University, Abu Dis, Jerusalem, State of Palestine; Division of Pulmonary & Critical Care Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA.
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2
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Hamadah A, Gharaibeh K. Fractional Excretion of Sodium and Urea are Useful Tools in the Evaluation of AKI: PRO. KIDNEY360 2023; 4:e725-e727. [PMID: 37384887 PMCID: PMC10371381 DOI: 10.34067/kid.0002492022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 07/01/2023]
Affiliation(s)
| | - Kamel Gharaibeh
- University of Maryland School of Medicine, Baltimore, Maryland
- Faculty of Medicine, Al-Quds University, Jerusalem, Israel
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3
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Maciel AT, Vitorio D, Osawa EA. Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box. Front Med (Lausanne) 2022; 9:912877. [PMID: 35957852 PMCID: PMC9360530 DOI: 10.3389/fmed.2022.912877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/05/2022] [Indexed: 12/12/2022] Open
Abstract
Urine biochemistry (UB) remains a controversial tool in acute kidney injury (AKI) monitoring, being considered to be of limited value both in terms of AKI diagnosis and prognosis. However, many criticisms can be made to the studies that have established the so called “pre-renal paradigm” (used for decades as the essential physiological basis for UB assessment in AKI) as well as to more recent studies suggesting that UB has no utility in daily clinical practice. The aim of this article is to describe our hypothesis on how to interpret simple and widely recognized urine biochemical parameters from a novel perspective, propose the rationale for their sequential assessment and demonstrate their usefulness in AKI monitoring, especially in the critical care setting.
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Affiliation(s)
- Alexandre T. Maciel
- Research Department, Imed Group, São Paulo, Brazil
- Adult Intensive Care Unit, São Camilo Hospital–Pompéia Unit, São Paulo, Brazil
- *Correspondence: Alexandre T. Maciel,
| | - Daniel Vitorio
- Research Department, Imed Group, São Paulo, Brazil
- Adult Intensive Care Unit, São Camilo Hospital–Pompéia Unit, São Paulo, Brazil
| | - Eduardo A. Osawa
- Research Department, Imed Group, São Paulo, Brazil
- Adult Intensive Care Unit, São Camilo Hospital–Pompéia Unit, São Paulo, Brazil
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4
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Abdelhafez M, Nayfeh T, Atieh A, AbuShamma O, Babaa B, Baniowda M, Hrizat A, Hasan B, Hassett L, Hamadah A, Gharaibeh K. Diagnostic Performance of Fractional Excretion of Sodium for the Differential Diagnosis of Acute Kidney Injury: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2022; 17:785-797. [PMID: 35545442 PMCID: PMC9269645 DOI: 10.2215/cjn.14561121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES AKI is classified as prerenal, intrinsic, and postrenal. Prerenal AKI and intrinsic AKI represent the most common causes for AKI in hospitalized patients. This study aimed to examine the accuracy of the fractional excretion of sodium for distinguishing intrinsic from prerenal AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, the Cochrane Library, and Scopus for all available studies that met the criteria until December 31, 2021. We included studies that evaluated fractional excretion of sodium in differentiating AKI etiologies in adults, whereas studies that did not have sufficient data to extract a 2×2 table were excluded. We assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and extracted the diagnostic accuracy data for all included studies. We conducted a meta-analysis using the bivariate random effects model. We performed subgroup analysis to investigate sources of heterogeneity and the effect of the relevant confounders on fractional excretion of sodium accuracy. RESULTS We included 19 studies with 1287 patients. In a subset of 15 studies (872 patients) that used a threshold of 1%, the pooled sensitivity and specificity for differentiating intrinsic from prerenal AKI were 90% (95% confidence interval, 81% to 95%) and 82% (95% confidence interval, 70% to 90%), respectively. In a subgroup of six studies (511 patients) that included CKD or patients on diuretics, the pooled sensitivity and specificity were 83% (95% confidence interval, 64% to 93%) and 66% (95% confidence interval, 51% to 78%), respectively. In five studies with 238 patients on diuretics, the pooled sensitivity and specificity were 80% (95% confidence interval, 69% to 87%) and 54% (95% confidence interval, 31% to 75%), respectively. In eight studies with 264 oliguric patients with no history of CKD or diuretic therapy, the pooled sensitivity and specificity were 95% (95% confidence interval, 82% to 99%) and 91% (95% confidence interval, 83% to 95%), respectively. CONCLUSIONS Fractional excretion of sodium has a limited role for AKI differentiation in patients with a history of CKD or those on diuretic therapy. It is most valuable when oliguria is present.
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Affiliation(s)
- Mohammad Abdelhafez
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine
| | - Tarek Nayfeh
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Anwar Atieh
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine
| | - Omar AbuShamma
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine
| | - Basheer Babaa
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine
| | - Muath Baniowda
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine
| | - Alaa Hrizat
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine
| | - Bashar Hasan
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Leslie Hassett
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
| | | | - Kamel Gharaibeh
- Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine .,Division of Pulmonary & Critical Care, University of Maryland, Baltimore, Maryland
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5
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Nucleic Acid Nanotechnology for Diagnostics and Therapeutics in Acute Kidney Injury. Int J Mol Sci 2022; 23:ijms23063093. [PMID: 35328515 PMCID: PMC8953740 DOI: 10.3390/ijms23063093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
Acute kidney injury (AKI) has impacted a heavy burden on global healthcare system with a high morbidity and mortality in both hospitalized and critically ill patients. However, there are still some shortcomings in clinical approaches for the disease to date, appealing for an earlier recognition and specific intervention to improve long-term outcomes. In the past decades, owing to the predictable base-pairing rule and highly modifiable characteristics, nucleic acids have already become significant biomaterials for nanostructure and nanodevice fabrication, which is known as nucleic acid nanotechnology. In particular, its excellent programmability and biocompatibility have further promoted its intersection with medical challenges. Lately, there have been an influx of research connecting nucleic acid nanotechnology with the clinical needs for renal diseases, especially AKI. In this review, we begin with the diagnostics of AKI based on nucleic acid nanotechnology with a highlight on aptamer- and probe-functionalized detection. Then, recently developed nanoscale nucleic acid therapeutics towards AKI will be fully elucidated. Furthermore, the strengths and limitations will be summarized, envisioning a wiser and wider application of nucleic acid nanotechnology in the future of AKI.
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6
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Shen K, Qu W, Zhao GK, Cheng ZH, Li J, Deng XQ, Xu DW. Kinetic changes in serum procalcitonin predict persistent acute kidney injury in critical patients. Nephrology (Carlton) 2021; 26:872-878. [PMID: 34482582 DOI: 10.1111/nep.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Persistent acute kidney injury (AKI) has been shown to be closely associated with poor prognosis in critical patients. Recent studies have shown that procalcitonin (PCT) is valuable for the early prediction of AKI in critically patients. Our aim was to determine whether PCT and its kinetic changes could predict the occurrence of persistent AKI in critical patients. METHODS This is a prospective observational study. The definition of AKI was based on the Kidney Disease: Improving Global Outcomes criteria. Persistent AKI was defined as renal function that does not return to baseline serum creatinine levels within 48 h. Blood samples were obtained at the onset of AKI and two subsequent days of hospital stay. 24-h PCT change (ΔPCT-24 h) was defined as 24 h PCT minus baseline PCT (day 0). RESULTS A total of 91 critical patients with AKI were included in this study. The persistent AKI group had a stepwise increase in PCT concentration. ΔPCT-24 h was higher in the persistent AKI group (p < .01). Logistic regression analysis showed that ΔPCT-24 h (p = .04) was independent predictors of persistent AKI. The receiver operating characteristic curves showed that area under the curve of ΔPCT-24 h was 0.84 (p < .01), and the cut-off value for PCT to predict persistent AKI was 0.56 ng/ml. CONCLUSION Our study showed that the observation of kinetic changes in PCT is more significant for the early prediction of persistent AKI than the index of PCT at a single time point. ΔPCT-24 h is a good predictor of persistent AKI in critical patients.
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Affiliation(s)
- Kan Shen
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Wei Qu
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Guang-Kuo Zhao
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhi-Hui Cheng
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jun Li
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xing-Qi Deng
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Dong-Wei Xu
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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7
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Scurt FG, Bose K, Canbay A, Mertens PR, Chatzikyrkou C. [Acute kidney injury following acute pancreatitis (AP-AKI): Definition, Pathophysiology, Diagnosis and Therapy]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:1241-1266. [PMID: 33291178 DOI: 10.1055/a-1255-3413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) is the most frequent gastrointestinal cause for hospitalization and one of the leading causes of in-hospital deaths. Severe acute pancreatitis is often associated with multiorgan failure and especially with acute kidney injury (AKI). AKI can develop early or late in the course of the disease and is a strong determinator of outcome. The mortality in the case of dialysis-dependent AKI and acute pancreatitis raises exponentially in the affected patients. AP-induced AKI (AP-AKI) shows many similarities but also distinct differences to other causes of AKI occurring in the intensive care unit setting. The knowledge of the exact pathophysiology can help to adjust, control and improve therapeutic approaches to the disease. Unfortunately, there are only a few studies dealing with AP and AKI.In this review, we discuss recent data about pathogenesis, causes and management of AP-AKI in patients with severe acute pancreatitis and exploit in this regard the diagnostic and prognostic potential of respective newer serum and urine markers.
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Affiliation(s)
- Florian Gunnar Scurt
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany
| | - Katrin Bose
- Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany.,Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Otto-von-Guericke-Universität, Magdeburg, Deutschland
| | - Ali Canbay
- Ruhr-Universität Bochum, Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - Peter R Mertens
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christos Chatzikyrkou
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany
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8
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Titeca-Beauport D, Daubin D, Van Vong L, Belliard G, Bruel C, Alaya S, Chaoui K, Andrieu M, Rouquette-Vincenti I, Godde F, Pascal M, Diouf M, Vinsonneau C, Klouche K, Maizel J. Urine cell cycle arrest biomarkers distinguish poorly between transient and persistent AKI in early septic shock: a prospective, multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:280. [PMID: 32487237 PMCID: PMC7268340 DOI: 10.1186/s13054-020-02984-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Background The urine biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been validated for predicting and stratifying AKI. In this study, we analyzed the utility of these biomarkers for distinguishing between transient and persistent AKI in the early phase of septic shock. Methods We performed a prospective, multicenter study in 11 French ICUs. Patients presenting septic shock, with the development of AKI within the first 6 h, were included. Urine [TIMP-2]*[IGFBP7] was determined at inclusion (0 h), 6 h, 12 h, and 24 h. AKI was considered transient if it resolved within 3 days. Discriminative power was evaluated by receiver operating characteristic (ROC) curve analysis. Results We included 184 patients, within a median [IQR] time of 1.0 [0.0–3.0] h after norepinephrine (NE) initiation; 100 (54%) patients presented transient and 84 (46%) presented persistent AKI. Median [IQR] baseline urine [TIMP-2]*[IGFBP7] was higher in the persistent AKI group (2.21 [0.81–4.90] (ng/ml)2/1000) than in the transient AKI group (0.75 [0.20–2.12] (ng/ml)2/1000; p < 0.001). Baseline urine [TIMP-2]*[IGFBP7] was poorly discriminant, with an AUROC [95% CI] of 0.67 [0.59–0.73]. The clinical prediction model combining baseline serum creatinine concentration, baseline urine output, baseline NE dose, and baseline extrarenal SOFA performed well for the prediction of persistent AKI, with an AUROC [95% CI] of 0.81 [0.74–0.86]. The addition of urine [TIMP-2]*[IGFBP7] to this model did not improve the predictive performance. Conclusions Urine [TIMP-2]*[IGFBP7] measurements in the early phase of septic shock discriminate poorly between transient and persistent AKI and do not improve clinical prediction over that achieved with the usual variables. Trial registration NCT02812784
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Affiliation(s)
- Dimitri Titeca-Beauport
- BoReal Study Group, Medical Intensive Care Unit and EA7517, Amiens University Hospital, F-80054, Amiens, France.
| | - Delphine Daubin
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Ly Van Vong
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Guillaume Belliard
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Cédric Bruel
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Sami Alaya
- Intensive Care Unit, Centre Hospitalier Général, 13300, Salon-de-Provence, France
| | - Karim Chaoui
- Intensive Care Unit, Jean Rougier Hospital, 335, rue du Président Wilson, 46000, Cahors, France
| | - Maud Andrieu
- Medical and Surgical Intensive Care Unit, Centre Hospitalier de Dax-Côte d'Argent, Dax, France
| | - Isabelle Rouquette-Vincenti
- Department of Anesthesia and Intensive Care, Princess Grace Hospital, Avenue Pasteur, Monaco (Principality), Monaco
| | - Frederic Godde
- Département de Réanimation Polyvalente, Centre Hospitalier Avranches-Granville, Granville, France
| | - Michel Pascal
- Intensive Care Unit, Centre Hospitalier de Mont De Marsan, 40000, Mont-de-Marsan, France
| | - Momar Diouf
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | | | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Julien Maizel
- BoReal Study Group, Medical Intensive Care Unit and EA7517, Amiens University Hospital, F-80054, Amiens, France
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9
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Rubin S, Orieux A, Prevel R, Garric A, Bats ML, Dabernat S, Camou F, Guisset O, Issa N, Mourissoux G, Dewitte A, Joannes-Boyau O, Fleureau C, Rozé H, Carrié C, Petit L, Clouzeau B, Sazio C, Bui HN, Pillet O, Rigothier C, Vargas F, Combe C, Gruson D, Boyer A. Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019. Clin Kidney J 2020; 13:354-361. [PMID: 32695326 PMCID: PMC7314187 DOI: 10.1093/ckj/sfaa099] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported. METHODS Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated. RESULTS Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12-23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54-140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively. CONCLUSION Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.
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Affiliation(s)
- Sébastien Rubin
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Antoine Garric
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Marie-Lise Bats
- Service de Biochimie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Sandrine Dabernat
- Service de Biochimie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Fabrice Camou
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Nahema Issa
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Gaelle Mourissoux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Antoine Dewitte
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Catherine Fleureau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Hadrien Rozé
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Cédric Carrié
- Service d’Anesthésie-Réanimation, Pellegrin CHU de Bordeaux, Bordeaux, France
| | - Laurent Petit
- Service d’Anesthésie-Réanimation, Pellegrin CHU de Bordeaux, Bordeaux, France
| | - Benjamin Clouzeau
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Charline Sazio
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Odile Pillet
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Claire Rigothier
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Frederic Vargas
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
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Darmon M, Truche AS, Abdel-Nabey M, Schnell D, Souweine B. Early Recognition of Persistent Acute Kidney Injury. Semin Nephrol 2020; 39:431-441. [PMID: 31514907 DOI: 10.1016/j.semnephrol.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite the vast amount of literature dedicated to acute kidney injury (AKI) and its clinical consequences, short-term renal recovery has been relatively neglected. Recent studies have suggested that timing of renal recovery is associated with longer-term risk of death, residual renal function, and end-stage renal failure risk. In addition, longer AKI duration is associated with an increased requirement for renal replacement therapy. Comorbidities, especially renal and cardiovascular, severity of AKI, criteria to reach AKI diagnosis, as well as severity of critical illness have been associated with longer AKI duration, and, more specifically, risk of persistent renal dysfunction. Because predicting short-term renal recovery is clinically relevant, several tests, imaging, and biomarkers have been tested in a way to predict the course of AKI and chances for early renal recovery. In this review, the definition of recovery, consequences of persistent AKI, and tools proposed to predict recovery are described. The performance of these tools and their limits are discussed.
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Affiliation(s)
- Michaël Darmon
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France; ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en sAnté), Biostatistics and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistic Sorbonne Paris Cité, INSERM, Paris, France.
| | - Anne-Sophie Truche
- Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France
| | | | - David Schnell
- Medical-Surgical Intensive Care Unit, Angoulême Hospital, Angoulême, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
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Cox ZL, Sury K, Rao VS, Ivey-Miranda JB, Griffin M, Mahoney D, Gomez N, Fleming JH, Inker LA, Coca SG, Turner J, Wilson FP, Testani JM. Effect of Loop Diuretics on the Fractional Excretion of Urea in Decompensated Heart Failure. J Card Fail 2020; 26:402-409. [PMID: 32007554 DOI: 10.1016/j.cardfail.2020.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fractional excretion of urea (FEUrea) is often used to understand the etiology of acute kidney injury (AKI) in patients receiving diuretics. Although FEUrea demonstrates diagnostic superiority over fractional excretion of sodium (FENa), clinicians often assume FEUrea is not affected by diuretics. OBJECTIVE To assess the intravenous loop diuretic effect on FEUrea. METHODS We analyzed a prospective cohort (n=297) hospitalized with hypervolemic heart failure at Yale New Haven Hospital System. FENa and FEUrea were calculated at baseline and serially after diuretics. The change in FEUrea at peak diuresis was compared with the pre-diuretic baseline. RESULTS Mean baseline FEUrea was 35.2% ± 10.5% and increased by a mean 5.6% ± 10.5% following 80 mg (40-160 mg) of furosemide equivalents (P < .001). The magnitude of change in FEUrea was clinically important as the distribution of change in FEUrea was similar to the overall distribution of baseline FEUrea. Change in FEUrea was related to the diuretic response (r = 0.61, P < .001), with a larger FEUrea increase in diuretic responders (8.8%, interquartile range [IQR]: 1.8-16.9) than non-responders (1.2%, IQR: -3.2 to 5.5; P < .001). Diuretic administration reclassified 27% of patients between low and high FEUrea groups across a 35% threshold. Neither change in FEUrea nor percentage reclassified out of a low FEUrea category differed between patients with and without AKI (P > .63 for both). CONCLUSIONS FEUrea is meaningfully affected by loop diuretics. The degree of change in FEUrea is highly variable between patients and commonly of a magnitude that could reclassify across categories of FEUrea.
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Affiliation(s)
- Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Krishna Sury
- Division of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Veena S Rao
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Juan B Ivey-Miranda
- Division of Cardiology, Hospital de Cardiologia Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Matthew Griffin
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Devin Mahoney
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole Gomez
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - James H Fleming
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lesley A Inker
- Department of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Steven G Coca
- Department of Nephrology, Mount Sinai, New York City, New York
| | - Jeff Turner
- Division of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - F Perry Wilson
- Division of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M Testani
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
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12
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Duvignaud A, Jaspard M, Etafo IC, Serra B, Abejegah C, Gabillard D, Doutchi M, Alabi JF, Adedokun MA, Akinpelu AO, Oyegunle OO, Etafo J, Dede AO, Onyechi MN, Ireneh MU, Gbenga-Ayeni O, Fadiminiyi KG, Ehigbor PI, Ouattara E, Levy-Marchal C, Karcher S, N'guessan-Koffi L, Ahyi I, Amani E, Diabaté M, Siloué B, Schaeffer J, Augier A, Ogbaini-Emovon E, Salam AP, Horby P, Ahmed LA, Günther S, Adedosu AN, Anglaret X, Ayodeji OO, Malvy D. Lassa fever clinical course and setting a standard of care for future randomized trials: A protocol for a cohort study of Lassa-infected patients in Nigeria (LASCOPE). Travel Med Infect Dis 2020; 36:101557. [PMID: 31978611 DOI: 10.1016/j.tmaid.2020.101557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/28/2019] [Accepted: 01/16/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lassa Fever (LF), is a severe viral disease prevalent in Western Africa. It is classified as a priority disease by the World Health Organization (WHO). Ribavirin is the recommended therapy despite weak evidence of its efficacy. Promising therapeutic agents are becoming available for evaluation in human. Before launching therapeutic trials, we need data on the evolution of the disease under the best possible conditions of care. METHODS We have initiated a prospective study in Nigeria to better understand the clinical course and prognostic factors of LF while implementing high quality standardized care. Inclusion criteria are: suspected or confirmed LF and informed consent. Participants are followed 60 days from admission and receive free of charge standardized supportive care and biological monitoring, as well as intravenous ribavirin for those with confirmed LF. Data are collected using standardized case report forms (CRF). Primary and secondary outcomes are fatality and severe morbidity, with special focus on acute kidney dysfunction and pregnancy complications. Factors associated with outcomes will be investigated. RESULTS The cohort is planned for 3 years. Inclusions started in April 2018 at the Federal Medical Center Owo in Ondo State. A second site will open in Nigeria in 2020 and discussions are underway to open a site in Benin. 150 to 200 new participants are expected per year. CONCLUSIONS This cohort will: provide evidence to standardize LF case management; provide key inputs to design future clinical trials of novel therapeutics; and establish clinical research teams capable of conducting such trials in LF-endemic areas. STUDY REGISTRATION The LASCOPE study was registered on ClinicalTrial.gov (NCT03655561).
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Affiliation(s)
- Alexandre Duvignaud
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Marie Jaspard
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire; The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Ijeoma Chukwudumebi Etafo
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Béatrice Serra
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire; The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Chukwuyem Abejegah
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Delphine Gabillard
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Mahamadou Doutchi
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal; Department of Infectious Diseases, Centre Hospitalier National de Zinder, Zinder, Niger.
| | - Josephine Funmilola Alabi
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Moses Adeniyi Adedokun
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Adewale Oladayo Akinpelu
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Oyebimpe Ope Oyegunle
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Johnson Etafo
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Ayoleyi Omowunmi Dede
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Macdonald Nonso Onyechi
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Moronke Uzuajemeh Ireneh
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Olufunke Gbenga-Ayeni
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Kehinde Gbemisola Fadiminiyi
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Patience Iziegbe Ehigbor
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Eric Ouattara
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Claire Levy-Marchal
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Sophie Karcher
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Larissa N'guessan-Koffi
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Irmine Ahyi
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Elvis Amani
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Mamoudou Diabaté
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Bertine Siloué
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Justine Schaeffer
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Augustin Augier
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, KM 87 Benin Auchi Rd, Irrua, Edo State, Nigeria.
| | - Alex Paddy Salam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7FZ, United Kingdom.
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7FZ, United Kingdom.
| | - Liasu Adeagbo Ahmed
- Department of Family Medicine, Owo Federal Medical Centre, Michael Adekun Ajasin Road, PMB, 1053, Owo, Ondo State, Nigeria.
| | - Stephan Günther
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany.
| | - Akinola Nelson Adedosu
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Xavier Anglaret
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Oladele Oluwafemi Ayodeji
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Denis Malvy
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
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13
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Biochemical Markers of Renal Hypoperfusion, Hemoconcentration, and Proteinuria after Extreme Physical Exercise. ACTA ACUST UNITED AC 2019; 55:medicina55050154. [PMID: 31108972 PMCID: PMC6571854 DOI: 10.3390/medicina55050154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/18/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Physical exercise increases the blood perfusion of muscles, but decreases the renal blood flow. There are several markers of renal hypoperfusion which are used in the differential diagnosis of acute kidney failure. Albuminuria is observed after almost any exercise. The aim of this study was to assess changes in renal hypoperfusion and albuminuria after a 100-km race. Materials and Methods: A total of 27 males who finished a 100-km run were studied. The mean age of the runners was 38.04 ± 5.64 years. The exclusion criteria were a history of kidney disease, glomerular filtration rate (GFR) <60 ml/min, and proteinuria. Blood and urine were collected before and after the race. The urinary albumin/creatinine ratio (ACR), fractional excretion of urea (FeUrea) and sodium (FeNa), plasma urea/creatinine ratio (sUrea/Cr), urine/plasma creatinine ratio (u/pCr), urinary sodium to potassium ratio (uNa/K), and urinary potassium to urinary potassium plus sodium ratio (uK/(K+Na)) were calculated. Results: After the race, significant changes in albuminuria and markers of renal hypoperfusion (FeNa, FeUrea, sUrea/Cr, u/sCr, urinary Na, uNa/K, uK/(K+Na)) were found. Fifteen runners (55.56%) had severe renal hypoperfusion (FeUrea <35, uNa/K <1, and uK/(Na+K) >0.5) after the race. The mean ACR increased from 6.28 ± 3.84 mg/g to 48.43 ± 51.64 mg/g (p < 0.001). The ACR was higher in the group with severe renal hypoperfusion (59.42 ± 59.86 vs. 34.68 ± 37.04 mg/g), but without statistical significance. Conclusions: More than 50% of the runners had severe renal hypoperfusion after extreme exercise. Changes in renal hemodynamics are probably an important, but not the only, factor of post-exercise proteinuria.
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14
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Zhang Z, Ho KM, Hong Y. Machine learning for the prediction of volume responsiveness in patients with oliguric acute kidney injury in critical care. Crit Care 2019; 23:112. [PMID: 30961662 PMCID: PMC6454725 DOI: 10.1186/s13054-019-2411-z] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Excess fluid balance in acute kidney injury (AKI) may be harmful, and conversely, some patients may respond to fluid challenges. This study aimed to develop a prediction model that can be used to differentiate between volume-responsive (VR) and volume-unresponsive (VU) AKI. METHODS AKI patients with urine output < 0.5 ml/kg/h for the first 6 h after ICU admission and fluid intake > 5 l in the following 6 h in the US-based critical care database (Medical Information Mart for Intensive Care (MIMIC-III)) were considered. Patients who received diuretics and renal replacement on day 1 were excluded. Two predictive models, using either machine learning extreme gradient boosting (XGBoost) or logistic regression, were developed to predict urine output > 0.65 ml/kg/h during 18 h succeeding the initial 6 h for assessing oliguria. Established models were assessed by using out-of-sample validation. The whole sample was split into training and testing samples by the ratio of 3:1. MAIN RESULTS Of the 6682 patients included in the analysis, 2456 (36.8%) patients were volume responsive with an increase in urine output after receiving > 5 l fluid. Urinary creatinine, blood urea nitrogen (BUN), age, and albumin were the important predictors of VR. The machine learning XGBoost model outperformed the traditional logistic regression model in differentiating between the VR and VU groups (AU-ROC, 0.860; 95% CI, 0.842 to 0.878 vs. 0.728; 95% CI 0.703 to 0.753, respectively). CONCLUSIONS The XGBoost model was able to differentiate between patients who would and would not respond to fluid intake in urine output better than a traditional logistic regression model. This result suggests that machine learning techniques have the potential to improve the development and validation of predictive modeling in critical care research.
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Affiliation(s)
- Zhongheng Zhang
- 0000 0004 1759 700Xgrid.13402.34Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
| | - Kwok M. Ho
- 0000 0004 1936 7910grid.1012.2School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Yucai Hong
- 0000 0004 1759 700Xgrid.13402.34Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
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15
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Urinary Biochemistry in the Diagnosis of Acute Kidney Injury. DISEASE MARKERS 2018; 2018:4907024. [PMID: 30008975 PMCID: PMC6020498 DOI: 10.1155/2018/4907024] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/03/2018] [Accepted: 05/20/2018] [Indexed: 12/29/2022]
Abstract
Acute kidney injury (AKI) is a common complication, impacting short- and long-term patient outcomes. Although the application of the classification systems for AKI has improved diagnosis, early clinical recognition of AKI is still challenging, as increments in serum creatinine may be late and low urine output is not always present. The role of urinary biochemistry has remained unclear, especially in critically ill patients. Differentiating between a transient and persistent acute kidney injury is of great need in clinical practice, and despite studies questioning their application in clinical practice, biochemistry indices continue to be used while we wait for a novel early injury biomarker. An ideal marker would provide more detailed information about the type, intensity, and location of the injury. In this review, we will discuss factors affecting the fractional excretion of sodium (FeNa) and fractional excretion of urea (FeU). We believe that the frequent assessment of urinary biochemistry and microscopy can be useful in evaluating the likelihood of AKI reversibility. The availability of early injury biomarkers could help guide clinical interventions.
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16
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Urine biochemistry assessment in critically ill patients: controversies and future perspectives. J Clin Monit Comput 2016; 31:539-546. [PMID: 27038161 DOI: 10.1007/s10877-016-9871-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/30/2016] [Indexed: 12/17/2022]
Abstract
In the past, urine biochemistry was a major tool in acute kidney injury (AKI) management. Classic papers published some decades ago established the values of the urine indices which were thought to distinguish "pre-renal" (functional) AKI attributed to low renal perfusion and "renal" (structural) AKI attributed to acute tubular necrosis (ATN). However, there were a lot of drawbacks and limitations in these studies and some recent articles have questioned the utility of measuring urine electrolytes especially because they do not seem to adequately inform about renal perfusion nor AKI duration (transient vs. persistent). At the same time, the "pre-renal" paradigm has been consistently criticized because hypoperfusion followed by ischemia and ATN does not seem to explain most of the AKI developing in critically ill patients and distinct AKI durations do not seem to be clearly related to different pathophysiological mechanisms or histopathological findings. In this new context, other possible roles for urine biochemistry have emerged. Some studies have suggested standardized changes in the urine electrolyte composition preceding increases in serum creatinine independently of AKI subsequent duration, which might actually be due to intra-renal microcirculatory changes and activation of sodium-retaining mechanisms even in the absence of impaired global renal blood flow. In the present review, the points of controversy regarding urine biochemistry assessment were evaluated as well as future perspectives for its role in AKI monitoring. An alternative approach for the interpretation of measured urine electrolytes is proposed which needs further larger studies to be validated and incorporated in daily ICU practice.
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17
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Pahwa AK, Sperati CJ. Urinary fractional excretion indices in the evaluation of acute kidney injury. J Hosp Med 2016; 11:77-80. [PMID: 26689284 DOI: 10.1002/jhm.2501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/29/2015] [Accepted: 09/30/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Amit K Pahwa
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C John Sperati
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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18
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Insuffisances rénales aiguës : pertinence d’une classification fondée sur le délai de récupération. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Varela CF, Greloni G, Schreck C, Bratti G, Medina A, Marenchino R, Pizarro R, Belziti C, Rosa-Diez G. Assessment of fractional excretion of urea for early diagnosis of cardiac surgery associated acute kidney injury. Ren Fail 2015; 37:327-31. [PMID: 26398357 DOI: 10.3109/0886022x.2015.1087800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine, but it is not widely used in clinical practice. Fractional excretion of urea (FeU) has been referred to as a useful tool to discriminate between prerenal and established AKI. The aim of our study is to evaluate the sensitivity and specificity of FeU, in the early diagnosis of AKI in patients undergoing CS. METHODS We performed a prospective study on adults undergoing CS. AKI was defined by AKIN criteria. Individuals suffering from CKD, were excluded. Sensitivity and specificity of FeU, fractional excretion of sodium (FeNa) and urine NGAL, measured at 1, 6 and 24 h following CS, were assessed. RESULTS We included 66 patients (26% female) aging 68 ± 11 years. AKI prevalence was 24% and mortality was 3.28%. Patients with AKI had a significantly lower FeU compared to those without AKI (23.89 ± 0.67% vs. 34.22 ± 0.58%; p < 0.05) 6 h after CS, but not at the 1- and 24-h time points. NGAL was also statistically significant between both groups. FeU showed a 75% sensitivity and 79.5% specificity; the AUC was 0.786. ROC analysis of FeU and NGAL yielded similar values (p = NS). CONCLUSION FeU is useful as an early biomarker to predict AKI after CS and it is comparable to the new biomarker NGAL.
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Affiliation(s)
- Carlos Federico Varela
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Gustavo Greloni
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Carlos Schreck
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Griselda Bratti
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Angel Medina
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Ricardo Marenchino
- b Servicio de Cirugía Cardiovascular del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina , and
| | - Rodolfo Pizarro
- c Servicio de Cardiología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Cesar Belziti
- c Servicio de Cardiología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Guillermo Rosa-Diez
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
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Dewitte A, Joannès-Boyau O, Sidobre C, Fleureau C, Bats ML, Derache P, Leuillet S, Ripoche J, Combe C, Ouattara A. Kinetic eGFR and Novel AKI Biomarkers to Predict Renal Recovery. Clin J Am Soc Nephrol 2015; 10:1900-10. [PMID: 26342047 DOI: 10.2215/cjn.12651214] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Prompt recognition of severe renal impairment could improve the early management of critically ill patients. We compared the value of kinetic eGFR, plasma neutrophil gelatinase-associated lipocalin (NGAL), and urine tissue inhibitor of metalloproteinase-2 and urine insulin-like growth factor-binding protein 7 ([TIMP-2]*[IGFBP7]) in predicting short-term recovery from AKI and major adverse kidney events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS During the 6-month study period, 245 patients were admitted to our intensive care unit. This study included 57 consecutive patients presenting with AKI within the first 24 hours after admission. AKI markers were evaluated at inclusion (day 0) and 24 hours later (day 1). Kinetic eGFR was calculated on day 1 according to serum creatinine evolution. Renal recovery was defined as normalization of serum creatinine with reversal of oliguria within 48 hours. Major adverse kidney events included death, need for RRT, or persistence of renal dysfunction at hospital discharge. RESULTS Plasma NGAL and [TIMP-2]*[IGFBP7] predicted renal recovery, with area under the receiver-operating characteristic curve (AUC-ROC) values between 0.70 and 0.79 at inclusion. Although plasma NGAL values frequently reached the maximal measurement range, their decrease on day 1 predicted recovery. The kinetic eGFR calculation after initial resuscitation provided the best AUC-ROC value for renal recovery, at 0.87. The best predictions for major adverse kidney events were provided by [TIMP-2]*[IGFBP7] and kinetic eGFR (equal AUC-ROCs of 0.81). Combining AKI markers in addition to clinical prediction models improved the discrimination and reclassification of patients who will recover from AKI or suffer from major adverse kidney events. CONCLUSIONS Biomarkers of kidney damage predicted short-term renal recovery and major adverse kidney events for an unselected cohort of critically ill patients. Calculating the kinetic eGFR imposed a delay after initial resuscitation but provided a good diagnostic and prognostic approach. The utility of functional and damage AKI marker combinations in addition to clinical information requires validation in larger prospective studies.
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Affiliation(s)
- Antoine Dewitte
- Departments of Anesthesia and Intensive Care II, French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France;
| | | | | | | | | | | | | | - Jean Ripoche
- French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France
| | - Christian Combe
- French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France; Nephrology, Transplantation, Dialysis, University Hospital, Bordeaux, France
| | - Alexandre Ouattara
- Departments of Anesthesia and Intensive Care II, INSERM U1034, Cardiovascular Adaptation to Ischemia, University of Bordeaux, Pessac, France
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Doppler-based renal resistive index for prediction of renal dysfunction reversibility: A systematic review and meta-analysis. J Crit Care 2015; 30:629-35. [PMID: 25746587 DOI: 10.1016/j.jcrc.2015.02.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Doppler-based renal resistive index (RI) might help in distinguishing transient from persistent acute kidney injury (AKI). The main objective of these systematic review and meta-analysis was to investigate the diagnostic performance of RI in predicting short-term reversibility of AKI. STUDY DESIGN A systematic review of the literature was performed. Relevant studies were identified in Pubmed and Cochrane databases covering the years 1985 to 2013 and reviewed independently by 3 authors. Renal transplant recipients were excluded from this analysis. The summary estimates were computed using a random-effects model based on the DerSimonian and Lair meta-analytic method. RESULTS Among the 154 unique articles identified, 9 studies were included. Of the 176 patients in these studies with elevated RI or pulsatility index, 146 (83%) had a persistent AKI vs 44 (16%) of the 273 patients with normal values. Elevated RI or pulsatility index was associated with an increased risk of persistent AKI (odds ratio, 29.85; 95% confidence interval [CI], 8.73-102.16; P < .00001) with significant heterogeneity (I(2) = 75.0%, P < .0001). The pooled sensitivity and specificity were 0.83 (95% CI, 0.77-0.88) and 0.84 (95% CI, 0.79-0.88). The summary positive and negative likelihood ratios were 4.9 (95% CI, 2.44-9.87) and 0.21 (95% CI, 0.11-0.41). CONCLUSION These results suggest that an elevated RI may be a predictor of persistent AKI in critically ill patients. Further studies are warranted, however, to clarify the exact test performance given the marked heterogeneity among the included studies.
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Abstract
Urea is generated by the urea cycle enzymes, which are mainly in the liver but are also ubiquitously expressed at low levels in other tissues. The metabolic process is altered in several conditions such as by diets, hormones, and diseases. Urea is then eliminated through fluids, especially urine. Blood urea nitrogen (BUN) has been utilized to evaluate renal function for decades. New roles for urea in the urinary system, circulation system, respiratory system, digestive system, nervous system, etc., were reported lately, which suggests clinical significance of urea.
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Wlodzimirow KA, Abu-Hanna A, Royakkers AANM, Spronk PE, Hofstra LS, Kuiper MA, Schultz MJ, Bouman CSC. Transient versus persistent acute kidney injury and the diagnostic performance of fractional excretion of urea in critically ill patients. Nephron Clin Pract 2014; 126:8-13. [PMID: 24434683 DOI: 10.1159/000357678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 11/29/2013] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the performance of fractional excretion of urea (FeU) for differentiating transient (T) from persistent (P) acute kidney injury (AKI) and to assess performance of FeU in predicting AKI in patients admitted to the ICU. METHODS We performed secondary analysis of a multicenter prospective observational cohort study on the predictive performance of biological markers for AKI in critically ill patients. AKI was diagnosed according to RIFLE staging. RESULTS Of 150 patients, 51 and 41 patients were classified as having T-AKI and P-AKI, respectively. The diagnostic performance for FeU to discriminate T-AKI from P-AKI on the day of AKI was poor (AUC-ROC = 0.61; 95% CI: 0.49-0.73). The diagnostic performance of FeU to predict AKI 1 and 2 days prior to AKI was poor as well (AUC-ROC = 0.61; 95% CI: 0.47-0.74, and 0.58; 95% CI: 0.43-0.73, respectively). CONCLUSIONS FeU does not seem to be helpful in differentiating T- from P-AKI in critically ill patients and it is a poor predictor of AKI.
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Affiliation(s)
- K A Wlodzimirow
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Vanmassenhove J, Glorieux G, Hoste E, Dhondt A, Vanholder R, Van Biesen W. Urinary output and fractional excretion of sodium and urea as indicators of transient versus intrinsic acute kidney injury during early sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R234. [PMID: 24119730 PMCID: PMC4057160 DOI: 10.1186/cc13057] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/16/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The pathophysiology of acute kidney injury (AKI) in sepsis is ill defined. We investigated parameters associated with low glomerular filtration, and their predictive value to discriminate transient from intrinsic septic AKI. METHODS In 107 sepsis patients, AKI was defined by the Risk, Injury, Failure, Loss of Kidney Function, End-stage renal disease (RIFLE) urinary output or serum creatinine criterion, or both. Transient AKI (TAKI) versus intrinsic AKI was defined as RIFLE R, I, or F on the first day evolving to no AKI or not, respectively, over the following 5 days. Fractional excretion of sodium (FENa), urea (FEUrea), and NGAL (FENGAL) at admission (d0t0), 4 (d0t4), and 24 hours (d1) was determined. RESULTS Including versus not including the urinary-output criterion of RIFLE increased AKI from 43% to 64.5%. Median uNGAL levels and FENGAL were lower in no AKI versus transient AKI when AKI was defined based on creatinine (P = 0.002 and P = 0.04, respectively), but not when based on urinary output (P = 0.9 and P = 0.49, respectively). FENa < 1% and FEUrea <35% was present in 77.3% and 63.2% of patients. Urinary NGAL was higher (P < 0.001) in those with high versus low fractional sodium excretion, but this was only in patients with transient or intrinsic AKI (P < 0.001 in subgroups), and not in patients without AKI. The negative predictive value for either intrinsic AKI or not restoring diuresis in patients with FENa > 0.36% and FEUrea > 31.5% was 92% and 94.5% respectively. CONCLUSIONS A low FENa and FEUrea is highly prevalent in the first hours of sepsis. In sepsis, oliguria is an earlier sign of impending AKI than increase in serum creatinine. A combination of a high FENa and a low FEUrea is associated with intrinsic AKI, whereas a combined high FENa and FEUrea is strongly predictive of transient AKI.
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Maciel AT, Park M, Macedo E. Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study. BMC Anesthesiol 2013; 13:31. [PMID: 24112801 PMCID: PMC3851869 DOI: 10.1186/1471-2253-13-31] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/03/2013] [Indexed: 12/12/2022] Open
Abstract
Background Sequential physicochemical alterations in blood and urine in the course of acute kidney injury (AKI) development have not been previously described. We aimed to describe these alterations in parallel to traditional renal and acid–base parameters. Methods One hundred and sixty eight consecutive critically ill patients with no previous kidney disease, who had an indwelling urinary catheter at ICU admission and who remained with the catheter for at least two days without dialysis were included. A sample of blood and spot urine were collected simultaneously, once daily, until catheter removal or dialysis requirement. Traditional acid–base and renal parameters were sequentially evaluated in parallel to blood and urinary physicochemical parameters. Patients were classified during this period as having or not AKI and, for patients with AKI, duration (transient or persistent) and severity (creatinine-based AKIN stage) were evaluated. Results One hundred and thirteen patients (67.3%) had AKI: 92 at ICU admission and 21 during the observation period. AKI development was characterized in blood by increased values of phosphate and unmeasured anions (SIG), decreased albumin, and in urine by decreased values of sodium (NaU), chloride (ClU) as well as high urinary strong ion difference (SIDu). These alterations began to occur before AKI diagnosis, and they reverted in transient AKI but remained in persistent AKI. NaU, ClU and albumin decreased, and phosphate, SIG and SIDu increased with AKI severity progression. NaU and ClU values increased again when AKIN stage 3 was reached. Conclusions Simultaneous physicochemical analysis of blood and urine revealed standardized alterations that characterize AKI development in critically ill patients. These alterations paralleled AKI duration and severity. Future studies should consider including sequential evaluation of urine biochemistry as part of the armamentarium for AKI diagnosis and management.
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Affiliation(s)
- Alexandre Toledo Maciel
- Intensive Care Unit, Department of Medical Emergencies, Hospital das Clínicas University of São Paulo, São Paulo, Brazil.
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Jean-Vivien S, Pierre P, Julie R, Audrey J, Alexandre S, Stéphane M. Renal Doppler in the management of the acute kidney injury in intensive care unit. J Crit Care 2013; 28:313-4. [DOI: 10.1016/j.jcrc.2012.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
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Honoré PM, Jacobs R, Joannes-Boyau O, Boer W, De Waele E, Van Gorp V, Spapen HD. Fractional excretion of urea to differentiate transient from persistent acute kidney injury: should we still trust old tools in the biomarker era? J Crit Care 2013; 27:514-5. [PMID: 23062846 DOI: 10.1016/j.jcrc.2012.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 10/27/2022]
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Comparison between fractional excretion of sodium and fractional excretion of urea in differentiating prerenal from renal azotemia in circulatory shock. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2013. [DOI: 10.1016/j.ejccm.2013.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Renal Doppler in the management of the acute kidney injury in intensive care unit. J Crit Care 2013; 28:314. [PMID: 23428708 DOI: 10.1016/j.jcrc.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/10/2013] [Indexed: 01/13/2023]
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