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Magnusson MMM, Gerk U, Schüpbach G, Rieger J, Plendl J, Marin I, Drews B, Kaessmeyer S. Microvascular changes following exposure to iodinated contrast media in vitro. A qualitative comparison to serum creatinine concentrations in post-cardiac catheterization patients. Microvasc Res 2024; 153:104659. [PMID: 38286222 DOI: 10.1016/j.mvr.2024.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Contrast-associated acute kidney injury (CA-AKI) is characterized as a loss of renal function following radiological contrast media administration. While all contrast media induce variable changes in microvascular endothelial cells in vitro, only few studies report clinical significance of their findings. A comprehensive assessment of the effect of iodinated contrast media on the renal function in vitro and in vivo is essential. The aim of our study was to morphometrically quantify the effect of two different contrast media (Iobitridol and Iodixanol) on vascular endothelial capillaries in vitro and to analyze their effect on the renal function of patients who underwent cardiac catheterization including the intra-arterial administration of contrast media, by measuring serum creatinine concentration (SCr), a byproduct of muscle metabolism, primarily excreted by the kidneys. Our hypothesis suggests that conducting a qualitative comparison of both outcomes will enable identification of differences and similarities between in vitro and in vivo exposure. MATERIAL AND METHODS In vitro, co-cultures of human dermal fibroblasts and human dermal microvascular endothelial cells forming capillary beds were exposed to a mixture of phosphate buffered saline and either Iobitridol, Iodixanol, or one of their supplements EDTA or Trometamol for 1.5 or 5 min. Negative control co-cultures were exposed exclusively to phosphate buffered saline. Co-cultures were either directly fixed or underwent a regeneration time of 1, 3 or 7 days. An artificial intelligence software was trained for detection of labeled endothelial capillaries (CD31) on light microscope images and measurements of morphometric parameters. In vivo, we retrospectively analyzed data from patients who underwent intra-arterial administration of contrast media and for whom SCr values were available pre- and post-contrast exposition (1, 3, and 7 days following procedure). Temporal development of SCr and incidence of CA-AKI were assessed. Both exposure types were qualitatively compared. RESULTS In vitro, Iobitridol, Iodixanol and EDTA induced a strong decrease of two morphometric parameters after 3 days of regeneration. In vivo, a significant increase of SCr and incidence of CA-AKI was observed 3 days following procedure in the post-contrast media patients. No difference was observed between groups. DISCUSSION Two of the morphometric parameters were inversely proportional to the SCr of the patients. If the endothelial damages observed in vitro occur in vivo, it may result in renal hypoxia, inducing a loss of kidney function clinically translated into an increase of SCr. Further development of our in vitro model could allow closer replication of the internal structure of a kidney and bridge the gap between in vitro studies and their clinical findings.
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Affiliation(s)
- Marine M M Magnusson
- Division of Veterinary Anatomy, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ulrich Gerk
- Städtisches Klinikum Dresden, Dresden, Germany
| | - Gertraud Schüpbach
- Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Juliane Rieger
- Institute of Translational Medicine for Health Care Systems, Department of Human Medicine, Faculty of Medicine, MSB Medical School Berlin, Berlin, Germany
| | - Johanna Plendl
- Institute of Veterinary Anatomy, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ilka Marin
- Institute of Veterinary Anatomy, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Barbara Drews
- Division of Veterinary Anatomy, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Sabine Kaessmeyer
- Division of Veterinary Anatomy, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
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Waikar SS. Biomarker blues: balancing hope and hype in acute kidney injury. Kidney Int 2024; 105:679-682. [PMID: 38519237 DOI: 10.1016/j.kint.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
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3
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Harris RE, Yates AR, Nandi D, Krawczeski CD, Klamer B, Martinez GV, Andrade GM, Beckman BF, Bi J, Zepeda-Orozco D. Urinary biomarkers associated with acute kidney injury in pediatric mechanical circulatory support patients. Pediatr Nephrol 2024; 39:569-577. [PMID: 37552466 DOI: 10.1007/s00467-023-06089-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND In patients requiring mechanical circulatory support (MCS), the incidence of acute kidney injury (AKI) is between 37 and 63%. In this study, we performed an exploratory analysis evaluating the relationship of multiple urine biomarkers with AKI development in pediatric MCS patients. METHODS This is a single center retrospective study in a pediatric cohort receiving MCS from August 2014 to November 2020. We measured 14 urine biomarkers of kidney injury on day 1 following MCS initiation and analyzed their association with development of AKI in the first 7 days of MCS initiation. RESULTS Sixty patients met inclusion criteria. Patients with AKI were more likely to be supported by venoarterial extracorporeal membrane oxygenation (65% vs. 8.3%, p < 0.001), compared to the no AKI group and less likely to have ventricular assist devices (10% vs. 50%, p < 0.001). There was a significant increase in the median urine albumin and urine osteoactivin in the AKI group, compared to the no AKI group (p = 0.020 and p = 0.018, respectively). When normalized to urine creatinine (UCr), an increased log osteoactivin/UCr was associated with higher odds of AKI development (OR: 2.05; 95% CI: 1.07, 4.44; p = 0.028), and higher log epidermal growth factor (EGF)/UCr (OR: 0.41; 95% CI: 0.15, 0.96) was associated with decreased odds of AKI. CONCLUSIONS Early increase in urine osteoactivin is associated with AKI development within 7 days of MCS initiation in pediatric patients. Contrary, an increased urine EGF is associated with kidney protection. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rachel E Harris
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Andrew R Yates
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Deipanjan Nandi
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine D Krawczeski
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brett Klamer
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gabriela Vasquez Martinez
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
| | - Gabriel Mayoral Andrade
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
| | - Brian F Beckman
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jianli Bi
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Diana Zepeda-Orozco
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
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4
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Zhang M, Lang B, Li H, Huang L, Zeng L, Jia ZJ, Cheng G, Zhu Y, Zhang L. Incidence and risk factors of drug-induced kidney injury in children: a systematic review and meta-analysis. Eur J Clin Pharmacol 2023; 79:1595-1606. [PMID: 37787852 DOI: 10.1007/s00228-023-03573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To comprehensively summarize the incidence and risk factors of drug-induced kidney injury (DIKI) in children. METHODS We systematically searched seven databases from inception to November 2022. Two independent reviewers selected studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted to quantify the incidence and risk factors of DIKI in children. RESULTS A total of 69 studies comprising 195,894 pediatric patients were included. Overall, the incidence of DIKI in children was 18.2% (95%CI: 16.4%-20.1%). The incidence of DIKI in critically ill children (19.6%, 95%CI: 15.9%-23.3%) was higher than that in non-critically ill children (16.1%, 95%CI: 12.9%-19.4%). Moreover, the risk factors for DIKI in children were intensive care unit (ICU) admission (OR = 1.59, 95% CI: 1.42-1.78, P = 0.000), treatment days (OR = 1.04, 95% CI: 1.03-1.05, P = 0.000), surgical intervention (OR = 1.43, 95% CI: 1.00-2.02, P = 0.048), infection (OR = 2.30, 95% CI: 1.44-3.66, P = 0.000), patent ductus arteriosus (OR = 4.78, 95% CI: 1.82-12.57, P = 0.002), chronic kidney disease (OR = 2.78, 95% CI: 1.92-4.02, P = 0.000), combination with antibacterial agents (OR = 1.98, 95% CI: 1.54-2.55, P = 0.000), diuretics (OR = 1.97, 95% CI: 1.51-2.56, P = 0.000), combination with antiviral agents (OR = 1.50, 95% CI: 1.11-2.04, P = 0.008), combination with non-steroidal anti-inflammatory drugs (OR = 1.79, 95% CI: 1.40-2.28, P = 0.000), and combination with immunosuppressive agents (OR = 2.84, 95% CI: 1.47-5.47, P = 0.002). CONCLUSION The incidence of DIKI in children is high, especially in critically ill children. Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of DIKI in children. In clinical practice, clinicians should adjust medication regimens for high-risk pediatric groups, such as ICU admission, some underlying diseases, combination with nephrotoxic drugs, etc., and regularly evaluate kidney function throughout treatment.
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Affiliation(s)
- Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Bingchen Lang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Yu Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Soliman M, Eskander A, Effat H, Fayad T, Elgohary T. Adverse Cardiovascular Events in Post-Renal Transplant Patients, a Retrospective Study of Five Hundred Cases Over Twenty-Two Years. CURRENT TRANSPLANTATION REPORTS 2023; 10:89-99. [DOI: 10.1007/s40472-023-00399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 10/13/2023]
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Nübel J, Hoffmeister M, Labrenz O, Jost K, Oess S, Hauptmann M, Schön J, Fritz G, Haase M, Butter C, Haase-Fielitz A. NT-proBNP/urine hepcidin-25 ratio and cardiorenal syndrome type 1 in patients with severe symptomatic aortic stenosis. Biomark Med 2023; 17:475-485. [PMID: 37675894 DOI: 10.2217/bmm-2023-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Background: This study aimed to determine whether novel and conventional cardiorenal biomarkers in patients before transcatheter aortic valve implantation may be associated with cardiorenal syndrome (CRS) type 1. Methods: Serum NT-proBNP and urine biomarkers (hepcidin-25, NGAL, IL-6) were measured before and 24 h after transcatheter aortic valve implantation. Results: 16/95 patients had CRS type 1. Those patients had longer length of stay in hospital (12.5 [9.0-16.0] vs 9.0 [8-12] days; p = 0.025) and were more frequently readmitted to hospital within 6 months after discharge (46.7 vs 15.6%; odds ratio: 4.7; 95% CI: 1.5-15.5; p = 0.007). The NT-proBNP/urine hepcidin-25 ratio (odds ratio: 2.89; 95% CI: 1.30-6.41; p = 0.009) was an independent modifier of CRS type 1. Conclusion: The NT-proBNP/urine hepcidin-25 ratio appears to be a modifier of risk of CRS type 1.
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Affiliation(s)
- Jonathan Nübel
- Department of Cardiology, University Hospital Heart Centre Brandenburg & Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB), Bernau, 16321, Germany
| | - Meike Hoffmeister
- Institute of Biochemistry, Brandenburg Medical School (MHB), Brandenburg, 14770, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School & the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
| | - Oliver Labrenz
- Department of Psychology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School (MHB), Neuruppin, 16816, Germany
| | - Kerstin Jost
- Department of Psychology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School (MHB), Neuruppin, 16816, Germany
| | - Stefanie Oess
- Institute of Biochemistry, Brandenburg Medical School (MHB), Brandenburg, 14770, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School & the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
| | - Michael Hauptmann
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School & the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
- Institute of Biostatistics & Registry Research, Brandenburg Medical School (MHB), Neuruppin, 16816, Germany
| | - Julika Schön
- Anesthesia & Intensive Care, University Hospital Ruppin-Brandenburg, Brandenburg Medical School (MHB), Neuruppin, 16816, Germany
| | - Georg Fritz
- Department of Anesthesiology, Intensive Care & Pain Therapy, University Hospital Heart Centre Brandenburg, Brandenburg Medical School (MHB), Bernau, 16321, Germany
| | - Michael Haase
- Diamedikum Kidney Care Centre, Potsdam, 14473, Germany
- Department of Nephrology & Hypertension, Hannover Medical School, Hannover, 30625, Germany
- Institute of Social Medicine & Health System Research, Otto von Guericke University Magdeburg, Magdeburg, 39120, Germany
| | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg & Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB), Bernau, 16321, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School & the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, University Hospital Heart Centre Brandenburg & Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB), Bernau, 16321, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School & the Brandenburg Technical University Cottbus-Senftenberg, Cottbus, Germany
- Institute of Social Medicine & Health System Research, Otto von Guericke University Magdeburg, Magdeburg, 39120, Germany
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Schaubroeck H, Vandenberghe W, Boer W, Boonen E, Dewulf B, Bourgeois C, Dubois J, Dumoulin A, Fivez T, Gunst J, Hermans G, Lormans P, Meersseman P, Mesotten D, Stessel B, Vanhoof M, De Vlieger G, Hoste E. Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium. Crit Care 2022; 26:225. [PMID: 35879765 PMCID: PMC9310674 DOI: 10.1186/s13054-022-04086-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acute kidney injury (AKI) has been reported as a frequent complication of critical COVID-19. We aimed to evaluate the occurrence of AKI and use of kidney replacement therapy (KRT) in critical COVID-19, to assess patient and kidney outcomes and risk factors for AKI and differences in outcome when the diagnosis of AKI is based on urine output (UO) or on serum creatinine (sCr). Methods Multicenter, retrospective cohort analysis of patients with critical COVID-19 in seven large hospitals in Belgium. AKI was defined according to KDIGO within 21 days after ICU admission. Multivariable logistic regression analysis was used to explore the risk factors for developing AKI and to assess the association between AKI and ICU mortality. Results Of 1286 patients, 85.1% had AKI, and KRT was used in 9.8%. Older age, obesity, a higher APACHE II score and use of mechanical ventilation at day 1 of ICU stay were associated with an increased risk for AKI. After multivariable adjustment, all AKI stages were associated with ICU mortality. AKI was based on sCr in 40.1% and UO in 81.5% of patients. All AKI stages based on sCr and AKI stage 3 based on UO were associated with ICU mortality. Persistent AKI was present in 88.6% and acute kidney disease (AKD) in 87.6%. Rapid reversal of AKI yielded a better prognosis compared to persistent AKI and AKD. Kidney recovery was observed in 47.4% of surviving AKI patients. Conclusions Over 80% of critically ill COVID-19 patients had AKI. This was driven by the high occurrence rate of AKI defined by UO criteria. All AKI stages were associated with mortality (NCT04997915). Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04086-x.
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8
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Katz-Greenberg G, Malinchoc M, Broyles DL, Oxman D, Hamrahian SM, Maarouf OH. Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Intensive Care Unit Admission Diagnosis: A Prospective Cohort Study. KIDNEY360 2022; 3:1502-1510. [PMID: 36245663 PMCID: PMC9528386 DOI: 10.34067/kid.0001492022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/13/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is most commonly caused by tubular injury and is associated with a wide variety of critical illnesses. It is well known that urinary biomarkers can lead to the early identification of AKI. However, the ability of urinary biomarkers to distinguish between different types of critical illness has been less studied. METHODS In this prospective cohort study, urinary neutrophil gelatinase-associated lipocalin (uNGAL) was measured in 107 patients consecutively admitted to the ICUs in our tertiary medical center. uNGAL samples were collected within 3-6 hours of admission to an ICU and measured by ELISA. All data were analyzed using R statistical software, and univariate analysis was used to determine the correlations of uNGAL levels with AKI stage, admission diagnoses, and ICU course. RESULTS uNGAL level increased by a mean of 24-fold (SD 10-59) in ICU patients with AKI and demonstrated a significant correlation with the different AKI stages. uNGAL predicted the need for RRT, with values increased by more than 15-fold (P<0.05) in patients needing RRT, and remained a useful tool to predict AKI in ICU patients with a urinary tract infection. uNGAL level was correlated with certain ICU admitting diagnoses whereby uNGAL levels were lower in ICU patients with cardiogenic shock compared with other admission diagnoses (β=-1.92, P<0.05). CONCLUSIONS uNGAL can be used as an early predictor of AKI and its severity in patients admitted to the ICU, including the need for RRT. uNGAL may also help in distinguishing patients with cardiogenic shock from those with other critical illnesses and identifying those at risk for poor outcomes irrespective of the presence of AKI.
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Affiliation(s)
- Goni Katz-Greenberg
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Renal Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - David Oxman
- Pulmonary Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Seyed M. Hamrahian
- Renal Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Omar H. Maarouf
- Renal Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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A risk-stratified assessment of biomarker-based acute kidney injury phenotypes in children. Pediatr Res 2022; 93:1354-1360. [PMID: 35933485 PMCID: PMC9899867 DOI: 10.1038/s41390-022-02233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/06/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The functional acute kidney injury (AKI) diagnostic tests serum creatinine (SCr) and urine output are imprecise and make management challenging. Combining tubular injury biomarkers with functional markers reveal AKI phenotypes that may facilitate personalized care. However, when and in whom to obtain injury biomarkers remains unclear. METHODS This was a prospective, observational study of patients admitted to a pediatric intensive care unit (PICU). Using the Renal Angina Index (RAI), subjects were screened for the presence (RAI+) or absence (RAI-) of renal angina 12 h post-admission and assigned an AKI phenotype using urinary NGAL (NGAL+: ≥150 ng/ml) and SCr (SCr+: ≥KDIGO Stage 1). Outcomes for each AKI phenotype were assessed and compared by RAI status. RESULTS In all, 200/247 (81%) subjects were RAI+. RAI+ subjects who were NGAL+ had higher risk of Day 3 AKI, renal replacement therapy use, and mortality and fewer ventilator- and PICU-free days, compared to NGAL-, irrespective of Day 0 SCr. Similar findings were not demonstrated in RAI- subjects, though NGAL+/SCr+ was associated with fewer ventilator- and PICU-free days compared to NGAL-/SCr+. CONCLUSIONS NGAL- and SCr-based AKI phenotypes provide improved prognostic information in children with renal angina (RAI+) and/or with SCr elevation. These populations may be appropriate for targeted biomarker testing. IMPACT New consensus recommendations encourage the integration of kidney tubular injury biomarkers such as urinary NGAL with serum creatinine for diagnosis and staging of acute kidney injury; however, no structured testing framework exists guiding when to test and in whom. Urinary NGAL- and serum creatinine-based acute kidney injury phenotypes increase diagnostic precision in critically ill children experiencing renal angina (RAI+) or serum creatinine-defined acute kidney injury. These data provide preliminary evidence for a proposed framework for directed urinary NGAL assessment in the pediatric intensive care unit.
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10
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Interplay between mineral bone disorder and cardiac damage in acute kidney injury: from Ca 2+ mishandling and preventive role of Klotho in mice to its potential mortality prediction in human. Transl Res 2022; 243:60-77. [PMID: 35077866 DOI: 10.1016/j.trsl.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/27/2022]
Abstract
Biomarkers of mineral bone disorders (MBD) including phosphorus, fibroblast growth factor (FGF)-23 and Klotho are strongly altered in patients with acute kidney injury (AKI) who have high cardiac outcomes and mortality rates. However, the crosslink between MBD and cardiac damage after an AKI episode still remains unclear. We tested MBD and cardiac biomarkers in an experimental AKI model after 24 or 72 hours of folic acid injection and we analyzed structural cardiac remodeling, intracellular calcium (Ca2+) dynamics in cardiomyocytes and cardiac rhythm. AKI mice presented high levels of FGF-23, phosphorus and cardiac troponin T and exhibited a cardiac hypertrophy phenotype accompanied by an increase in systolic Ca2+ release 24 hours after AKI. Ca2+ transients and contractile dysfunction were reduced 72 hours after AKI while diastolic sarcoplasmic reticulum Ca2+ leak, pro-arrhythmogenic Ca2+ events and ventricular arrhythmias were increased. These cardiac events were linked to the activation of the calcium/calmodulin-dependent kinase II pathway through the increased phosphorylation of ryanodine receptors and phospholamban specific sites after AKI. Cardiac hypertrophy and the altered intracellular Ca2+ dynamics were prevented in transgenic mice overexpressing Klotho after AKI induction. In a translational retrospective longitudinal clinical study, we determined that combining FGF-23 and phosphorus with cardiac troponin T levels achieved a better prediction of mortality in AKI patients at hospital admission. Thus, monitoring MBD and cardiac damage biomarkers could be crucial to prevent mortality in AKI patients. In this setting, Klotho might be considered as a new cardioprotective therapeutic tool to prevent deleterious cardiac events in AKI conditions.
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Lima C, Gorab DL, Fernandes CR, Macedo E. Role of proenkephalin in the diagnosis of severe and subclinical acute kidney injury during the perioperative period of liver transplantation. Pract Lab Med 2022; 31:e00278. [PMID: 35733419 PMCID: PMC9207138 DOI: 10.1016/j.plabm.2022.e00278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2022] Open
Abstract
In recent decades, clinical research on early biomarkers of renal injury has been frequent and intensive, with proenkephalin (PENK) being indicated as a promising filtration biomarker (BM). From a cohort of 57 patients, blood samples were collected preoperatively and 48 h after liver transplantation (LT). The following BMs were analyzed: PENK, cystatin-C (CYS-C), and serum creatinine (Scr). Diagnosis of AKI was based on the KDIGO criteria. Of the 57 patients undergoing LT, 50 (88%) developed acute kidney injury (AKI) and were categorized as follows: no-AKI/mild-AKI - 21 (36.8%) and severe-AKI 36 (63.2%). During the preoperative period, only PENK was significantly higher in patients with severe AKI, with an AUC of 0.69 (CI 0.54–0.83), a cutoff of 55.30 pmol/l, a sensitivity of 0.86, a specificity of 0.52, and an accuracy of 0.75. In addition, subclinical AKI was determined preoperatively in 32 patients. Forty-eight hours after LT, PENK maintained its performance in determining severe AKI, with an AUC of 0.83 (CI 0.72–0.94), a cutoff of 119.05 pmol/l, a sensitivity of 0.81, a specificity of 0.90, and an accuracy of 0.84. PENK detected AKI 48 h earlier than serum creatinine. In a multivariate linear regression analysis, PENK was an independent predictor of severe AKI. This small study suggests that the filtration biomarker PENK shows promise for detecting AKI in patients undergoing LT, revealing greater accuracy and an earlier rise in patients with severe AKI. The combination of kidney functional and filtration BMs may aid in the management and prevention of AKI progression.
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12
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Fuhrman D. The use of diagnostic tools for pediatric AKI: applying the current evidence to the bedside. Pediatr Nephrol 2021; 36:3529-3537. [PMID: 33492454 PMCID: PMC8813176 DOI: 10.1007/s00467-021-04940-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
Given the known deleterious consequences of acute kidney injury (AKI), exciting recent research efforts have focused on developing strategies for the earlier recognition of AKI in the pediatric population. Recognizing the limitations of serum creatinine, investigators have focused on the study of novel biomarkers and practical bedside tools for identifying patients at risk for AKI prior to a rise in serum creatinine. In PubMed, there are presently over 30 original research papers exploring the use of pediatric AKI risk prediction tools in just the last 2 years. The following review highlights the most recent advances in the literature regarding opportunities to refine our ability to detect AKI early. Importantly, this review discusses how prediction tools including novel urine and serum biomarkers, practical risk stratification tests, renal functional reserve, and electronic medical record alerts may ultimately be applied to routine clinical practice.
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Affiliation(s)
- Dana Fuhrman
- Department of Critical Care Medicine, Department of Pediatrics, Division of Nephrology, The Center for Critical Care Nephrology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
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13
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Meijers WC, Bayes-Genis A, Mebazaa A, Bauersachs J, Cleland JGF, Coats AJS, Januzzi JL, Maisel AS, McDonald K, Mueller T, Richards AM, Seferovic P, Mueller C, de Boer RA. Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC). Eur J Heart Fail 2021; 23:1610-1632. [PMID: 34498368 PMCID: PMC9292239 DOI: 10.1002/ejhf.2346] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.
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Affiliation(s)
- Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Alexandre Mebazaa
- Inserm U942-MASCOT; Université de Paris; Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière; FHU PROMICE, Paris, France.,Université de Paris, Paris, France.,Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière, Paris, France.,FHU PROMICE, Paris, France
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow; National Heart & Lung Institute, Imperial College London, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
| | | | | | | | - Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - A Mark Richards
- Christchurch Heart Institute, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgarde, Serbia
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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14
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Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders HJ. Acute kidney injury. Nat Rev Dis Primers 2021; 7:52. [PMID: 34267223 DOI: 10.1038/s41572-021-00284-z] [Citation(s) in RCA: 462] [Impact Index Per Article: 154.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
Acute kidney injury (AKI) is defined by a sudden loss of excretory kidney function. AKI is part of a range of conditions summarized as acute kidney diseases and disorders (AKD), in which slow deterioration of kidney function or persistent kidney dysfunction is associated with an irreversible loss of kidney cells and nephrons, which can lead to chronic kidney disease (CKD). New biomarkers to identify injury before function loss await clinical implementation. AKI and AKD are a global concern. In low-income and middle-income countries, infections and hypovolaemic shock are the predominant causes of AKI. In high-income countries, AKI mostly occurs in elderly patients who are in hospital, and is related to sepsis, drugs or invasive procedures. Infection and trauma-related AKI and AKD are frequent in all regions. The large spectrum of AKI implies diverse pathophysiological mechanisms. AKI management in critical care settings is challenging, including appropriate volume control, nephrotoxic drug management, and the timing and type of kidney support. Fluid and electrolyte management are essential. As AKI can be lethal, kidney replacement therapy is frequently required. AKI has a poor prognosis in critically ill patients. Long-term consequences of AKI and AKD include CKD and cardiovascular morbidity. Thus, prevention and early detection of AKI are essential.
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Affiliation(s)
- John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padua, Italy.,Department of Nephrology, Dialysis and Kidney Transplant, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany.
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15
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Basu RK, Hackbarth R, Gillespie S, Akcan-Arikan A, Brophy P, Bagshaw S, Alobaidi R, Goldstein SL. Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children. Pediatr Res 2021; 90:1031-1038. [PMID: 33531676 PMCID: PMC7852056 DOI: 10.1038/s41390-021-01363-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 12/25/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Assessment of acute kidney injury (AKI) in septic patients remains imprecise. In adults, the classification of septic patients by clinical AKI phenotypes (severity and timing) demonstrates unique associations with patient outcome vs. broadly defined AKI. METHODS In a multinational prospective observational study, AKI diagnosis in critically ill septic children was stratified by duration (transient vs. persistent) and severity (mild vs. severe by creatinine change and urine output). The outcomes of interest were mortality and intensive care unit resource complexity at 28 days. RESULTS Seven hundred and fifty-seven septic children were studied (male 52.7%, age 4.6 years (1.5-11.9)). Mortality (overall 12.1%) was different between severe AKI and mild AKI (18.3 vs. 4.4%, p < 0.001) as well as intensive care unit (ICU) complexity (overall 34.5%, 45 vs. 21.7%, p < 0.001). Patients with Persistent AKI had fewer ICU-free days (17 (7, 21) vs. 24 (17, 26), p < 0.001) and higher ICU complexity (52.8 vs. 22.9%, p = 0.002) than transient AKI, even after exclusion of patients with early mortality. AKI phenotypes incorporating temporal and severity data correlate with unique survival (range 4.4-21.6%) and ICU-free days (range of 15-25 days) CONCLUSIONS: The outcome of septic children with AKI changes by clinical phenotype. Our findings underscore the importance of prognostic enrichment in sepsis and AKI for the purpose of trial design and patient management. IMPACT Although AKI occurs commonly in patients with sepsis (S-AKI), outcomes for children with S-AKI varies based on the severity and timing of the AKI. Existing S-AKI pediatric data utilize a broad singular definition of kidney injury. Increasing the precision of AKI classification results in a new understanding of how S-AKI associates with patient outcome. A refined classification of S-AKI identifies subgroups of children, making possible a targeted and a personalized medicine approach to S-AKI study and management.
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Affiliation(s)
- Rajit K. Basu
- grid.189967.80000 0001 0941 6502Division of Pediatric Critical Care, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA USA
| | - Richard Hackbarth
- grid.416230.20000 0004 0406 3236Division of Pediatric Critical Care, Helen DeVos Children’s Hospital, Spectrum Health, Grand Rapids, MI USA
| | - Scott Gillespie
- grid.189967.80000 0001 0941 6502Department of Pediatrics, Division of Biostatistics, Emory University, Atlanta, GA USA
| | - Ayse Akcan-Arikan
- grid.416975.80000 0001 2200 2638Department of Pediatrics, Sections of Critical Care and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Patrick Brophy
- grid.438870.00000 0004 0451 2572Department of Pediatrics, Golisano Children’s Hospital, Fort Myers, FL USA
| | - Sean Bagshaw
- grid.17089.37Stollery Children’s Hospital, University of Alberta, Edmonton, AB Canada
| | - Rashid Alobaidi
- grid.17089.37Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - Stuart L. Goldstein
- grid.239573.90000 0000 9025 8099Center for Acute Care Nephrology, Cincinnati Children’s Hospital, Cincinnati, OH USA
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16
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Ghionzoli N, Sciaccaluga C, Mandoli GE, Vergaro G, Gentile F, D'Ascenzi F, Mondillo S, Emdin M, Valente S, Cameli M. Cardiogenic shock and acute kidney injury: the rule rather than the exception. Heart Fail Rev 2020; 26:487-496. [PMID: 33006038 PMCID: PMC8024234 DOI: 10.1007/s10741-020-10034-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/21/2023]
Abstract
Cardiogenic shock (CS) is a life-threatening condition of poor end-organ perfusion, caused by any cardiovascular disease resulting in a severe depression of cardiac output. Despite recent advances in replacement therapies, the outcome of CS is still poor, and its management depends more on empirical decisions rather than on evidence-based strategies. By its side, acute kidney injury (AKI) is a frequent complication of CS, resulting in the onset of a cardiorenal syndrome. The combination of CS with AKI depicts a worse clinical scenario and holds a worse prognosis. Many factors can lead to acute renal impairment in the setting of CS, either for natural disease progression or for iatrogenic causes. This review aims at collecting the current evidence-based acknowledgments in epidemiology, pathophysiology, clinical features, diagnosis, and management of CS with AKI. We also attempted to highlight the major gaps in evidence as well as to point out possible strategies to improve the outcome.
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Affiliation(s)
- N Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy.
| | - C Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
| | - G E Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
| | - G Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - F Gentile
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - F D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
| | - S Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
| | - M Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
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17
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Duarte DB, Lacerda MCSR, Ribeiro YJP, Ribeiro MZD, Frederico MDA, Oliveira MJC. Kidney biomarkers in tropical infections: an update. Pathog Glob Health 2020; 114:302-308. [PMID: 32726193 PMCID: PMC7480515 DOI: 10.1080/20477724.2020.1799605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Neglected tropical diseases affect over 1 billion people, and cause 170,000 deaths each year. They result in disability, stigma and disfigurement, and also push families into poverty. Tropical infections can involve the kidney, presenting as a wide variety of ways, varying from transient urinary abnormalities to severe acute kidney injury (AKI). It is important to assess renal function in patients with tropical infections for earlier detection of AKI, appropriate treatment and prevention of Chronic Kidney Disease (CKD) outcome in some of them. There was an exponential increase in research on new kidney biomarkers that were earlier and specific for renal damage but few in the scope of tropical infections. In this review, we focus on kidney biomarkers that are being studied in some of the most prevalent tropical infections such as visceral leishmaniasis, leptospirosis, malaria, schistosomiasis and leprosy. Further studies are needed to evaluate the usefulness of renal biomarkers in the early diagnosis of renal diseases associated with tropical infections.
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Affiliation(s)
- Daniella Bezerra Duarte
- Post-Graduation Program in Medical Sciences, Department of
Internal Medicine, Federal University of Ceará, Fortaleza, Brazil
- School of Medicine, Federal University of Alagoas, Maceió, Brazil
- School of Medicine, Tiradentes University Center, Maceió, Brazil
- School of Medicine, CESMAC University Center, Maceió, Brazil
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18
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de Oliveira Vilar Neto J, da Silva CA, Meneses GC, Pinto DV, Brito LC, da Cruz Fonseca SG, de Sousa Alves R, Martins AMC, de Oliveira Assumpção C, De Francesco Daher E. Novel renal biomarkers show that creatine supplementation is safe: a double-blind, placebo-controlled randomized clinical trial. Toxicol Res (Camb) 2020; 9:263-270. [PMID: 32670557 DOI: 10.1093/toxres/tfaa028] [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: 11/27/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to evaluate the impact of creatine supplementation (CS) on renal function in young, healthy, and active subjects. We used a randomized, double-blind, placebo-controlled clinical trial as the study design. Thirty-six healthy male university students were recruited and divided into three groups: group placebo, group G3 (3 g/day of CS), and group G5 (5 g/day of CS). To assess renal function, new kidney biomarkers, kidney injury molecule-1 (KIM-1) and monocyte chemoattractant protein-1 (MCP-1), were quantified. Serum albumin, serum creatinine, serum urea, estimated glomerular filtration rate (eGFR), proteinuria, and albuminuria were also measured. All groups were evaluated at two times: prior CS or placebo (pre) and after 35 days on CS or placebo (post). After 35 days of intervention, all characteristics were maintained without significant difference (P > 0.05) between the groups, including serum creatinine, eGFR, and more sensitive kidney biomarker concentrations (KIM-1 and MCP-1). The paired analysis showed that the supplemented groups (G3 and 5G) had increased serum creatinine and decreased eGFR levels (P < 0.05). However, the values were still within the normal reference range. In conclusion, the results of renal function evaluation did not show any difference between the evaluated groups. Increased serum creatinine and decreased eGFR levels in CS groups can be explained by increased creatine stores and metabolism, since creatinine is a by-product of creatine metabolism. These findings indicate that the use of CS at doses of 3 g and 5 g/day for a short period (35 days) is safe and did not impair the kidneys or renal function in young healthy subjects.
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Affiliation(s)
- José de Oliveira Vilar Neto
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil.,Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Carlos Alberto da Silva
- Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Gdayllon Cavalcante Meneses
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil.,Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Daniel Vieira Pinto
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil
| | - Luciana Catunda Brito
- Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Said Goncalves da Cruz Fonseca
- Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Renata de Sousa Alves
- Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Alice Maria Costa Martins
- Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Cláudio de Oliveira Assumpção
- Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Elizabeth De Francesco Daher
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil
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19
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Meneses GC, da Silva GB, Tôrres PPBF, de Castro VQ, Lopes RL, Martins AMC, Daher EDF. Novel kidney injury biomarkers in tropical infections: a review of the literature. Rev Inst Med Trop Sao Paulo 2020; 62:e14. [PMID: 32074217 PMCID: PMC7032010 DOI: 10.1590/s1678-9946202062014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 12/29/2022] Open
Abstract
Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.
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Affiliation(s)
- Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Paulo Pacelli Bezerra Filizola Tôrres
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Valeska Queiroz de Castro
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Renata Lima Lopes
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
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20
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21
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The Predictive Role of the Biomarker Kidney Molecule-1 (KIM-1) in Acute Kidney Injury (AKI) Cisplatin-Induced Nephrotoxicity. Int J Mol Sci 2019; 20:ijms20205238. [PMID: 31652595 PMCID: PMC6834366 DOI: 10.3390/ijms20205238] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) following platinum-based chemotherapeutics is a frequently reported serious side-effect. However, there are no approved biomarkers that can properly identify proximal tubular injury while routine assessments such as serum creatinine lack sensitivity. Kidney-injury-molecule 1 (KIM-1) is showing promise in identifying cisplatin-induced renal injury both in vitro and in vivo studies. In this review, we focus on describing the mechanisms of renal tubular cells cisplatin-induced apoptosis, the associated inflammatory response and oxidative stress and the role of KIM-1 as a possible biomarker used to predict cisplatin associated AKI.
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22
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Ronco C. Acute Kidney Injury Biomarkers: Are We Ready for the Biomarker Curve? Cardiorenal Med 2019; 9:354-357. [DOI: 10.1159/000503443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
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23
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McCullough PA, Ostermann M, Forni LG, Bihorac A, Koyner JL, Chawla LS, Shi J, Kampf JP, McPherson P, Kellum JA. Serial Urinary Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor-Binding Protein 7 and the Prognosis for Acute Kidney Injury over the Course of Critical Illness. Cardiorenal Med 2019; 9:358-369. [PMID: 31618746 DOI: 10.1159/000502837] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Over the course of critical illness, there is a risk of acute kidney injury (AKI), and when it occurs, it is associated with increased length of stay, morbidity, and mortality. The urinary cell-cycle arrest markers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) have been utilized to predict the risk of AKI over the next 12 h from the time of sampling. The aim of this analysis was to evaluate the utility of [TIMP-2] × [IGFBP7] measured serially to anticipate the occurrence of AKI over the first 7 days of critical illness. METHODS This analysis is from a prospective, blinded, observational, international study of patients admitted to intensive care units. We designed the analysis to emulate a clinician-driven serial testing strategy. Urine samples collected every 12 h up to 3 days from 530 patients were considered for analysis. We evaluated [TIMP-2] × [IGFBP7] results for the first 3 measurements (baseline, 12 and 24 h) and continued to evaluate additional results if any of the first 3 were positive >0.3 (ng/mL)2/1,000. Patients were stratified by number of [TIMP-2] × [IGFBP7] results >0.3 (ng/mL)2/1,000 and number of results >2.0 (ng/mL)2/1,000. The primary endpoint was AKI stage 2-3 defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. RESULTS The median (interquartile range) age was 64 (53-74) years, 61% were men, and 79% were Caucasian. The median APACHE III score was 71 (51-93), and 82% required mechanical ventilation. Baseline serum creatinine was 0.8 mg/dL and 164/530 (31%) developed the primary endpoint by day 7 with a median time from baseline to stage 2/3 AKI of 26 (8-56) h. In patients with negative values for the first 3 tests (≤0.3 (ng/mL)2/1,000), the cumulative incidence of the primary endpoint at 7 days was 13.0%. Conversely, for those with one, two, or three strongly positive values (>2.0 (ng/mL)2/1,000), the cumulative incidence for the primary endpoint at 7 days was 57.7, 75.0, and 94.4%, respectively, p < 0.001 for trend. There were 3.4% with test results between 0.3 and 2.0 (ng/mL)2/1,000 at all measurements; one third of those patients developed the primary endpoint. We observed a graded increase in the primary endpoint in Kaplan-Meier plots for successively positive test results over time. CONCLUSION Serial urinary [TIMP-2] × [IGFBP7] at baseline, 12 and 24 h, and up through 3 days are prognostic for the occurrence of stage 2/3 AKI over the course of critical illness. Three consecutive negative values (≤0.3 (ng/mL)2/1,000) are associated with very low (13.0%) incidence of stage 2/3 AKI over the course of 7 days. Conversely, emerging or persistent, strongly positive results [>2.0 [ng/mL]2/1,000] predict very high incidence rates (up to 94.4%) of stage 2/3 AKI. There was a low rate of test results between 0.3 and 2.0 (ng/mL)2/1,000, where the primary endpoint was observed in a third of cases.
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Affiliation(s)
- Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Dallas, Texas, USA,
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Lui G Forni
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Azra Bihorac
- Precision and Intelligence in Medicine Partnership, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jay L Koyner
- Department of Internal Medicine, Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Jing Shi
- Walker Biosciences, Carlsbad, California, USA
| | | | | | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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24
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Murray PT, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Horiuchi Y, Clopton P, Taub P, Vilke GM, Barnett O, McDonald K, Mahon N, NuÑez J, Briguori C, Passino C, Maisel A. Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS). J Card Fail 2019; 25:654-665. [DOI: 10.1016/j.cardfail.2019.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/06/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022]
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Stanski N, Menon S, Goldstein SL, Basu RK. Integration of urinary neutrophil gelatinase-associated lipocalin with serum creatinine delineates acute kidney injury phenotypes in critically ill children. J Crit Care 2019; 53:1-7. [PMID: 31174170 DOI: 10.1016/j.jcrc.2019.05.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Acute kidney injury (AKI) is prevalent in critically ill patients and associated with poor outcomes. Current AKI diagnostics- changes to serum creatinine (SCr) and urine output- are imprecise. Integration of injury biomarkers with SCr may improve diagnostic precision. METHODS We performed a secondary analysis of a study of critically ill children. Measurements of urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr samples from ICU admission facilitated the creation of four groups for comparison, based on elevation of SCr from baseline and reference NGAL cut-off value: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr + and uNGAL+/SCr+. The primary outcome assessed was AKI severity on Day 3. RESULTS 178 children were studied. Compared to uNGAL-/SCr-, uNGAL+/SCr- patients had increased risk for all-stage Day 3 AKI (≥ KDIGO stage 1) (OR 3.83, [1.3-11.3], p = .025). Compared to uNGAL-/SCr+, uNGAL+/SCr + patients had increased risk for severe Day 3 AKI (≥ KDIGO stage 2) (OR 12, [1.4-102], p = .018). The only patients to suffer all-stage Day 3 AKI and mortality were uNGAL+ (3.2% uNGAL+/SCr-; 6.5% uNGAL+/SCr+). CONCLUSIONS Unique biomarker combinations on admission are predictive of distinct Day 3 AKI severity phenotypes. These classifications may enable a more personalized approach to the early management of AKI. Expanded study in larger populations is warranted.
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Affiliation(s)
- Natalja Stanski
- Cincinnati Children's Hospital Medical Center, Division of Critical Care Medicine, 3333 Burnet Avenue, MLC 2005, Cincinnati, OH 45229, United States of America.
| | - Shina Menon
- University of Washington School of Medicine, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, United States of America.
| | - Stuart L Goldstein
- Cincinnati Children's Hospital Medical Center, Center for Acute Care Nephrology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, United States of America.
| | - Rajit K Basu
- Children's Healthcare of Atlanta, Division of Critical Care Medicine, United States of America.
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26
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Neyra JA, Hu MC, Minhajuddin A, Nelson GE, Ahsan SA, Toto RD, Jessen ME, Moe OW, Fox AA. Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery. Kidney Int Rep 2019; 4:1131-1142. [PMID: 31440703 PMCID: PMC6698294 DOI: 10.1016/j.ekir.2019.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. Methods Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. Results A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m2, and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2, the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). Conclusions Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.
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Affiliation(s)
- Javier A Neyra
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Ming-Chang Hu
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Nelson
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Syed A Ahsan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert D Toto
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Orson W Moe
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amanda A Fox
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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27
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Basu RK. Dynamic Biomarker Assessment: A Diagnostic Paradigm to Match the AKI Syndrome. Front Pediatr 2019; 7:535. [PMID: 32039106 PMCID: PMC6986245 DOI: 10.3389/fped.2019.00535] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of injury as well as to reconsider the existing diagnostic framework. Novel urinary and serum biomarkers of injury have, however, not been readily integrated into practice-partially because of the limited scope to current testing. The predominant focus to date has been the adjudication of a single biomarker measured at a single point of time for the prediction of either AKI progression or disease-related mortality. This approach is pragmatically problematic. The imprecise, umbrella classification of AKI diagnosis coupled with the absence of a consistently effective set of therapies creates a difficult rubric for biomarkers to demonstrate value in the scope of practice. AKI is, however, not a binary process but more an ICU syndrome-with complex biology underpinning injury, interacting and disrupting other organ function, multidimensional in manifestation, and varying in severity over time. As such, a more appropriate diagnostic paradigm is needed. In this minireview, the status quo for AKI diagnosis and associated limitations will be discussed, and a novel, dynamic, and multidimensional paradigm will be presented. Appreciation of AKI as an ICU syndrome and creation of an appropriately matching and sophisticated diagnostic platform of injury assessment are possible and represent the next step in AKI management.
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Affiliation(s)
- Rajit K Basu
- Division of Critical Care, Department of Pediatrics, Emory School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
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28
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Zhang J, Tian J, Sun H, Digvijay K, Neri M, Bhargava V, Yin Y, Ronco C. How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury? Blood Purif 2018; 46:326-331. [PMID: 30173223 DOI: 10.1159/000492026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/10/2018] [Indexed: 12/26/2022]
Abstract
Sepsis is the leading cause of acute kidney injury (AKI) in the intensive care unit. As the most common treatment of septic AKI, it is believed that continuous renal replacement therapy (CRRT) can not only maintain the water balance and excrete the metabolic products but also regulate the inflammation and promote kidney recovery. CRRT can remove the inflammatory cytokines to regulate the metabolic adaption in kidney and restore the kidney recovery to protect the kidney in septic AKI. Second, CRRT can provide extra energy supply in septic AKI to improve the kidney energy balance in septic AKI. Third, the anticoagulant used in CRRT also regulates the inflammation in septic AKI. CRRT is not only a treatment to deal with the water balance and metabolic products, but also a method to regulate the inflammation in septic AKI.
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Affiliation(s)
- Jingxiao Zhang
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Jiakun Tian
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
| | - Hongzhi Sun
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
| | - Kumar Digvijay
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Nephrology and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Mauro Neri
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Vinant Bhargava
- Department of Nephrology and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Yongjie Yin
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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29
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Meneses GC, De Francesco Daher E, da Silva Junior GB, Bezerra GF, da Rocha TP, de Azevedo IEP, Libório AB, Martins AMC. Visceral leishmaniasis-associated nephropathy in hospitalised Brazilian patients: new insights based on kidney injury biomarkers. Trop Med Int Health 2018; 23:1046-1057. [PMID: 29987885 DOI: 10.1111/tmi.13127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the usefulness of early acute kidney injury (AKI) biomarkers in clinical management of visceral leishmaniasis. METHODS Prospective study with 50 hospitalised VL patients. AKI biomarkers, that is, serum and urinary neutrophil gelatinase-associated lipocalin (sNGAL, uNGAL, respectively), urinary kidney injury molecule-1 (uKIM-1) and urinary monocyte chemotactic protein-1 (uMCP-1), were quantified by immunoassay (ELISA). Also, interferon-gamma (INF-y) and C-reactive protein (CRP) were evaluated as inflammatory biomarkers possibly related to VL severity. RESULTS VL patients had hyponatremia, hypoalbuminemia, hypergammaglobulinemia, haematologic and hepatic disorders. AKI was found in 46%, and one death (2%) occurred. The AKI group had significant longer hospital stay, lower levels of IFN-y and higher levels of CRP, more clinical renal abnormalities and higher levels of sNGAL, uNGAL, uKIM-1 and uMCP-1. Overall, sNGAL, uKIM-1 and uMCP-1 showed correlations with important clinical renal abnormalities, such as proteinuria, albuminuria, serum creatinine and glomerular filtration rate using adjusted correlations with CRP and IFN-y. Only sNGAL showed an early association with AKI development (OR = 2.78, 95% CI = 1.429-5.428, per each increase of 50 ng/ml), even after adjusting for clinical signals of VL severity and for immune biomarkers. Moreover, sNGAL showed a better performance in predicting AKI development (AUC-ROC = 0.81, 95% CI = 0.69-0.93; cut-off = 154 ng/ml, sensitivity = 82.6%, specificity = 74.1%, P < 0.001). CONCLUSIONS Visceral leishmaniasis-associated nephropathy showed important proximal tubular injury and glomerular inflammation. Serum NGAL showed an early association with VL-associated nephropathy and may be used to improve clinical management strategies and decrease morbimortality in VL patients.
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Affiliation(s)
- Gdayllon C Meneses
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Medical Sciences Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Geraldo B da Silva Junior
- Collective Health Graduate Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Brazil
| | - Gabriela F Bezerra
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Thaiany P da Rocha
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Isabella E P de Azevedo
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre B Libório
- Medical Sciences Post-Graduate Program, University of Fortaleza, Fortaleza, Brazil
| | - Alice M C Martins
- Pharmacology Post-Graduate Program, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
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30
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Kane-Gill SL, Smithburger PL, Kashani K, Kellum JA, Frazee E. Clinical Relevance and Predictive Value of Damage Biomarkers of Drug-Induced Kidney Injury. Drug Saf 2018; 40:1049-1074. [PMID: 28674842 DOI: 10.1007/s40264-017-0565-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nephrotoxin exposure accounts for up to one-fourth of acute kidney injury episodes in hospitalized patients, and the associated consequences are as severe as acute kidney injury due to other etiologies. As the use of nephrotoxic agents represents one of the few modifiable risk factors for acute kidney injury, clinicians must be able to identify patients at high risk for drug-induced kidney injury rapidly. Recently, significant advancements have been made in the field of biomarker utilization for the prediction and detection of acute kidney injury. Such biomarkers may have a role both for detection of drug-induced kidney disease and implementation of preventative and therapeutic strategies designed to mitigate injury. In this article, basic principles of renal biomarker use in practice are summarized, and the existing evidence for six markers specifically used to detect drug-induced kidney injury are outlined, including liver-type fatty acid binding protein, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase-2 times insulin-like growth factor-binding protein 7 ([TIMP-2]·[IGFBP7]), kidney injury molecule-1 and N-acetyl-β-D-glucosaminidase. The results of the literature search for these six kidney damage biomarkers identified 29 unique articles with none detected for liver-type fatty acid binding protein and [TIMP-2]·[IGFBP7]. For three biomarkers, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin and N-acetyl-β-D-glucosaminidase, the majority of the studies suggest utility in clinical practice. While many questions need to be answered to clearly articulate the use of biomarkers to predict drug-induced kidney disease, current data are promising.
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Affiliation(s)
- Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 638 Salk Hall, 3501, Terrace St., Pittsburgh, PA, 15261, USA. .,The Center for Critical Care Nephology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Pamela L Smithburger
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 638 Salk Hall, 3501, Terrace St., Pittsburgh, PA, 15261, USA.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - John A Kellum
- The Center for Critical Care Nephology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erin Frazee
- Department of Pharmacy and Medicine, Mayo Clinic, Rochester, MN, USA
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31
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Tecson KM, Brown D, Choi JW, Feghali G, Gonzalez-Stawinski GV, Hamman BL, Hebeler R, Lander SR, Lima B, Potluri S, Schussler JM, Stoler RC, Velasco C, McCullough PA. Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery. Ann Thorac Surg 2018; 105:1724-1730. [DOI: 10.1016/j.athoracsur.2018.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 02/04/2023]
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32
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Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery. Pediatr Nephrol 2018; 33:511-520. [PMID: 29128923 DOI: 10.1007/s00467-017-3818-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/09/2017] [Accepted: 09/28/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fluid overload (FO) is common after neonatal congenital heart surgery and may contribute to mortality and morbidity. It is unclear if the effects of FO are independent of acute kidney injury (AKI). METHODS This was a retrospective cohort study which examined neonates (age < 30 days) who underwent cardiopulmonary bypass in a university-affiliated children's hospital between 20 October 2010 and 31 December 2012. Demographic information, risk adjustment for congenital heart surgery score, surgery type, cardiopulmonary bypass time, cross-clamp time, and vasoactive inotrope score were recorded. FO [(fluid in-out)/pre-operative weight] and AKI defined by Kidney Disease Improving Global Outcomes serum creatinine criteria were calculated. Outcomes were all-cause, in-hospital mortality and median postoperative hospital and intensive care unit lengths of stay. RESULTS Overall, 167 neonates underwent cardiac surgery using cardiopulmonary bypass in the study period, of whom 117 met the inclusion criteria. Of the 117 neonates included in the study, 76 (65%) patients developed significant FO (>10%), and 25 (21%) developed AKI ≥ Stage 2. When analyzed as FO cohorts (< 10%,10-20%, > 20% FO), patients with greater FO were more likely to have AKI (9.8 vs. 18.2 vs. 52.4%, respectively, with AKI ≥ stage 2; p = 0.013) and a higher vasoactive-inotrope score, and be premature. In the multivariable regression analyses of patients without AKI, FO was independently associated with hospital and intensive care unit lengths of stay [0.322 extra days (p = 0.029) and 0.468 extra days (p < 0.001), respectively, per 1% FO increase). In all patients, FO was also associated with mortality [odds ratio 1.058 (5.8% greater odds of mortality per 1% FO increase); 95% confidence interval 1.008,1.125;p = 0.032]. CONCLUSIONS Fluid overload is an important independent contributor to outcomes in neonates following congenital heart surgery. Careful fluid management after cardiac surgery in neonates with and without AKI is warranted.
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33
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Afzal A, Vallabhan RC, McCullough PA. Acute kidney injury in cardiogenic shock: in search of early detection and clinical certainty. Eur J Heart Fail 2018; 20:582-584. [DOI: 10.1002/ejhf.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/06/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Aasim Afzal
- Baylor University Medical Center; Dallas TX USA
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital; Dallas TX USA
| | - Ravi C. Vallabhan
- Baylor University Medical Center; Dallas TX USA
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital; Dallas TX USA
| | - Peter A. McCullough
- Baylor University Medical Center; Dallas TX USA
- Baylor Heart and Vascular Institute; Dallas TX USA
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34
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Ronco C, Ronco F, McCullough PA. A Call to Action to Develop Integrated Curricula in Cardiorenal Medicine. Blood Purif 2017; 44:251-259. [PMID: 29065398 DOI: 10.1159/000480318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
With the adoption of the new definition and classification of cardiorenal syndrome (CRS) and its relevant subtypes, much attention has been placed on elucidating the mechanisms of heart and kidney interactions. Of great interest are the pathophysiological pathways by which acute heart failure may result in acute kidney injury (AKI; type 1), chronic heart failure accelerating the progression of chronic kidney disease (CKD; type 2), AKI provoking cardiac events (type 3), and CKD increasing the risk and severity of cardiovascular disease (type 4). A remarkable interest has also been placed on the acute and chronic systemic conditions, such as sepsis and diabetes, which simultaneously affect heart and kidney function (type 5). Furthermore, the physiology of acute and chronic heart-kidney cross talk is drawing attention to hemodynamics (fluids, pressures, flows, resistances, perfusion), physiochemical (electrolytes, pH, and toxins), and biological (inflammation, immune system activation, neurohormonal signals) processes. Common clinical scenarios call for recognition, knowledge, and skill in managing CRS. There is a clear need for medical and surgical specialists that are well versed in the pathophysiology and the clinical manifestations that arise in the setting of CRS. With this editorial, we are making a call to action to stimulate universities, medical schools, and teaching hospitals to create a core curriculum for cardiorenal medicine to better equip the physicians of the future for these common, serious, and frequently fatal syndromes.
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Affiliation(s)
- Claudio Ronco
- Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
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Rizvi MS, Kashani KB. Biomarkers for Early Detection of Acute Kidney Injury. J Appl Lab Med 2017; 2:386-399. [PMID: 33636842 DOI: 10.1373/jalm.2017.023325] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/10/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalized patients and is associated with increased morbidity, mortality, and cost. Currently, AKI is diagnosed after symptoms manifest; available diagnostic tests (e.g., serum creatinine, urine microscopy, urine output) have limited ability to identify subclinical AKI. Because of the lack of treatment strategies, AKI typically is managed with supportive measures. However, strategies exist that may prevent renal insults in critically ill patients; therefore, early recognition of AKI is crucial for minimizing damage propagation. CONTENT Experimental and clinical studies have identified biomarkers that may facilitate earlier recognition of AKI or even identify patients at risk of AKI. Such biomarkers might aid in earlier implementation of preventive strategies to slow disease progression and potentially improve outcomes. This review describes some of the most promising novel biomarkers of AKI, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (lL-18), liver-type fatty-acid-binding protein (L-FABP), insulin-like-growth-factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinase 2 (TIMP-2). SUMMARY We discuss biomarker test characteristics, their strengths and weaknesses, and future directions of their clinical implementation.
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Affiliation(s)
- Mahrukh S Rizvi
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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Tecson KM, Erhardtsen E, Eriksen PM, Gaber AO, Germain M, Golestaneh L, Lavoria MDLA, Moore LW, McCullough PA. Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults: retrospective determination and clinical validation of a prospective multicentre study. BMJ Open 2017; 7:e016028. [PMID: 28698338 PMCID: PMC5726065 DOI: 10.1136/bmjopen-2017-016028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To determine the optimal threshold of blood and urine neutrophil gelatinase-associated lipocalin (NGAL) to predict moderate to severe acute kidney injury (AKI) and persistent moderate to severe AKI lasting at least 48 consecutive hours, as defined by an adjudication panel. METHODS A multicentre prospective observational study enrolled intensive care unit (ICU) patients and recorded daily ethylenediaminetetraacetic acid (EDTA) plasma, heparin plasma and urine NGAL. We used natural log-transformed NGAL in a logistic regression model to predict stage 2/3 AKI (defined by Kidney Disease International Global Organization). We performed the same analysis using the NGAL value at the start of persistent stage 2/3 AKI. RESULTS Of 245 subjects, 33 (13.5%) developed stage 2/3 AKI and 25 (10.2%) developed persistent stage 2/3 AKI. Predicting stage 2/3 AKI revealed the optimal NGAL cutoffs in EDTA plasma (142.0 ng/mL), heparin plasma (148.3 ng/mL) and urine (78.0 ng/mL) and yielded the following decision statistics: sensitivity (SN)=78.8%, specificity (SP)=73.0%, positive predictive value (PPV)=31.3%, negative predictive value (NPV)=95.7%, diagnostic accuracy (DA)=73.8% (EDTA plasma); SN=72.7%, SP=73.8%, PPV=30.4%, NPV=94.5%, DA=73.7% (heparin plasma); SN=69.7%, SP=76.8%, PPV=32.9%, NPV=94%, DA=75.8% (urine). The optimal NGAL cutoffs to predict persistent stage 2/3 AKI were similar: 148.3 ng/mL (EDTA plasma), 169.6 ng/mL (heparin plasma) and 79.0 ng/mL (urine) yielding: SN=84.0%, SP=73.5%, PPV=26.6%, NPV=97.6, DA=74.6% (EDTA plasma), SN=84%, SP=76.1%, PPV=26.8%, NPV=96.5%, DA=76.1% (heparin plasma) and SN=75%, SP=75.8%, PPV=26.1, NPV=96.4%, DA=75.7% (urine). CONCLUSION Blood and urine NGAL predicted stage 2/3 AKI, as well as persistent 2/3 AKI in the ICU with acceptable decision statistics using a single cut point in each type of specimen.
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Affiliation(s)
- Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Texas A&M College of Medicine Health Science Center, Dallas, Texas, USA
| | | | | | | | | | | | | | | | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Texas, USA
- Texas A&M College of Medicine Health Science Center, Dallas, Texas, USA
- Baylor University Medical Center, Dallas, Texas, USA
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
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Maisel AS, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müller GA, Birkhahn R, Clopton P, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Murray PT. Neutrophil Gelatinase-Associated Lipocalin for Acute Kidney Injury During Acute Heart Failure Hospitalizations: The AKINESIS Study. J Am Coll Cardiol 2017; 68:1420-1431. [PMID: 27659464 DOI: 10.1016/j.jacc.2016.06.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/19/2016] [Accepted: 06/28/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown. OBJECTIVES This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents. METHODS This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events. RESULTS We enrolled 927 subjects (mean age, 68.5 years; 62% men). The primary outcome occurred in 72 subjects (7.8%). Peak NGAL was more predictive than the first NGAL, but neither added significant diagnostic utility over the first creatinine (areas under the curve: 0.656, 0.647, and 0.652, respectively). There were 235 adverse events in 144 subjects. The first NGAL was a better predictor than peak NGAL, but similar to the first creatinine (areas under the curve: 0.691, 0.653, and 0.686, respectively). In a post hoc analysis of subjects with an estimated glomerular filtration rate <60 ml/min/1.73 m(2), a first NGAL <150 ng/ml indicated a low likelihood of adverse events. CONCLUSIONS Plasma NGAL was not superior to creatinine for the prediction of WRF or adverse in-hospital outcomes. The use of plasma NGAL to diagnose acute kidney injury in AHF cannot be recommended at this time. (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin [N-GAL] Evaluation of Symptomatic Heart Failure Study [AKINESIS]; NCT01291836).
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Affiliation(s)
- Alan S Maisel
- Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, La Jolla, California; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California.
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Hospital, Kansas City, Kansas
| | - Gerhard A Müller
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist, Brooklyn, New York
| | - Paul Clopton
- Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, La Jolla, California
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California
| | - Gary M Vilke
- Departement of Emergency Medicine, University of California, San Diego, La Jolla, California
| | - Kenneth McDonald
- Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland; Department of Nephrology, Mater Misericordaie University Hospital, University College Dublin, Dublin, Ireland
| | - Niall Mahon
- Department of Nephrology, Mater Misericordaie University Hospital, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordaie University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, University of Valencia, Valencia, Spain
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Patrick T Murray
- Department of Nephrology, Mater Misericordaie University Hospital, University College Dublin, Dublin, Ireland
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McCullough PA, Choi JP, Feghali GA, Schussler JM, Stoler RM, Vallabahn RC, Mehta A. Contrast-Induced Acute Kidney Injury. J Am Coll Cardiol 2017; 68:1465-1473. [PMID: 27659469 DOI: 10.1016/j.jacc.2016.05.099] [Citation(s) in RCA: 253] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 12/31/2022]
Abstract
Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrast-induced acute kidney injury (CI-AKI) for a subgroup of patients at risk for this complication. There has been a consistent and graded signal of risk for associated outcomes including need for renal replacement therapy, rehospitalization, and death, according to the incidence and severity of CI-AKI. This paper reviews the epidemiology, pathophysiology, prognosis, and management of CI-AKI as it applies to the cardiac catheterization laboratory.
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Affiliation(s)
- Peter A McCullough
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, Texas; Baylor Heart and Vascular Institute, Dallas, Texas; Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas; The Heart Hospital Baylor Plano, Plano, Texas.
| | - James P Choi
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Georges A Feghali
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | | | - Robert M Stoler
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Ravi C Vallabahn
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Ankit Mehta
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, Texas
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39
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Hassan RH, Kandil SM, Zeid MS, Zaki ME, Fouda AE. Kidney injury in infants and children with iron-deficiency anemia before and after iron treatment. ACTA ACUST UNITED AC 2017; 22:565-570. [PMID: 28506129 DOI: 10.1080/10245332.2017.1325587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Our study aimed to investigate the effects of iron-deficiency anemia (IDA) on renal tubular functions before and after iron treatment for infants and children with IDA. We measured urinary levels of two kidney injury markers: neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid-binding protein (L-FABP). MATERIAL AND METHODS Thirty-six infants and children with IDA and 20 matched healthy controls were included. We assessed different laboratory parameters, estimated glomerular filtration rate, urinary levels of NGAL, and L-FABP. Urinary kidney injury markers were measured in IDA patients before and after 3 months of oral iron therapy. RESULTS IDA patients had significantly higher urinary NGAL and L-FABP levels compared to their healthy controls. After 3 months of oral iron treatment, there was a significant improvement (decrease) in urinary NGAL and L-FABP in infants and children with IDA. Urinary markers returned to normal levels (healthy control levels) in children with IDA, but not for infants with IDA compared to their healthy controls. CONCLUSION Subclinical kidney injury was found in infants and children with IDA. This injury was completely reversible in older children with IDA and partially reversible in infants with IDA after iron therapy. Higher urinary levels of kidney injury molecules in IDA infants after iron treatment are suggestive of more sensitivity of these infants to oxidative stress caused by iron therapy or may be due to the immaturity of the kidney and more damage caused by IDA which may require more time to recover.
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Affiliation(s)
- Rasha H Hassan
- a Pediatric Infectious Diseases and Malnutrition Unit, Pediatrics Department, Faculty of Medicine , Mansoura University Children's Hospital, Mansoura University , Mansoura, Egypt
| | - Shaimaa M Kandil
- a Pediatric Infectious Diseases and Malnutrition Unit, Pediatrics Department, Faculty of Medicine , Mansoura University Children's Hospital, Mansoura University , Mansoura, Egypt
| | - Mayada S Zeid
- a Pediatric Infectious Diseases and Malnutrition Unit, Pediatrics Department, Faculty of Medicine , Mansoura University Children's Hospital, Mansoura University , Mansoura, Egypt
| | - Maysaa E Zaki
- b Clinical Pathology Department, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Ashraf E Fouda
- c Pediatric Hematology/Oncology Unit, Pediatrics Department, Faculty of Medicine , Mansoura University , Mansoura, Egypt
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40
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Bellomo R, Ronco C, Mehta RL, Asfar P, Boisramé-Helms J, Darmon M, Diehl JL, Duranteau J, Hoste EAJ, Olivier JB, Legrand M, Lerolle N, Malbrain MLNG, Mårtensson J, Oudemans-van Straaten HM, Parienti JJ, Payen D, Perinel S, Peters E, Pickkers P, Rondeau E, Schetz M, Vinsonneau C, Wendon J, Zhang L, Laterre PF. Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference. Ann Intensive Care 2017. [PMID: 28474317 DOI: 10.1186/s13613-017-0260-y.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The French Intensive Care Society organized its yearly Paris International Conference in intensive care on June 18-19, 2015. The main purpose of this meeting is to gather the best experts in the field in order to provide the highest quality update on a chosen topic. In 2015, the selected theme was: "Acute Renal Failure in the ICU: from injury to recovery." The conference program covered multiple aspects of renal failure, including epidemiology, diagnosis, treatment and kidney support system, prognosis and recovery together with acute renal failure in specific settings. The present report provides a summary of every presentation including the key message and references and is structured in eight sections: (a) diagnosis and evaluation, (b) old and new diagnosis tools,
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Affiliation(s)
- Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of ICU, Austin Health, Heidelberg, Australia
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Ravindra L Mehta
- Vice Chair Clinical Research, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Pierre Asfar
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, Angers, France.,Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, PRES L'UNAM, Angers, France
| | - Julie Boisramé-Helms
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France
| | - Michael Darmon
- Medical-Surgical ICU, Saint-Etienne University Hospital and Jean Monnet University, Saint-Étienne, France
| | - Jean-Luc Diehl
- Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.,INSERM UMR_S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France
| | - Jacques Duranteau
- AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Eric A J Hoste
- ICU, Ghent University Hospital, Ghent University, Ghent, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
| | | | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Paris, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale et de Médecine Hyperbare, CHU, Angers, France
| | | | - Johan Mårtensson
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.,Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Jean-Jacques Parienti
- Department of Infectious Diseases, University Hospital, Caen, France.,Department of Biostatistic and Clinical Research, University Hospital, Caen, France
| | - Didier Payen
- Department of Anesthesia and Critical Care, SAMU, Lariboisière University Hospital, Paris, France
| | - Sophie Perinel
- Medical-Surgical ICU, Saint-Etienne University Hospital, Jean Monnet University Saint-Etienne, Saint-Étienne, France
| | - Esther Peters
- Department of Pharmacology and Toxicology, Radboud university Medical Center, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Rondeau
- Urgences néphrologiques et Transplantation rénale, Hôpital Tenon, Université Paris 6, Paris, France
| | - Miet Schetz
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium
| | - Christophe Vinsonneau
- Service de Réanimation et Surveillance continue, Centre Hospitalier de BETHUNE, Bethune, France
| | - Julia Wendon
- Kings College Hospital Foundation Trust, London, UK
| | - Ling Zhang
- Department of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
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41
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Bellomo R, Ronco C, Mehta RL, Asfar P, Boisramé-Helms J, Darmon M, Diehl JL, Duranteau J, Hoste EAJ, Olivier JB, Legrand M, Lerolle N, Malbrain MLNG, Mårtensson J, Oudemans-van Straaten HM, Parienti JJ, Payen D, Perinel S, Peters E, Pickkers P, Rondeau E, Schetz M, Vinsonneau C, Wendon J, Zhang L, Laterre PF. Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference. Ann Intensive Care 2017; 7:49. [PMID: 28474317 PMCID: PMC5418176 DOI: 10.1186/s13613-017-0260-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
The French Intensive Care Society organized its yearly Paris International Conference in intensive care on June 18-19, 2015. The main purpose of this meeting is to gather the best experts in the field in order to provide the highest quality update on a chosen topic. In 2015, the selected theme was: "Acute Renal Failure in the ICU: from injury to recovery." The conference program covered multiple aspects of renal failure, including epidemiology, diagnosis, treatment and kidney support system, prognosis and recovery together with acute renal failure in specific settings. The present report provides a summary of every presentation including the key message and references and is structured in eight sections: (a) diagnosis and evaluation, (b) old and new diagnosis tools,
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Affiliation(s)
- Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of ICU, Austin Health, Heidelberg, Australia
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Ravindra L Mehta
- Vice Chair Clinical Research, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Pierre Asfar
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, Angers, France.,Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, PRES L'UNAM, Angers, France
| | - Julie Boisramé-Helms
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France
| | - Michael Darmon
- Medical-Surgical ICU, Saint-Etienne University Hospital and Jean Monnet University, Saint-Étienne, France
| | - Jean-Luc Diehl
- Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.,INSERM UMR_S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France
| | - Jacques Duranteau
- AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Eric A J Hoste
- ICU, Ghent University Hospital, Ghent University, Ghent, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
| | | | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Paris, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale et de Médecine Hyperbare, CHU, Angers, France
| | | | - Johan Mårtensson
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.,Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Jean-Jacques Parienti
- Department of Infectious Diseases, University Hospital, Caen, France.,Department of Biostatistic and Clinical Research, University Hospital, Caen, France
| | - Didier Payen
- Department of Anesthesia and Critical Care, SAMU, Lariboisière University Hospital, Paris, France
| | - Sophie Perinel
- Medical-Surgical ICU, Saint-Etienne University Hospital, Jean Monnet University Saint-Etienne, Saint-Étienne, France
| | - Esther Peters
- Department of Pharmacology and Toxicology, Radboud university Medical Center, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Rondeau
- Urgences néphrologiques et Transplantation rénale, Hôpital Tenon, Université Paris 6, Paris, France
| | - Miet Schetz
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium
| | - Christophe Vinsonneau
- Service de Réanimation et Surveillance continue, Centre Hospitalier de BETHUNE, Bethune, France
| | - Julia Wendon
- Kings College Hospital Foundation Trust, London, UK
| | - Ling Zhang
- Department of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
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42
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Makris K, Spanou L. Acute Kidney Injury: Diagnostic Approaches and Controversies. Clin Biochem Rev 2016; 37:153-175. [PMID: 28167845 PMCID: PMC5242479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acute kidney injury (AKI) is a significant independent risk factor for morbidity and mortality. In the last ten years a large number of publications have highlighted the limitations of traditional approaches and the inadequacies of conventional biomarkers to diagnose and monitor renal insufficiency in the acute setting. A great effort was directed not only to the discovery and validation of new biomarkers aimed to detect AKI more accurately but also to standardise the definition of AKI. Despite the advances in both areas, biomarkers have not yet entered into routine clinical practice and the definition of this syndrome has many areas of uncertainty. This review will discuss the controversies in diagnosis and the potential of novel biomarkers to improve the definition of the syndrome.
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Affiliation(s)
- Konstantinos Makris
- Clinical Biochemistry Department, KAT General Hospital, Kifissia, Athens, 14561, Greece
| | - Loukia Spanou
- Clinical Biochemistry Department, KAT General Hospital, Kifissia, Athens, 14561, Greece
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43
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Cooper DS, Basu RK, Price JF, Goldstein SL, Krawczeski CD. The Kidney in Critical Cardiac Disease: Proceedings From the 10th International Conference of the Pediatric Cardiac Intensive Care Society. World J Pediatr Congenit Heart Surg 2016; 7:152-63. [PMID: 26957397 DOI: 10.1177/2150135115623289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. The focus of intensive care unit care has now shifted to that of morbidity reduction and eventual elimination. Acute kidney injury (AKI) after cardiac surgery is associated with adverse outcomes, including prolonged intensive care and hospital stays, diminished quality of life, and increased long-term mortality. Acute kidney injury occurs frequently, complicating the care of both postoperative patients and those with heart failure. Patients who become fluid overloaded and/or require dialysis are at high risk of mortality, but even minor degrees of AKI portend a significant increase in mortality and morbidity. Clinicians continue to seek methods of early diagnosis and risk stratification of AKI to prevent its adverse sequelae. Previous conventional wisdom that survivors of AKI fully recover renal function without subsequent consequences may be flawed.
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Affiliation(s)
- David S Cooper
- The Heart Institute and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rajit K Basu
- Division of Critical Care and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jack F Price
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Stuart L Goldstein
- The Heart Institute and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine D Krawczeski
- Dvision of Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
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Moltrasio M, Cosentino N, De Metrio M, Rubino M, Cabiati A, Milazzo V, Discacciati A, Marana I, Bonomi A, Veglia F, Lauri G, Marenzi G. Brain natriuretic peptide in acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 17:803-9. [DOI: 10.2459/jcm.0000000000000353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Abstract
Nicholas Selby and colleagues describe how the definition of acute kidney injury brings opportunities and challenges in identifying patients at higher risk of adverse outcomes.
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46
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Abstract
Acute kidney injury is a frequent complication of acute heart failure syndromes, portending an adverse prognosis. Acute cardiorenal syndrome represents a unique form of acute kidney injury specific to acute heart failure syndromes. The pathophysiology of acute cardiorenal syndrome involves renal venous congestion, ineffective forward flow, and impaired renal autoregulation caused by neurohormonal activation. Biomarkers reflecting different aspects of acute cardiorenal syndrome pathophysiology may allow patient phenotyping to inform prognosis and treatment. Adjunctive vasoactive, neurohormonal, and diuretic therapies may relieve congestive symptoms and/or improve renal function, but no single therapy has been proved to reduce mortality in acute cardiorenal syndrome.
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Affiliation(s)
- Jacob C Jentzer
- Department of Critical Care Medicine, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lakhmir S Chawla
- Division of Intensive Care Medicine, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA; Division of Nephrology, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA.
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47
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Development of a Prediction Model of Early Acute Kidney Injury in Critically Ill Children Using Electronic Health Record Data. Pediatr Crit Care Med 2016; 17:508-15. [PMID: 27124567 DOI: 10.1097/pcc.0000000000000750] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Acute kidney injury is independently associated with poor outcomes in critically ill children. However, the main biomarker of acute kidney injury, serum creatinine, is a late marker of injury and can cause a delay in diagnosis. Our goal was to develop and validate a data-driven multivariable clinical prediction model of acute kidney injury in a general PICU using electronic health record data. DESIGN Derivation and validation of a prediction model using retrospective data. PATIENTS All patients 1 month to 21 years old admitted between May 2003 and March 2015 without acute kidney injury at admission and alive and in the ICU for at least 24 hours. SETTING A multidisciplinary, tertiary PICU. INTERVENTION The primary outcome was early acute kidney injury, which was defined as new acute kidney injury developed in the ICU within 72 hours of admission. Multivariable logistic regression was performed to derive the Pediatric Early AKI Risk Score using electronic health record data from the first 12 hours of ICU stay. MEASUREMENTS AND MAIN RESULTS A total of 9,396 patients were included in the analysis, of whom 4% had early acute kidney injury, and these had significantly higher mortality than those without early acute kidney injury (26% vs 3.3%; p < 0.001). Thirty-three candidate variables were tested. The final model had seven predictors and had good discrimination (area under the curve 0.84) and appropriate calibration. The model was validated in two validation sets and maintained good discrimination (area under the curves, 0.81 and 0.86). CONCLUSION We developed and validated the Pediatric Early AKI Risk Score, a data-driven acute kidney injury clinical prediction model that has good discrimination and calibration in a general PICU population using only electronic health record data that is objective, available in real time during the first 12 hours of ICU care and generalizable across PICUs. This prediction model was designed to be implemented in the form of an automated clinical decision support system and could be used to guide preventive, therapeutic, and research strategies.
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48
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Shiao CC, Wu PC, Huang TM, Lai TS, Yang WS, Wu CH, Lai CF, Wu VC, Chu TS, Wu KD. Long-term remote organ consequences following acute kidney injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:438. [PMID: 26707802 PMCID: PMC4699348 DOI: 10.1186/s13054-015-1149-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acute kidney injury (AKI) has been a global health epidemic problem with soaring incidence, increased long-term risks for multiple comorbidities and mortality, as well as elevated medical costs. Despite the improvement of patient outcomes following the advancements in preventive and therapeutic strategies, the mortality rates among critically ill patients with AKI remain as high as 40–60 %. The distant organ injury, a direct consequence of deleterious systemic effects, following AKI is an important explanation for this phenomenon. To date, most evidence of remote organ injury in AKI is obtained from animal models. Whereas the observations in humans are from a limited number of participants in a relatively short follow-up period, or just focusing on the cytokine levels rather than clinical solid outcomes. The remote organ injury is caused with four underlying mechanisms: (1) “classical” pattern of acute uremic state; (2) inflammatory nature of the injured kidneys; (3) modulating effect of AKI of the underlying disease process; and (4) healthcare dilemma. While cytokines/chemokines, leukocyte extravasation, oxidative stress, and certain channel dysregulation are the pathways involving in the remote organ damage. In the current review, we summarized the data from experimental studies to clinical outcome studies in the field of organ crosstalk following AKI. Further, the long-term consequences of distant organ-system, including liver, heart, brain, lung, gut, bone, immune system, and malignancy following AKI with temporary dialysis were reviewed and discussed.
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Affiliation(s)
- Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, 160 Chong-Cheng South Road, Luodong, Yilan, 265, Taiwan.,Saint Mary's Medicine, Nursing and Management College, 160 Chong-Cheng South Road, Luodong, Yilan, 265, Taiwan
| | - Pei-Chen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Road, Taipei, 10449, Taiwan
| | - Tao-Min Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, 579, Sec. 2, Yunlin Road, Douliu City, Yunlin County, 640, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, 87 Neijiang Street, Taipei, 108, Taiwan
| | - Wei-Shun Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hisn-Chu Branch, No.25, Lane 442, Sec. 1, Jingguo Road, Hsin-Chu City, 300, Taiwan
| | - Che-Hsiung Wu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chun-Fu Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan.
| | - Tzong-Shinn Chu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan
| | - Kwan-Dun Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan
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49
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Güneş A, Ece A, Aktar F, Tan İ, Söker M, Karabel D, Balık H, Uluca Ü, Şen V, Yolbaş İ. Urinary Kidney Injury Molecules in Children with Iron-Deficiency Anemia. Med Sci Monit 2015; 21:4023-9. [PMID: 26697893 PMCID: PMC4694706 DOI: 10.12659/msm.896794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/08/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the urine levels of human kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with iron-deficiency anemia (IDA). MATERIAL AND METHODS Thirty-five children with IDA and 32 matched healthy controls were recruited. We assessed complete blood count, serum iron, iron-binding capacity, ferritin, serum levels of urea, creatinine (Cr), sodium (Na), potassium (K), calcium (Ca), and glucose levels. Estimated glomerular filtration rate (eGFR) was calculated. Urinary NAG, NGAL, KIM-1, and L-FABP were measured and divided by urine creatinine for comparisons. RESULTS There were no significant differences in serum urea, Cr, or eGFR between the IDA group and the control group (p>0.05, for all). IDA patients had significantly higher urine NGAL/Cr, L-FABP/Cr, KIM-1/Cr, and NAG/Cr compared with the control group (p<0.05). There were significant negative correlations between hemoglobin, hematocrit, red blood cell count, and urine NGAL/Cr, NAG/Cr, L-FABP/Cr, KIM-1/Cr levels (p<0.05). CONCLUSIONS Higher urinary kidney injury molecule levels in IDA patients suggest a possible subclinical renal injury in pediatric IDA patients whose renal functions and serum electrolytes were normal.
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Affiliation(s)
- Ali Güneş
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Aydın Ece
- Department of Pediatric Nephrology, Medical School, Dicle University, Diyarbakir, Turkey
| | - Fesih Aktar
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - İlhan Tan
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Murat Söker
- Department of Pediatric Hematology, Medical School, Dicle University, Diyarbakir, Turkey
| | - Duran Karabel
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Hasan Balık
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Ünal Uluca
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - Velat Şen
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
| | - İlyas Yolbaş
- Department of Pediatrics, Medical School, Dicle University, Diyarbakir, Turkey
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50
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Abstract
Acute kidney injury (AKI) is an epidemic problem. Sepsis has long been recognized as a foremost precipitant of AKI. Sepsis-associated AKI (SA-AKI) portends a high burden of morbidity and mortality in both children and adults with critical illness. Although our understanding of its pathophysiology is incomplete, SA-AKI likely represents a distinct subset of AKI contributed to by a unique constellation of hemodynamic, inflammatory, and immune mechanisms. SA-AKI poses significant clinical challenges for clinicians. To date, no singular effective therapy has been developed to alter the natural history of SA-AKI. Rather, current strategies to alleviate poor outcomes focus on clinical risk identification, early detection of injury, modifying clinician behavior to avoid harm, early appropriate antimicrobial therapy, and surveillance among survivors for the longer-term sequelae of kidney damage. Recent evidence has confirmed that patients no longer die with AKI, but from AKI. To improve the care and outcomes for sufferers of SA-AKI, clinicians need a robust appreciation for its epidemiology and current best-evidence strategies for prevention and treatment.
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Affiliation(s)
- Rashid Alobaidi
- Department of Pediatrics, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rajit K Basu
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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