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Skowron B, Baranowska A, Kaszuba-Zwoińska J, Więcek G, Malska-Woźniak A, Heczko P, Strus M. Experimental model for acute kidney injury caused by uropathogenic Escherichia coli. POSTEP HIG MED DOSW 2017; 71:520-529. [PMID: 28665281 DOI: 10.5604/01.3001.0010.3833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is the rapid deterioration of renal function, diagnosed on the basis of an increase in serum creatinine and abnormal urinary parameters. AKI is associated with increased risk of mortality or chronic kidney disease (CKD). The aim of the study was to develop an experimental model for AKI resulting from Escherichia coli-induced pyelonephritis. E. coli was isolated from a patient with clinical symptoms of urinary tract infection (UTI). MATERIAL/METHODS The study included three groups of female Wistar rats (groups 1, 2 and 3), in which pyelonephritis was induced by transurethral inoculation with highly virulent E. coli (105, 107 and 109 cfu/ml, respectively). Urine and blood samples for analysis were obtained prior to the inoculation (day 0), as well as 7, 14 and 21 days thereafter. RESULTS Aside from a microbiological examination of urine samples, daily urine output, serum creatinine (CreaS), creatinine clearance (CrCl), interleukin 6 (IL-6), fractional excretion of sodium (FENa) and fractional excretion of urea (FEUrea) were determined. A histopathological examination of kidney and urinary bladder specimens was conducted as well. While UTI-related pyelonephritis developed irrespective of E. coli inoculum size, AKI was observed only following transurethral administration of E. coli at the intermediate and high dose, i.e. 107 and 109 cfu/ml, respectively (group 2 and 3). DISCUSSION An increase in CreaS and abnormal diuresis were accompanied by changes in parameters specific for various forms of AKI, i.e. FENa and FEUrea. Based on these changes, administration of E. coli at 107 cfu/ml was demonstrated to induce renal AKI, whereas inoculation with 109 cfu/ml seemed to cause not only ascending pyelonephritis, but perhaps also bacteremia and urosepsis (prerenal component of AKI).
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Affiliation(s)
- Beata Skowron
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Baranowska
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Grażyna Więcek
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Malska-Woźniak
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Heczko
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Strus
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
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Interiano RB, McCarville MB, Santos ND, Mao S, Wu J, Dome JS, Kieran K, Williams MA, Brennan RC, Krasin MJ, Green DM, Davidoff AM. Comprehensive renal function evaluation in patients treated for synchronous bilateral Wilms tumor. J Pediatr Surg 2017; 52:98-103. [PMID: 27856008 PMCID: PMC5218869 DOI: 10.1016/j.jpedsurg.2016.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/20/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to perform a comprehensive assessment of long-term renal function in patients treated at our institution for synchronous bilateral Wilms tumor (BWT) and to determine the optimal method for estimating glomerular filtration rate (eGFR). METHODS Surgical approach, adjuvant therapy, and pathology reports were reviewed for patients with at least six months follow-up from definitive surgery. eGFRs, as assessed by the Schwartz and Chronic Kidney Disease in Children (CKiD) formulas, were compared to measured GFR (mGFR) determined by 99mTc-DTPA scanning. Urine studies, including microalbumin, β-microglobulin, and FENa were also reviewed. RESULTS Forty-two patients were identified. Of 36 living patients, 28 (77.8%) had greater than 6months follow-up, with a median overall follow-up of 5.2years (range: 1.4-13.4). The median mGFR was 97mL/min/1.73m2, while the median eGFRSchwartz and eGFRCKiD were 103.3mL/min/1.73m2 and 79.7mL/min/1.73m2, respectively, (p=0.13 and p=0.75, compared to mGFR). Eleven (39.3%) patients had at least one abnormal urine study (microalbumin >30μg/g creatinine, n=3; β-2 microglobulin >133μg/g creatinine, n=9; FENa>1%, n=4). CONCLUSIONS In our series, few patients had an abnormally low GFR. Neither method for estimating GFR gave a significantly different result from measured GFR, suggesting that the Schwartz equation is adequate, although specific urine tests may be more sensitive for detecting subtle renal dysfunction. LEVEL OF EVIDENCE Level IV - retrospective case series with no comparison group.
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Affiliation(s)
- Rodrigo B. Interiano
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - M. Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | - Noel Delos Santos
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jeffrey S. Dome
- Department of Oncology, Children's National Medical Center, Washington, DC
| | - Kathleen Kieran
- Department of Urology, Seattle Children's Hospital, Seattle, WA
| | - Mark A. Williams
- Division of Pediatric Urology, Levine Children's Hospital, Charlotte, NC
| | - Rachel C. Brennan
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children's Hospital, Memphis, TN
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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Fujita H, Shinjoh M, Ishii T, Awazu M. Utility of fractional excretion of urea in the differential diagnosis of acute kidney injury in children. Pediatr Nephrol 2016; 31:1349-53. [PMID: 26993815 DOI: 10.1007/s00467-016-3366-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The fractional excretion of sodium (FENa) has been used as an index for the differential diagnosis of acute tubular necrosis (ATN) and prerenal acute kidney injury (AKI). The reliability of this index, however, decreases with the use of the diuretic agent furosemide. The fractional excretion of urea nitrogen (FEUN) has been shown to be useful in such settings in adults. The objective of this study was to examine whether FEUN is also useful in these settings in children. METHODS We assessed 102 episodes of AKI in 74 children, classifying these into three groups based on history, physical examination, urine examination and subsequent clinical course: (1) prerenal AKI without furosemide (N = 37), (2) prerenal AKI with furosemide (N = 32) and (3) ATN (N = 33). RESULTS Of the 37 prerenal AKI episodes without furosemide, 35 showed low FENa of <1 %, with an overall average of 0.35 ± 0.11 %, whereas prerenal AKI with furosemide (1.63 ± 0.37 %) and ATN (8.76 ± 2.11 %) were associated with a higher FENa. FEUN in the clinical setting of prerenal AKI was lower than that in ATN (27.9 ± 2.1 vs. 51.6 ± 3.8 %, respectively) and, in contrast to FENa, not significantly different between the categories of prerenal AKI with and without furosemide (29.2 ± 3.1 vs. 25.1 ± 2.9, respectively). The sensitivity of FEUN <35 % was 75 % in prerenal AKI with furosemide, whereas that of FENa was 53 %. CONCLUSIONS FEUN is useful in detecting prerenal AKI in children administered furosemide.
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Affiliation(s)
- Hisayo Fujita
- Department of Pediatrics, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Midori Awazu
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Tam RK, Wong H, Plint A, Lepage N, Filler G. Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: a case comparison trial. BMC Pediatr 2014; 14:149. [PMID: 24935348 PMCID: PMC4081489 DOI: 10.1186/1471-2431-14-149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/30/2014] [Indexed: 12/19/2022] Open
Abstract
Background The clinical dehydration scale (CDS) is a quick, easy-to-use tool with 4 clinical items and a score of 1–8 that serves to classify dehydration in children with gastroenteritis as no, some or moderate/severe dehydration. Studies validating the CDS (Friedman JN) with a comparison group remain elusive. We hypothesized that the CDS correlates with a wide spectrum of established markers of dehydration, making it an appropriate and easy-to-use clinical tool. Methods This study was designed as a prospective double-cohort trial in a single tertiary care center. Children with diarrhea and vomiting, who clinically required intravenous fluids for rehydration, were compared with minor trauma patients who required intravenous needling for conscious sedation. We compared the CDS with clinical and urinary markers (urinary electrolytes, proteins, ratios and fractional excretions) for dehydration in both groups using receiver operating characteristic (ROC) curves to determine the area under the curve (AUC). Results We enrolled 73 children (male = 36) in the dehydration group and 143 (male = 105) in the comparison group. Median age was 32 months (range 3–214) in the dehydration and 96 months (range 2.6-214 months, p < 0.0001) in the trauma group. Median CDS was 3 (range 0–8) within the dehydration group and 0 in the comparison group (p < 0.0001). The following parameters were statistically significant (p < 0.05) between the comparison group and the dehydrated group: difference in heart rate, diastolic blood pressure, urine sodium/potassium ratio, urine sodium, fractional sodium excretion, serum bicarbonate, and creatinine measurements. The best markers for dehydration were urine Na and serum bicarbonate (ROC AUC = 0.798 and 0.821, respectively). CDS was most closely correlated with serum bicarbonate (Pearson r = -0.3696, p = 0.002). Conclusion Although serum bicarbonate is not the gold standard for dehydration, this study provides further evidence for the usefulness of the CDS as a dehydration marker in children. Trial registration Registered at ClinicalTrials.gov (NCT00462527) on April 18, 2007.
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Affiliation(s)
| | | | | | | | - Guido Filler
- Department of Pediatrics, Western University, 800 Commissioners Road East, London, ON N6A 5W9, Canada.
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Comparison between fractional excretion of sodium and fractional excretion of urea in differentiating prerenal from renal azotemia in circulatory shock. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2013. [DOI: 10.1016/j.ejccm.2013.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Bibliography. Neonatology and perinatology. Current world literature. Curr Opin Pediatr 2011; 23:253-7. [PMID: 21412083 DOI: 10.1097/mop.0b013e3283454167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW This review will highlight recent studies on the diagnosis of acute kidney injury (AKI), review the differential diagnosis, highlight the importance of cumulative fluid overload and provide key management strategies for the pediatric patient with AKI. RECENT FINDINGS Over the last decade, serum creatinine-based categorical definitions of AKI have been accepted, which allow detection earlier in the disease process. Evidence-based modifications of these definitions have occurred. Fluid overload portends poor outcomes in critically ill patients. Significant improvements in our understanding of the pathophysiology of glomerular/vascular causes of AKI have occurred. SUMMARY Categorical definitions of AKI have shown that higher AKI portends poor outcomes even with adjustment for severity of illness and other confounders. Cumulative fluid overload independently predicts poor outcomes. Strategies to prevent and/or treat fluid overload are likely to improve outcomes.
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Koyner JL, Vaidya VS, Bennett MR, Ma Q, Worcester E, Akhter SA, Raman J, Jeevanandam V, O'Connor MF, Devarajan P, Bonventre JV, Murray PT. Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury. Clin J Am Soc Nephrol 2010; 5:2154-65. [PMID: 20798258 DOI: 10.2215/cjn.00740110] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Several novel urinary biomarkers have shown promise in the early detection and diagnostic evaluation of acute kidney injury (AKI). Clinicians have limited tools to determine which patients will progress to more severe forms of AKI at the time of serum creatinine increase. The diagnostic and prognostic utility of novel and traditional AKI biomarkers was evaluated during a prospective study of 123 adults undergoing cardiac surgery. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Urinary neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CyC), kidney injury molecule-1 (KIM-1), hepatocyte growth factor (HGF), π-glutathione-S-transferase (π-GST), α-GST, and fractional excretions of sodium and urea were all measured at preoperative baseline, postoperatively, and at the time of the initial clinical diagnosis of AKI. Receiver operator characteristic curves were generated and the areas under the curve (AUCs) were compared. RESULTS Forty-six (37.4%) subjects developed AKI Network stage 1 AKI; 9 (7.3%) of whom progressed to stage 3. Preoperative KIM-1 and α-GST were able to predict the future development of stage 1 and stage 3 AKI. Urine CyC at intensive care unit (ICU) arrival best detected early stage 1 AKI (AUC = 0.70, P < 0.001); the 6-hour ICU NGAL (AUC = 0.88; P < 0.001) best detected early stage 3 AKI. π-GST best predicted the progression to stage 3 AKI at the time of creatinine increase (AUC = 0.86; P = 0.002). CONCLUSION Urinary biomarkers may improve the ability to detect early AKI and determine the clinical prognosis of AKI at the time of diagnosis.
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Affiliation(s)
- Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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