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Szumilas D, Owczarek AJ, Brzozowska A, Niemir ZI, Olszanecka-Glinianowicz M, Chudek J. The Value of Urinary NGAL, KIM-1, and IL-18 Measurements in the Early Detection of Kidney Injury in Oncologic Patients Treated with Cisplatin-Based Chemotherapy. Int J Mol Sci 2024; 25:1074. [PMID: 38256147 PMCID: PMC10816507 DOI: 10.3390/ijms25021074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Cisplatin is still a widely used anticancer drug characterized by significant nephrotoxicity. Acute kidney injury (AKI), diagnosed based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, has limitations, including a delayed increase in creatinine. We determined the usefulness of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) in diagnosing AKI according to the KDIGO criteria in patients treated with cisplatin. We recruited 21 subjects starting cisplatin-based chemotherapy (Cisplatin-based group) and 11 treated with carboplatin-based chemotherapy or 5-fluorouracil regimens (non-cisplatin-based group). Blood and urine samples were collected during four subsequent cycles of chemotherapy (68 and 38 cycles, respectively). AKI occurred in four patients in the cisplatin-based group (5.9% of 68 cisplatin-based chemotherapy cycles). Among them, three urinary markers were increased by over 100% in two cases, two in one case and one in another. A doubling of at least one investigated parameter was observed more frequently during cisplatin-based chemotherapy (80.3% vs. 52.8%; OR = 3.65, 95% CI: 1.49-8.90; p < 0.01). The doubling of at least one new urinary AKI marker was more common in patients receiving cisplatin and frequently was not associated with overt AKI. Thus, a subclinical kidney injury detected by these markers occurs more frequently than deterioration in kidney function stated with creatinine changes.
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Affiliation(s)
- Dawid Szumilas
- Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, 40-027 Katowice, Poland;
| | - Aleksander Jerzy Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (A.J.O.); (A.B.); (M.O.-G.)
| | - Aniceta Brzozowska
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (A.J.O.); (A.B.); (M.O.-G.)
| | - Zofia Irena Niemir
- Department of Nephrology, Transplantology and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland;
| | - Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (A.J.O.); (A.B.); (M.O.-G.)
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, 40-027 Katowice, Poland;
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (A.J.O.); (A.B.); (M.O.-G.)
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Orhon Ergun M, Zengin SU, Mustafayeva A, Umuroglu T. Neutrophil gelatinase associated lipocalin in predicting postoperative acute kidney injury in elderly. Ir J Med Sci 2021; 191:1297-1303. [PMID: 34822023 DOI: 10.1007/s11845-021-02865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Elderly patients are at increased risk of developing acute kidney injury (AKI) following major surgery and rapid diagnosis is essential. AIM This study aimed to examine the potential utility of plasma neutrophil gelatinase associated lipocalin levels in early prediction of AKI in geriatric patients undergoing laparotomic oncological surgery. METHODS This prospective single-center cohort study included 60 geriatric patients (≥ 65 years of age) that underwent major oncologic surgery with laparotomy. Perioperative measurements of plasma creatinine, blood urinary nitrogen, plasma lactate, urine output, and neutrophil gelatinase associated lipocalin (NGAL) were made. Patients were followed for AKI development, which is the primary outcome measure, and predictive role of NGAL was investigated. RESULTS At 48 h follow-up, AKI developed in 13 patients (21.7%). Significant differences in creatinine (p < 0.001), NGAL (p < 0.001), and urine output levels (p = 0.001) were evident over time between the two groups. High NGAL measurements at 6 and 24 h after surgery seem to be highly predictive of AKI development. At 6 h, a plasma NGAL level greater than 71.8 ng/mL has a sensitivity and specificity of 85% and 81% in predicting subsequent AKI development. CONCLUSIONS Plasma NGAL levels seem to represent an early and reliable marker for AKI in elderly patients undergoing laparotomic surgery with the potential to allow early diagnosis and prevent further renal deterioration. Further confirmatory studies are warranted. TRIAL REGISTRATION The study was registered to ClinicalTrials.gov (number, NCT05030727). IMPLICATION STATEMENT Elderly patients are at increased risk of postoperative acute kidney injury (AKI). This study shows that plasma neutrophil gelatinase associated lipocalin is a helpful marker to predict AKI in elderly patients undergoing laparotomic major surgery, which will allow early diagnosis and prevent further renal deterioration in this vulnerable patient group.
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Affiliation(s)
- Meliha Orhon Ergun
- Department of Anesthesiology and Reanimation, Pendik Research and Training Hospital, Marmara University Medical Faculty, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 10, 34899, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Seniyye Ulgen Zengin
- Department of Anesthesiology and Reanimation, Pendik Research and Training Hospital, Marmara University Medical Faculty, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 10, 34899, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Aynur Mustafayeva
- Department of Anesthesiology and Reanimation, Pendik Research and Training Hospital, Marmara University Medical Faculty, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 10, 34899, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Tumay Umuroglu
- Department of Anesthesiology and Reanimation, Pendik Research and Training Hospital, Marmara University Medical Faculty, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 10, 34899, Ustkaynarca, Pendik, Istanbul, Turkey
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Mohammed M, Mohammad J, Fathi Z, Al-Hamdany M, Alkazzaz N. Comparative evaluation of cystatin C and neutrophil gelatinase-associated lipocalin in patients with thalassemia major versus thalassemia intermedia. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e71475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Kidney disorders are long-term complications in thalassemia patients, especially with the high life expectancy of these patients. Proper evaluation of kidney impairment in β-thalassemia patients can be difficult due to higher intake of iron chelators, resulting in renal impairment. Early biomarkers of renal disease are used for the diagnosis of tubular and glomerular abnormalities. The current study was conducted on 88 individuals, 25 healthy people and 63 β-thalassemia patients. Circulating levels of urea, creatinine, cystatin C and neutrophil gelatinase-associated lipocalin were measured in all groups. Compared to healthy control, patients with thalassemia major and intermedia showed a significant increase in both cystatin C and NGAL levels, with no effects on creatinine levels. Furthermore, urea levels were markedly higher in patients with thalassemia major compared to control. As early renal dysfunction markers, cystatin C and NGAL should be routinely evaluated in thalassemia patients major and intermedia.
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Walls AB, Bengaard AK, Iversen E, Nguyen CN, Kallemose T, Juul-Larsen HG, Jawad BN, Hornum M, Andersen O, Eugen-Olsen J, Houlind MB. Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department. Pharmaceuticals (Basel) 2021; 14:843. [PMID: 34577543 PMCID: PMC8471084 DOI: 10.3390/ph14090843] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022] Open
Abstract
Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.
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Affiliation(s)
- Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
| | - Anne Kathrine Bengaard
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Camilla Ngoc Nguyen
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Emergency Department, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Nephrology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Emergency Department, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Morten Baltzer Houlind
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
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Abstract
PURPOSE Adults with congenital heart disease (ACHD) are a rapidly growing population with ever-increasing complexity, and intensive care unit (ICU) management is often necessary. This review summarizes common cardiovascular and non-cardiovascular complications in ACHD and provides a framework for ICU care. RECENT FINDINGS Heart failure is the leading cause of hospitalization and mortality in ACHD. Varied anatomy and repairs, as well as differing physiological complications, limit generalized application of management algorithms. Recent studies suggest that earlier mechanical support in advanced cases is feasible and potentially helpful. Cardiac arrhythmias are poorly tolerated and often require immediate attention. Other complications requiring intensive care include infections such as endocarditis and COVID-19, pulmonary hypertension, renal failure, hepatic dysfunction, coagulopathy, and stroke. Successful ICU care in ACHD requires a multi-disciplinary approach with careful consideration of anatomy, physiology, and associated comorbidities. Few studies have formally examined ICU management in ACHD and further research is necessary.
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Affiliation(s)
- Payton Kendsersky
- Department of Medicine, Duke University Medical Center, Durham, NC USA
| | - Richard A. Krasuski
- Division of Cardiology, Duke University Medical Center, DUMC 3010, Durham, NC 27710 USA
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Hussain ML, Hamid PF, Chakane N. Will urinary biomarkers provide a breakthrough in diagnosing cardiac surgery-associated AKI? - A systematic review. Biomarkers 2020; 25:375-383. [PMID: 32479185 DOI: 10.1080/1354750x.2020.1777199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Acute kidney injury following cardiac surgery is a dreaded complication contributing to early mortality. Diagnosing AKI using serum creatinine usually results in a delay. To combat this, certain kidney damage specific biomarkers were investigated to identify if they can serve as early predictors of cardiac surgery-associated AKI (CSA-AKI). This study systematically reviews three such biomarkers; NGAL, tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP7) to identify if they can serve as early predictors of CSA-AKI.Methods: Systematic search was carried out on literature reporting the diagnostic ability of the three biomarkers from databases in accordance with PRISMA guidelines.Results: We found 43 articles reporting urinary-NGAL levels (n = 34 in adults, n = 9 in children) and 10 studies reporting TIMP-2 and IGFBP7 levels among adults. Interestingly, NGAL showed high diagnostic value in predicting AKI in children (seven among nine studies with AUROC > 0.8). The cell cycle arrest biomarkers, namely TIMP-2 and IGFBP7, showed high diagnostic value in predicting AKI in adults (five among ten studies with AUROC > 0.8).Conclusion: In predicting CSA-AKI; the diagnostic value of NGAL is high in the paediatric population while the diagnostic value of TIMP-2 and IGFBP7 is high in adults.
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Affiliation(s)
- Mohmmed Laique Hussain
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
| | - Pousette Farouk Hamid
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
| | - Ntema Chakane
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
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Memon MKY, Akhtar S, Martins RS, Ahmed R, Saeed A, Shaheen F. Adult congenital heart disease: frequency, risk factors and outcomes of acute kidney injury in postoperative period. Indian J Thorac Cardiovasc Surg 2020; 36:365-372. [PMID: 33061144 DOI: 10.1007/s12055-020-00926-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/01/2020] [Accepted: 01/07/2020] [Indexed: 01/11/2023] Open
Abstract
Background Acute kidney injury (AKI) after surgery for congenital heart disease (CHD) in adults is poorly studied despite being well-recognized as a postoperative complication after cardiac surgery in adults. The primary aim of our study was to determine the frequency of AKI in adults undergoing surgery for CHD. We also aimed to determine risk factors and predictors of AKI in this patient population, and to explore outcomes in terms of duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. Methods This retrospective cross-sectional study included all adult patients (18 years) who underwent cardiac surgery with cardiopulmonary bypass for their congenital heart problems from January 2011 to December 2016 in a tertiary-care private hospital. Results A total of 166 patients with a mean age of 32.05 ± 12.11 years were included in this study. The postoperative course was complicated by AKI in 29.5% of patients. Thirty-two percent of these patients had moderate-to-severe kidney disease. Two patients (4%) developing AKI required renal replacement therapy in the form of transient hemodialysis. All patients in our study showed complete resolution of AKI, with no mortalities in the postoperative period. On univariable analysis, (Risk adjusted classification for congenital heart surgery-1) RACHS-1 category 2 and 3, aortic valve replacement, preoperative creatinine clearance, ventricular septal defect closure, cardiopulmonary bypass time, aortic cross-clamp time, intra-operative excessive blood loss, intra-operative ionotropic score, and postoperative hypotension were found to be significant predictors for the development of AKI. On age-adjusted multivariable analysis, RACHS-1 category 2 (OR = 3.49; CI = 1.22-9.95) and category 3 (OR = 3.28 = 1.15-9.36), and intra-operative excessive blood loss (OR = 2.9; CI = 1.07-7.85) were significant predictors of AKI development in the postoperative period. Moreover, development of AKI postoperatively was a predictor of a significantly longer cardiac intensive care unit (CICU) stay (OR = 1.21; CI = 1.08-1.37). Conclusion We found that preoperative creatinine clearance, ACC time, intraoperative excessive blood loss, and RACHS-1Category 2 and 3 are potential risk factors for postoperative AKI development. Moreover, patients who develop AKI are likely to have a significantly longer CICU stay. Our study has tried to fill the lacunae with regard to AKI in adults undergoing surgery for CHD. However, there is a need for more studies with larger cohorts involving more complex surgeries to truly estimate the incidence and potential risk factors for AKI in this group of patients.
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Affiliation(s)
| | | | | | | | - Amjad Saeed
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fariha Shaheen
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Badeli H, Baghersalimi A, Eslami S, Saadat F, Rad AH, Basavand R, Papkiadeh SR, Darbandi B, Kooti W, Peluso I. Early Kidney Damage Markers after Deferasirox Treatment in Patients with Thalassemia Major: A Case-Control Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5461617. [PMID: 31178966 PMCID: PMC6501149 DOI: 10.1155/2019/5461617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The life of patients with β-thalassemia major depends on blood transfusion. Regular blood transfusion leads to hemosiderosis in their main organs. The aim of this study was to compare the effects of deferasirox and deferoxamine on renal damage in patients with β-thalassemia major. METHOD The present case-control study was conducted on 60 individuals who were referred to the 17th Shahrivar Tertiary Referral Hospital in Guilan province, Iran. In this study, patients with β-thalassemia major who used deferasirox (n = 21) and patients who used deferoxamine (n = 19) were evaluated. The control group (n = 20) was selected from healthy individuals. Serum creatinine (CREA), blood urea nitrogen (BUN), and Cystatin C were measured from blood samples. Furthermore, urinary (U.) neutrophil gelatinase-associated lipocalin (NGAL), albumin (Alb), interleukin- (IL-) 18, and Kidney Injury Molecule-1 (KIM-1) were measured by the ELISA method and normalized for U. creatinine (CREA). RESULTS U. NGAL, U. IL-18, and BUN biomarkers in the deferasirox group were significantly higher than those in the control group (p < 0.001). U. NGAL/CREA and U. KIM-1/CREA ratios increased in both the deferoxamine and deferasirox groups compared to the control group (p < 0.05). U. Alb was significantly higher in patients treated with deferoxamine than in healthy participants (p < 0.05). CONCLUSION The findings of this study indicate that after taking deferasirox, there was renal damage and an increase in inflammatory factors. Also, minor renal impairment was observed after deferoxamine administration, but it was not confirmed at the molecular level (U. NGAL and KIM-1). Therefore, it seems that patients who are taking these two drugs should be monitored carefully.
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Affiliation(s)
- Hamidreza Badeli
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Adel Baghersalimi
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sajjad Eslami
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farshid Saadat
- Department of Immunology and Microbiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Afagh Hassanzadeh Rad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rokhsar Basavand
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Bahram Darbandi
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Wesam Kooti
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Ilaria Peluso
- Council for Agricultural Research and Economics, Research Centre for Food and Nutrition (CREA-AN), Via Ardeatina 546, 00178 Rome, Italy
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Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease. Cardiol Young 2017; 27:1068-1075. [PMID: 27869053 DOI: 10.1017/s1047951116002067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes. METHODS This single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013. RESULTS Data from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis. CONCLUSIONS We demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.
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Shao Y, Fan Y, Xie Y, Yin L, Zhang Y, Deng L, Sun X, Shao X, Tan X, He J, Zhao S. Effect of continuous renal replacement therapy on kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury. Exp Ther Med 2017; 13:3594-3602. [PMID: 28588686 DOI: 10.3892/etm.2017.4436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/13/2017] [Indexed: 12/28/2022] Open
Abstract
Kidney injury molecule-1 (Kim-1) and neutrophil gelatinase-associated lipocalin (NGAL) have been investigated as biomarkers for acute kidney injury (AKI). However, they are seldom investigated in patients with septic AKI treated with continuous renal replacement therapy (CRRT). The aim of the present study was to investigate the therapeutic effectiveness and possible mechanisms of CRRT in septic AKI by observing the changes in Kim-1 and NGAL levels. A group of 38 patients with septic AKI was randomly divided into the conventional drug treatment group (group A) and the CRRT group (group B). All patients were treated with standard antisepsis agents, and group B was additionally submitted to CRRT for 24 h. The levels of Kim-1 and NGAL in serum, urine and the ultrafiltrate of CRRT were measured prior to and at 12, 24, and 48 h after treatment. In group A, urinary Kim-1 (uKim-1) levels at 12, 24 and 48 h were lower than prior to treatment (P<0.05), whereas urinary NGAL (uNGAL) showed no difference among the various time points (P>0.05). In group B, uKim-1 was decreased at 24 and 48 h compared with before treatment (all P<0.05), whereas uNGAL was decreased at 48 h (P<0.05). Serum Kim-1 did not change with time in groups A and B (P>0.05), whereas serum NGAL was increased after treatment in group A (P<0.05) but did not change in group B (P>0.05). Kim-1 and NGAL were not detected in the ultrafiltrate of CRRT. uKim-1 and uNGAL decreased significantly after CRRT, and therefore may be used to reflect the change of renal function during CRRT and to evaluate the therapeutic effectiveness of the method.
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Affiliation(s)
- Yiming Shao
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Yinqiang Fan
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Yuliu Xie
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Lu Yin
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Yuanli Zhang
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Liehua Deng
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Xiaocong Sun
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Xin Shao
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Xinzhang Tan
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Junbing He
- Intensive Care Unit, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Shiman Zhao
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
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McCaffrey J, Dhakal AK, Milford DV, Webb NJA, Lennon R. Recent developments in the detection and management of acute kidney injury. Arch Dis Child 2017; 102:91-96. [PMID: 27496911 PMCID: PMC5256404 DOI: 10.1136/archdischild-2015-309381] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is a common condition in children admitted to hospital and existing serum and urine biomarkers are insensitive. There have been significant developments in stratifying the risk of AKI in children and also in the identification of new AKI biomarkers. Risk stratification coupled with a panel of AKI biomarkers will improve future detection of AKI, however, paediatric validation studies in mixed patient cohorts are required. The principles of effective management rely on treating the underlying cause and preventing secondary AKI by the appropriate use of fluids and medication. Further therapeutic innovation will depend on improving our understanding of the basic mechanisms underlying AKI in children.
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Affiliation(s)
- James McCaffrey
- Department of Paediatric Nephrology, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Ajaya Kumar Dhakal
- Department of Paediatric Nephrology, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK,KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - David V Milford
- Department of Nephrology, Birmingham Children's Hospital, Birmingham, UK
| | - Nicholas J A Webb
- Department of Paediatric Nephrology, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Rachel Lennon
- Department of Paediatric Nephrology, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK,Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK
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Liu X, Ye Y, Mi Q, Huang W, He T, Huang P, Xu N, Wu Q, Wang A, Li Y, Yuan H. A Predictive Model for Assessing Surgery-Related Acute Kidney Injury Risk in Hypertensive Patients: A Retrospective Cohort Study. PLoS One 2016; 11:e0165280. [PMID: 27802302 PMCID: PMC5089779 DOI: 10.1371/journal.pone.0165280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Acute kidney injury (AKI) is a serious post-surgery complication; however, few preoperative risk models for AKI have been developed for hypertensive patients undergoing general surgery. Thus, in this study involving a large Chinese cohort, we developed and validated a risk model for surgery-related AKI using preoperative risk factors. Methods and Findings This retrospective cohort study included 24,451 hypertensive patients aged ≥18 years who underwent general surgery between 2007 and 2015. The endpoints for AKI classification utilized by the KDIGO (Kidney Disease: Improving Global Outcomes) system were assessed. The most discriminative predictor was selected using Fisher scores and was subsequently used to construct a stepwise multivariate logistic regression model, whose performance was evaluated via comparisons with models used in other published works using the net reclassification index (NRI) and integrated discrimination improvement (IDI) index. Results Surgery-related AKI developed in 1994 hospitalized patients (8.2%). The predictors identified by our Xiang-ya Model were age, gender, eGFR, NLR, pulmonary infection, prothrombin time, thrombin time, hemoglobin, uric acid, serum potassium, serum albumin, total cholesterol, and aspartate amino transferase. The area under the receiver-operating characteristic curve (AUC) for the validation set and cross validation set were 0.87 (95% CI 0.86–0.89) and (0.89; 95% CI 0.88–0.90), respectively, and was therefore similar to the AUC for the training set (0.89; 95% CI 0.88–0.90). The optimal cutoff value was 0.09. Our model outperformed that developed by Kate et al., which exhibited an NRI of 31.38% (95% CI 25.7%-37.1%) and an IDI of 8% (95% CI 5.52%-10.50%) for patients who underwent cardiac surgery (n = 2101). Conclusions/Significance We developed an AKI risk model based on preoperative risk factors and biomarkers that demonstrated good performance when predicting events in a large cohort of hypertensive patients who underwent general surgery.
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Affiliation(s)
- Xing Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Yongkai Ye
- School of Computer, National University of Defense Technology, Changsha, 410073, The People’s Republic of China
| | - Qi Mi
- Department of Sports Medicine and Nutrition, University of Pittsburgh, PA, 15260, United States of America
| | - Wei Huang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Ting He
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Pin Huang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Nana Xu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Qiaoyu Wu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Anli Wang
- Information Department, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Ying Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- * E-mail: (YL); (HY)
| | - Hong Yuan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- * E-mail: (YL); (HY)
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Buelow MW, Cohen SB, Earing MG. Renal dysfunction in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.11.003] [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: 10/22/2022]
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14
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The importance of renal function for the management of the sick newborn with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.12.002] [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: 11/23/2022]
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15
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16
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Effect of iodinated contrast medium in diabetic rat kidneys as evaluated by blood-oxygenation-level-dependent magnetic resonance imaging and urinary neutrophil gelatinase-associated lipocalin. Invest Radiol 2016; 50:392-6. [PMID: 25668748 DOI: 10.1097/rli.0000000000000141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The objective of this study was to assess whether streptozotocin (STZ)-induced diabetic rats develop iodinated contrast-induced acute kidney injury. The intrarenal R2* (=1/T2*) was evaluated continuously before, during, and after contrast administration. Renal injury was confirmed using urinary neutrophil gelatinase-associated lipocalin measurements. MATERIALS AND METHODS Six Sprague-Dawley rats were administered with STZ to induce diabetes (group 1). R2* was measured before, during, and after administration of iodixanol. R2* readings were sampled from 4 renal regions: inner medulla, inner stripe of outer medulla (ISOM), outer stripe of outer medulla, and cortex. Peak R2* and initial upslope of R2* increase after iodinated contrast were calculated. Data from 12 nondiabetic rats pretreated with nitric oxide synthase and prostaglandin inhibitors to induce susceptibility to contrast-induced acute kidney injury (pretreatment model) from a previous study were reanalyzed for peak R2* and initial upslope of R2* increase after contrast. Six of these animals received saline (group 2), and the other 6 received furosemide (group 3) before iodixanol. RESULTS Peak R2* and initial upslope of R2* increase were used as blood-oxygenation-level-dependent response parameters. R2* in ISOM was comparable in all 3 groups before administration of furosemide/saline. Except for the furosemide group, ISOM showed a rapid increase in R2* immediately after contrast administration. Unlike the L-NAME- and indomethacin-treated groups, the diabetic group showed a quick reversal of R2* toward baseline measurements after contrast administration. Urinary neutrophil gelatinase-associated lipocalin indicated significant increase in diabetic rats 4 hours after contrast administration. The observed trends with peak R2* and initial upslope of R2* increase in renal ISOM were in agreement with those of urinary neutrophil gelatinase-associated lipocalin. CONCLUSIONS The STZ-induced diabetic rat may be suitable for studying the effects of iodinated contrast on renal oxygenation status and may mimic human condition closer than the pretreatment model described before. The peak R2* value and initial upslope of R2* in ISOM appear to be effective magnetic resonance imaging markers to predict renal injury after administration of an iodinated contrast agent.
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Bhatt AB, Foster E, Kuehl K, Alpert J, Brabeck S, Crumb S, Davidson WR, Earing MG, Ghoshhajra BB, Karamlou T, Mital S, Ting J, Tseng ZH. Congenital Heart Disease in the Older Adult. Circulation 2015; 131:1884-931. [DOI: 10.1161/cir.0000000000000204] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Buelow MW, Earing MG, Hill GD, Cohen SB, Bartz PJ, Tweddell JS, Ginde S. The Impact of Obesity on Postoperative Outcomes in Adults with Congenital Heart Disease Undergoing Pulmonary Valve Replacement. CONGENIT HEART DIS 2015; 10:E197-202. [DOI: 10.1111/chd.12266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Matthew W. Buelow
- Department of Pediatrics; Division of Pediatric Cardiology; Medical College of Wisconsin; Milwaukee Wis USA
| | - Michael G. Earing
- Department of Pediatrics; Division of Pediatric Cardiology; Medical College of Wisconsin; Milwaukee Wis USA
- Department of Internal Medicine; Division of Adult Cardiovascular Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - Garick D. Hill
- Department of Pediatrics; Division of Pediatric Cardiology; Medical College of Wisconsin; Milwaukee Wis USA
| | - Scott B. Cohen
- Department of Pediatrics; Division of Pediatric Cardiology; Medical College of Wisconsin; Milwaukee Wis USA
- Department of Internal Medicine; Division of Adult Cardiovascular Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - Peter J. Bartz
- Department of Pediatrics; Division of Pediatric Cardiology; Medical College of Wisconsin; Milwaukee Wis USA
- Department of Internal Medicine; Division of Adult Cardiovascular Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - James S. Tweddell
- Department of Surgery; Division of Cardiothoracic Surgery; Medical College of Wisconsin; Milwaukee Wis USA
| | - Salil Ginde
- Department of Pediatrics; Division of Pediatric Cardiology; Medical College of Wisconsin; Milwaukee Wis USA
- Department of Internal Medicine; Division of Adult Cardiovascular Medicine; Medical College of Wisconsin; Milwaukee Wis USA
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Cho E, Kim SC, Kim MG, Jo SK, Cho WY, Kim HK. The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study. BMC Nephrol 2014; 15:169. [PMID: 25342079 PMCID: PMC4221681 DOI: 10.1186/1471-2369-15-169] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/14/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Although intraperitoneal surgery is a major operation associated with postoperative acute kidney injury (AKI), the incidence, risk factors, and long-term renal outcome are not well known. We aimed to determine the risk factors and 6 months renal outcome in patients with clinical or subclinical AKI after hepatobiliary surgery. We also assessed the validity of urine neutrophil gelatinase-associated lipocalin (NGAL) in the early detection of AKI or prediction of renal outcome. METHODS This prospective observational study enrolled patients with normal renal function who underwent hepatobiliary surgeries. Urine and serum samples were collected for NGAL measurement. RESULTS Among 131 patients, 10 (7.6%) developed postoperative AKI. Urine NGAL at 12 h postsurgery was the most predictive parameter for the diagnosis of AKI (cutoff, 92.85 ng/mL). With the cutoff value, subclinical AKI was diagnosed in 42 (32.1%) patients. Patients with clinical AKI and those with subclinical AKI were assigned to the AKI group. The AKI group had significantly higher model for end-stage liver disease and sodium (MELD-Na) score, lower albumin level, and longer hospital stay after surgery than the non-AKI group. Older age and higher MELD-Na score were independent risk factors for the development of postoperative AKI. At 6 months postsurgery, the estimated glomerular filtration rate (eGFR) in the AKI group was significantly lower than that in the non-AKI group, although the baseline eGFR was not different. In multiple linear regression analysis, the maximum urine NGAL level during 24 h postsurgery, intraoperative fluid balance, and having liver transplantation were significantly associated with a poor 6 months renal outcome. CONCLUSION Urine NGAL was useful in the early diagnosis of postoperative AKI as well as in predicting the 6 months renal outcome after hepatobiliary surgery. A considerable proportion of patients developed subclinical AKI, and these patients showed worse renal outcome compared with the non-AKI group.
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Affiliation(s)
| | | | | | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, 5Ka, Anam-Dong, Sungbuk-Gu, Seoul 136-705, Korea.
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Brott DA, Adler SH, Arani R, Lovick SC, Pinches M, Furlong ST. Characterization of renal biomarkers for use in clinical trials: biomarker evaluation in healthy volunteers. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:227-37. [PMID: 24611000 PMCID: PMC3928457 DOI: 10.2147/dddt.s54956] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several preclinical urinary biomarkers have been qualified and accepted by the health authorities (US Food and Drug Administration, European Medicines Agency, and Pharmaceuticals and Medical Devices Agency) for detecting drug-induced kidney injury during preclinical toxicologic testing. Validated human assays for many of these biomarkers have become commercially available, and this study was designed to characterize some of the novel clinical renal biomarkers. The objective of this study was to evaluate clinical renal biomarkers in a typical Phase I healthy volunteer population to determine confidence intervals (pilot reference intervals), intersubject and intrasubject variability, effects of food intake, effect of sex, and vendor assay comparisons. METHODS Spot urine samples from 20 male and 19 female healthy volunteers collected on multiple days were analyzed using single analyte and multiplex assays. The following analytes were measured: α-1-microglobulin, β-2-microglobulin, calbindin, clusterin, connective tissue growth factor, creatinine, cystatin C, glutathione S-transferase-α, kidney injury marker-1, microalbumin, N-acetyl-β-(D) glucosaminidase, neutrophil gelatinase-associated lipocalin, osteopontin, Tamm-Horsfall urinary glycoprotein, tissue inhibitor of metalloproteinase 1, trefoil factor 3, and vascular endothelial growth factor. RESULTS Confidence intervals were determined from the single analyte and multiplex assays. Intersubject and intrasubject variability ranged from 38% to 299% and from 29% to 82% for biomarker concentration, and from 24% to 331% and from 10% to 67% for biomarker concentration normalized to creatinine, respectively. There was no major effect of food intake or sex. Single analyte and multiplex assays correlated with r (2)≥0.700 for five of six biomarkers when evaluating biomarker concentration, but for only two biomarkers when evaluating concentration normalized to creatinine. CONCLUSION Confidence intervals as well as intersubject and intrasubject variability were determined for novel clinical renal biomarkers/assays, which should be considered for evaluation in the next steps of the qualification process.
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Affiliation(s)
- David A Brott
- Translational Patient Safety and Enabling Sciences, AstraZeneca Pharmaceuticals, Wilmington, DE, USA
| | - Scott H Adler
- Translational Patient Safety and Enabling Sciences, AstraZeneca Pharmaceuticals, Wilmington, DE, USA
| | - Ramin Arani
- AstraZeneca Pharmaceuticals, Wilmington, DE, USA
| | | | - Mark Pinches
- Global Safety Assessment, AstraZeneca Pharmaceuticals, Macclesfield, Cheshire, UK
| | - Stephen T Furlong
- Translational Patient Safety and Enabling Sciences, AstraZeneca Pharmaceuticals, Wilmington, DE, USA
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Anand KJS. Pediatric critical care: grand challenges for a glowing future. Front Pediatr 2014; 2:35. [PMID: 24818121 PMCID: PMC4012217 DOI: 10.3389/fped.2014.00035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/16/2014] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kanwaljeet J S Anand
- Pain Neurobiology Laboratory, Department of Pediatrics, University of Tennessee Neuroscience Institute, University of Tennessee Health Science Center , Memphis, TN , USA
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Liebetrau C, Dörr O, Baumgarten H, Gaede L, Szardien S, Blumenstein J, Rolf A, Möllmann H, Hamm C, Walther T, Nef H, Weber M. Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of cardiac surgery associated acute kidney injury. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 73:392-9. [PMID: 23668886 DOI: 10.3109/00365513.2013.787149] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication after cardiac surgery. Neutrophil gelatinase-associated lipocalin (NGAL) may be an early biomarker for cardiac surgery-associated (CSA) AKI. We investigated whether increased urinary NGAL concentrations were predictive of AKI within 4 days after surgery and of mortality within 9 months. METHODS Consecutive patients (n = 141) undergoing major cardiac surgery were included. Creatinine, blood urea nitrogen, cystatin C and urinary NGAL were measured before, 4 hours and 4 days after extracorporeal circulation. RESULTS AKI was observed in 47 (33.3%) patients. The 4-hour urinary NGAL measurement was an independent predictor of stage 2 and 3 AKI (AUC 0.901; 95% CI 0.81-0.99). Patients with AKI had a higher 9-month mortality rate (19.1% vs. 3.2%; logrank 10.9; P = 0.001; HR 19.8; 95% CI 3.7-107.1). Urinary NGAL was not predictive of mortality within 9 months after surgery. CONCLUSION Urinary NGAL is a biomarker for very early risk stratification of AKI after cardiac surgery and may be useful as a basis for early interventional strategies to prevent CSA-AKI.
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Affiliation(s)
- Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
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Cohen SB, Ginde S, Bartz PJ, Earing MG. Extracardiac complications in adults with congenital heart disease. CONGENIT HEART DIS 2013; 8:370-80. [PMID: 23663434 DOI: 10.1111/chd.12080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/27/2022]
Abstract
With the increasing number of adults living with repaired, or unrepaired, congenital heart disease, there is a growing incidence of extracardiac comorbidities. These comorbidities can affect various organ systems in complex ways, and may have a significant impact on a patient's quality of life and survival. Many of these potential complications may go undiagnosed until there is already a significant bearing on the patient's life. Therefore, it is important for physicians who care for the adult congenital patient to be mindful of these potential extracardiac complications, and actively assess for these complications in their adult congenital practice. Continued research to identify modifiable risk factors is needed so that both preventative and therapeutic management options for these extracardiac complications may be developed.
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Affiliation(s)
- Scott B Cohen
- The Wisconsin Adult Congenital Heart Disease Program (WAtCH), Medical College of Wisconsin, Milwaukee, Wis, USA
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Tehrani S, Laing C, Yellon DM, Hausenloy DJ. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest 2013; 43:483-90. [PMID: 23441924 DOI: 10.1111/eci.12061] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/03/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronary revascularization using percutaneous coronary intervention (PCI) is one of the major treatments for patients with stable coronary artery disease, with approximately 1.5 million patients undergoing PCI in the United States and Europe every year. An important neglected complication of PCI is contrast-induced acute kidney injury (CI-AKI). DESIGN In this article, we review the definition, pathogenesis and management of CI-AKI and highlight potential therapeutic options for preventing CI-AKI in post-PCI patients. RESULTS CI-AKI is an important but underdiagnosed complication of PCI that is associated with increased in-hospital morbidity and mortality. Patients with pre-existing renal impairment and diabetes are particularly susceptible to this complication post-PCI. Optimization of the patients' circulating volume remains the mainstay for preventing CI-AKI, although the best strategy for achieving this is still controversial. CONCLUSION Following PCI, CI-AKI is an overlooked complication which is associated with significant morbidity and mortality. In this article, we review the pathophysiology of CI-AKI in patients undergoing PCI and discuss the potential therapeutic options for preventing it.
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Affiliation(s)
- Shana Tehrani
- The Hatter Cardiovascular Institute, University College London, London, UK
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