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Villa G, Samoni S, Muzzi M, Fabbri S, Husain-Syed F, Tofani L, Allinovi M, Paparella L, Spatafora P, Di Costanzo R, Ricci Z, Serni S, Romagnoli S. Doppler-Derived Renal Functional Reserve in the Prediction of Postoperative Acute Kidney Injury in Patients Undergoing Robotic Surgery. Anesth Analg 2024; 139:211-219. [PMID: 38885478 PMCID: PMC11155286 DOI: 10.1213/ane.0000000000006967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Postoperative acute kidney injury (PO-AKI) is a frequent complication after surgery. Various tools have been proposed to identify patients at high risk for AKI, including preoperative serum creatinine or estimated glomerular filtration rate (eGFR), urinary cell cycle arrest, and tubular damage biomarkers; however, none of these can appropriately assess AKI risk before surgery. Renal functional reserve (RFR) screened by the Doppler-derived intraparenchymal renal resistive index variation (IRRIV) test has been proposed to identify patients at risk for AKI before a kidney insult. IRRIV test has been developed in healthy individuals and previously investigated in cardiac surgery patients. This study aims to evaluate the value of the IRRIV test in identifying PO-AKI among patients undergoing robotic abdominal surgery in the Trendelenburg position for pelvic oncological disease. METHODS We performed a prospective, double-blinded, observational study. Preoperative baseline renal function and RFR were assessed in 53 patients with baseline eGFR >60 mL/min/1.73 m2, undergoing robotic surgery in the Trendelenburg position for pelvic oncological disease. The capability of Doppler-derived RFR in predicting PO-AKI was investigated with the area under the receiver operating characteristic curve (ROC-AUC). RESULTS Approximately 15.1% of patients developed AKI within the first 3 postoperative days. Thirty-one (58.5%) patients had a physiologic delta-RRI (ie, ≥0.05), while 22 (41.5%) patients did not. The ROC-AUC for PO-AKI was 0.85 (95% confidence interval [CI], 0.74-0.97; P = .007) for serum creatinine, 0.84 (95% CI, 0.71-0.96; P = .006) for eGFR, and 0.84 (95% CI, 0.78-0.91; P = .017) for delta-RRI. When combined with eGFR, the ROC-AUC for delta-RRI was 0.95 (95% CI, 0.9-1). CONCLUSIONS Our findings show that the preoperative assessment of Doppler-derived RFR combined with baseline renal function improves the capability of identifying patients at high risk for PO-AKI with eGFR >60 mL/min/1.73 m2 after robotic abdominal surgery in Trendelenburg position for pelvic oncological disease.
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Affiliation(s)
- Gianluca Villa
- From the Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Sara Samoni
- Unit of Nephrology, Dialysis and Renal Transplant, Medical Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirko Muzzi
- From the Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
| | - Sergio Fabbri
- From the Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
| | - Faeq Husain-Syed
- Department of Internal Medicine II, Division of Nephrology, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
| | - Lorenzo Tofani
- Department of statistics, informatics, applications, University of Florence, Florence, Italy
| | - Marco Allinovi
- Unit of Nephrology, Dialysis and Transplantation, Geriatric Department, Careggi Hospital, University of Florence, Florence, Italy
| | - Laura Paparella
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Pietro Spatafora
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Urological Minimally, Invasive Robotic Surgery and Renal Transplantation, Department of Oncology and Robotic Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Roberto Di Costanzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Zaccaria Ricci
- From the Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Meyer Children’s University Hospital, IRCCS, Florence, Italy
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Urological Minimally, Invasive Robotic Surgery and Renal Transplantation, Department of Oncology and Robotic Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Stefano Romagnoli
- From the Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Scurt FG, Bose K, Mertens PR, Chatzikyrkou C, Herzog C. Cardiac Surgery-Associated Acute Kidney Injury. KIDNEY360 2024; 5:909-926. [PMID: 38689404 PMCID: PMC11219121 DOI: 10.34067/kid.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
AKI is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (cardiac surgery-associated AKI [CSA-AKI]) on the basis of changes in serum creatinine and/or urine output. There are various preoperative, intraoperative, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence, and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio, other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention, and treatment management.
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Affiliation(s)
- Florian G. Scurt
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katrin Bose
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christos Chatzikyrkou
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Carolin Herzog
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Nalesso F, Martino FK, Bogo M, Bettin E, Alessi M, Stefanelli LF, Silvestre C, Furian L, Calò LA. The Ultrasound Renal Stress Test for the Assessment of Functional Renal Reserve in Kidney Transplantation: A Pilot Study in Living Donors. J Clin Med 2024; 13:525. [PMID: 38256658 PMCID: PMC10816091 DOI: 10.3390/jcm13020525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
In the evolving landscape of nephrology and kidney transplants, assessing renal functional reserve (RFR) in living kidney donors is essential for ensuring donor safety and successful transplantation. This study explores the use of the Intra-Parenchymal Renal Resistive Index Variation (IRRIV) test, a novel non-invasive method, to measure RFR in living donors. Our observational study included 11 participants undergoing living kidney donations, evaluated using the IRRIV-based Renal Stress Test (RST) before and 12 months post-nephrectomy. The study demonstrated significant changes in creatinine and eGFR CKD-EPI levels post-donation, with an average creatinine rise from 69 to 97 µmol/L and a reduction in eGFR from 104 to 66 mL/min/1.73 m2. These variations align with the expected halving of nephron mass post-nephrectomy and the consequent recruitment of RFR and hyperfiltration in the remaining nephrons. This pilot study suggests that the IRRIV-based RST is a practical, safe, and reproducible tool, potentially revolutionizing the assessment of RFR in living kidney donors, with implications for broader clinical practice in donor eligibility evaluation, even in borderline renal cases. Furthermore, it confirms the feasibility of RST in living kidney donors and allows us to assess the sample size in 48 donors for a future study.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Francesca K. Martino
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Marco Bogo
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Elisabetta Bettin
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Marianna Alessi
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Lucia F. Stefanelli
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
| | - Cristina Silvestre
- Department of Surgical Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplant Unit, University of Padua, 35128 Padua, Italy; (C.S.); (L.F.)
| | - Lucrezia Furian
- Department of Surgical Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplant Unit, University of Padua, 35128 Padua, Italy; (C.S.); (L.F.)
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology-Dialysis-Kidney Transplant Unit, University of Padua, 35128 Padua, Italy; (F.K.M.); (M.B.); (L.F.S.); (L.A.C.)
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Samoni S, De Rosa S, Ronco C, Castellano G. Update on persistent acute kidney injury in critical illnesses. Clin Kidney J 2023; 16:1813-1823. [PMID: 37915904 PMCID: PMC10616499 DOI: 10.1093/ckj/sfad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 11/03/2023] Open
Abstract
Acute kidney injury (AKI) affects about half of patients admitted to the intensive care unit (ICU), and worsens their short- and long-term outcomes. Apparently self-limiting AKI episodes initiate a progression toward chronic kidney disease (CKD) through cellular and molecular mechanisms that are yet to be explained. In particular, persistent AKI, defined in 2016 by the Acute Dialysis Quality Initiative as an AKI which lasts more than 48 h from its onset, has been correlated with higher morbidity and mortality, and with a higher progression to acute kidney disease (AKD) and CKD than transient AKI (i.e. AKI with a reversal within 48 h). This classification has been also used in the setting of solid organ transplantation, demonstrating similar outcomes. Due to its incidence and poor prognosis and because prompt interventions seem to change its course, persistent AKI should be recognized early and followed-up also after its recovery. However, while AKI and CKD are well-described syndromes, persistent AKI and AKD are relatively new entities. The purpose of this review is to highlight the key phases of persistent AKI in ICU patients in terms of both clinical and mechanistic features in order to offer to clinicians and researchers an updated basis from which to start improving patients' care and direct future research.
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Affiliation(s)
- Sara Samoni
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia De Rosa
- Centre for Medical Sciences – CISMed, University of Trento, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padova, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Dialysis and Renal Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Giuseppe Castellano
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
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Yu Y, Li C, Zhu S, Jin L, Hu Y, Ling X, Miao C, Guo K. Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review. Eur J Med Res 2023; 28:45. [PMID: 36694233 PMCID: PMC9872411 DOI: 10.1186/s40001-023-00990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
Acute kidney injury (AKI) is a common and serious complication of cardiac surgery and is associated with increased mortality and morbidity, accompanied by a substantial economic burden. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is multifactorial and complex, with a variety of pathophysiological theories. In addition to the existing diagnostic criteria, the exploration and validation of biomarkers is the focus of research in the field of CSA-AKI diagnosis. Prevention remains the key to the management of CSA-AKI, and common strategies include maintenance of renal perfusion, individualized blood pressure targets, balanced fluid management, goal-directed oxygen delivery, and avoidance of nephrotoxins. This article reviews the pathogenesis, definition and diagnosis, and pharmacological and nonpharmacological prevention strategies of AKI in cardiac surgical patients.
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Affiliation(s)
- Ying Yu
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Chenning Li
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Shuainan Zhu
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Lin Jin
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Yan Hu
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Xiaomin Ling
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Changhong Miao
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
| | - Kefang Guo
- grid.8547.e0000 0001 0125 2443Department of Anaesthesiology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Xuhui District, Shanghai, 20032 China
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6
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Nalesso F, Rigato M, Cirella I, Protti MP, Zanella R, Rossi B, Putti MC, Martino FK, Calò LA. The Assessment of Renal Functional Reserve in β-Thalassemia Major Patients by an Innovative Ultrasound and Doppler Technique: A Pilot Study. J Clin Med 2022; 11:jcm11226752. [PMID: 36431228 PMCID: PMC9699445 DOI: 10.3390/jcm11226752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Beta-thalassemia syndromes are the most common inherited monogenic disorders worldwide. The most common pathophysiologic and clinical renal disease manifestations of in β-TM patients is the tubular dysfunctions related to iron overload, chronic anemia, and the need for chronic iron chelation therapy. The aim of this pilot study is to apply an innovative ultrasound and Doppler technique to assess the Renal Functional Reserve (RFR) in β-TM patients, and to evaluate its reliability in iron overload tubulopathy. Ultrasound assessment of intra-parenchymal renal resistive index variation (IRRIV) has recently been proposed as a safe and reproducible technique to identify RFR presence. We define the preserved RFR when the Delta Renal Resistive Index (RRI) is >0.05 (baseline RRI—minimum RRI value during stress) in the Renal Stress Test (RST). Nineteen β-TM patients were enrolled for this study. In our series, we found a strong negative correlation between mean ferritin values and Delta RRI (R = −0.51, p = 0.03). This pilot study suggested the RST as reliable tool for assessing the RFR by ultrasound. Specifically, RST could help in clinical practice suggesting the patient’s management and iron chelation therapy.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Matteo Rigato
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Irene Cirella
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | - Ruggero Zanella
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Bartolomeo Rossi
- Haematology-Oncology Clinic, Women and Child’s Health Department, University of Padua, 35122 Padua, Italy
| | - Maria Caterina Putti
- Haematology-Oncology Clinic, Women and Child’s Health Department, University of Padua, 35122 Padua, Italy
| | | | - Lorenzo A. Calò
- Department of Medicine, University of Padova, 35128 Padova, Italy
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