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Fogazzi GB, Garigali G, Abinti M, Lieti G, Verdesca S. An updated approach to the evaluation of the urinary sediment. Pediatr Nephrol 2024:10.1007/s00467-024-06545-9. [PMID: 39377940 DOI: 10.1007/s00467-024-06545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 08/23/2024] [Accepted: 09/16/2024] [Indexed: 10/09/2024]
Abstract
Examination of the urinary sediment (U-sed) is an important non-invasive, rapid, and inexpensive tool for the diagnosis and surveillance over time of renal diseases. In this Educational Review, we describe first how to collect, prepare, and examine urine samples in order to obtain reliable results. Then, we describe the U-sed findings in isolated microscopic hematuria, glomerular diseases, acute interstitial nephritis, acute kidney injury, reactivation of the BK virus in kidney transplant recipients, and crystalluric genetic diseases.
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Affiliation(s)
- Giovanni B Fogazzi
- Clinical and Research Laboratory On Urinary Sediment, SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giuseppe Garigali
- Clinical and Research Laboratory On Urinary Sediment, SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Abinti
- SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Lieti
- USC Di Nefrologia E Dialisi, Ospedale Di Garbagnate Milanese, Garbagnate Milanese, Italy
| | - Simona Verdesca
- SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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2
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Darvishzadeh Mahani F, Raji-Amirhasani A, Khaksari M, Mousavi MS, Bashiri H, Hajializadeh Z, Alavi SS. Caloric and time restriction diets improve acute kidney injury in experimental menopausal rats: role of silent information regulator 2 homolog 1 and transforming growth factor beta 1. Mol Biol Rep 2024; 51:812. [PMID: 39007943 DOI: 10.1007/s11033-024-09716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Estrogen has a protective impact on acute kidney injury (AKI); moreover, reducing the daily intake of calories impedes developing diseases. The present study aimed to determine the effects of calorie restriction (CR) and time restriction (TR) diets on the expression of silent information regulator 2 homolog 1 (SIRT1), transforming growth factor beta 1 (TGF-β1), and other indicators in the presence and absence of ovaries in AKI female rats. METHODS The female rats were divided into two groups, ovariectomized (OVX) and sham, and were placed on CR and TR diets for eight weeks; afterward, AKI was induced by injecting glycerol, and kidney injury indicators and biochemical parameters were measured before and after AKI. RESULTS After AKI, the levels of urine albumin excretion rate, urea, and creatinine in serum, and TGF-β1 increased, while creatinine clearance and SIRT1 decreased in kidney tissue. CR improved kidney indicators and caused a reduction in TGF-β1 and an increase in SIRT1 in ovary-intact rats. Moreover, CR prevented total antioxidant capacity (TAC) decrease and malondialdehyde (MDA) increase resulting from AKI. Before AKI, an increase in body weight, fasting blood sugar (FBS), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC), and a decrease in high-density lipoprotein (HDL) were observed in OVX rats compared to sham rats, but CR prevented these changes. The effects of TR were similar to those of CR in all indicators except for TGF-β1, SIRT1, urea, creatinine, and albumin. CONCLUSION The present study indicated that CR is more effective than TR in preventing AKI, probably by increasing SIRT1 and decreasing TGF-β1 in ovary-intact animals.
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Affiliation(s)
- Fatemeh Darvishzadeh Mahani
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Raji-Amirhasani
- Endocrinology and Metabolism Research Center, Kerman University of Medical SciencesKerman, Kerman, Iran
- Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Kerman University of Medical SciencesKerman, Kerman, Iran.
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
- Physiology Research Center, Department of Physiology and Pharmacology, 22 Bahman Blvd, Kerman, Iran.
| | - Maryam Sadat Mousavi
- Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamideh Bashiri
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Hajializadeh
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Samaneh Sadat Alavi
- Department of Physiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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3
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Gaggar P, Raju SB. Diagnostic Utility of Urine Microscopy in Kidney Diseases. Indian J Nephrol 2024; 34:213-221. [PMID: 39114391 PMCID: PMC11303840 DOI: 10.25259/ijn_362_23] [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: 08/16/2023] [Accepted: 11/03/2023] [Indexed: 08/10/2024] Open
Abstract
Urine sediment analysis is a highly valuable yet underutilized test in today's advanced medical landscape. The analysis of urine sediment is a simple, cost-effective, and powerful diagnostic tool in the hands of a skilled nephrologist, generally in all kidney diseases and particularly more so in the setting of acute kidney injury (AKI). The impact of AKI is far-reaching and encompasses elevated mortality rates, increased morbidity, longer hospital stays, and higher overall healthcare expenses. Timely and compartmental diagnosis of AKI with the use of a simple urine sediment analysis leads to targeted therapeutic strategies and also serves as a prognostic guide. The widespread use of automated analysis in recent times has its own set of limitations, as it fails to identify pathological casts, crystals, and dysmorphic red blood cells (RBCs). Hence, it is the need of the hour to learn this time-honored art of urine sediment analysis, to provide comprehensive patient care.
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Affiliation(s)
- Payal Gaggar
- Department of Nephrology, Medical Trust Hospital, Kochi, Kerala, India
| | - Sree B. Raju
- Department of Nephrology, NIMS, Hyderabad, Telangana, India
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4
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Asakage A, Ishihara S, Boutin L, Dépret F, Sugaya T, Sato N, Gayat E, Mebazaa A, Deniau B. Predictive Performance of Neutrophil Gelatinase Associated Lipocalin, Liver Type Fatty Acid Binding Protein, and Cystatin C for Acute Kidney Injury and Mortality in Severely Ill Patients. Ann Lab Med 2024; 44:144-154. [PMID: 37749888 PMCID: PMC10628750 DOI: 10.3343/alm.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common condition in severely ill patients associated with poor outcomes. We assessed the associations between urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes. Methods We assessed the predictive performances of uNGAL, uLFABP, and uCysC measured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes. The primary outcome was the occurrence of AKI during ICU stay; secondary outcomes were 28-day and 1-yr allcause mortality. Results In total, 1,759 patients were admitted to the ICU, and 728 (41.4%) developed AKI. Median (interquartile range, IQR) uNGAL, uLFABP, and uCysC concentrations on admission were 147.6 (39.9-827.7) ng/mL, 32.4 (10.5-96.0) ng/mL, and 0.33 (0.12-2.05) mg/L, respectively. Biomarker concentrations on admission were higher in patients who developed AKI and associated with AKI severity. Three hundred fifty-six (20.3%) and 647 (37.9%) patients had died by 28 days and 1-yr, respectively. Urinary biomarker concentrations at ICU discharge were higher in non-survivors than in survivors. The areas under the ROC curve (95% confidence interval) of uLFABP for the prediction of AKI, 28-day mortality, and 1-yr mortality (0.70 [0.67-0.72], 0.63 [0.59-0.66], and 0.57 [0.51-0.63], respectively) were inferior to those of the other biomarkers. Conclusions uNGAL, uLFABP, and uCysC concentrations on admission were associated with poor outcomes. However, their predictive performance, individually and in combination, was limited. Further studies are required to confirm our results.
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Affiliation(s)
- Ayu Asakage
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
| | - Shiro Ishihara
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Louis Boutin
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - François Dépret
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Takeshi Sugaya
- Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Etienne Gayat
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Benjamin Deniau
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
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Holthoff JH, Harville Y, Herzog C, Juncos LA, Karakala N, Arthur JM. SOD1 is a novel prognostic biomarker of acute kidney injury following cardiothoracic surgery. BMC Nephrol 2023; 24:299. [PMID: 37821813 PMCID: PMC10568797 DOI: 10.1186/s12882-023-03350-8] [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: 07/29/2022] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a major burden among hospitalized and critical care patients. Among hospitalized patients that progress to severe AKI there is increased risk for morbidity, mortality, and the need for renal replacement therapy (RRT). As there are no specific treatments for AKI, the discovery of novel biomarkers that predict the progression of AKI may aid in timely implementation of supportive care to improve outcomes. METHODS We collected urine from 204 patients that developed Stage 1 AKI by AKIN criteria within 72 h following cardiothoracic surgery. Urine samples were collected at the time of the initial diagnosis of AKI and stored at -80° C. Among the 204 patients, 25 progressed to a composite primary outcome of Stage 3 AKI, requirement of RRT, or 30-day mortality. The remaining 179 patients did not progress beyond Stage 2 AKI and were considered controls. Urinary concentrations of SOD1 and SOD1 activity were measured following collection of all samples. Samples were thawed and urinary superoxide dismutase 1 (SOD1) concentrations were measured by sandwich ELISA and urinary SOD1 activity was measured through a commercially available colorimetric assay. RESULTS Urinary concentrations of SOD1 were significantly elevated (67.0 ± 10.1 VS 880.3 ± 228.8 ng/ml, p < 0.0001) in patients that progressed to severe AKI and were able to predict the progression to severe AKI (AUC - 0.85, p < 0.0001). Furthermore, total SOD activity also increased in the urine of patients that required RRT (77.6% VS 49.81% median inhibition, p < 0.01) and was able to predict the need for RRT (AUC: 0.83, p < 0.01). CONCLUSION These findings show that urinary SOD1 concentrations and SOD activity are novel prognostic biomarkers for severe AKI following cardiothoracic surgery.
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Affiliation(s)
- Joseph H Holthoff
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA.
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA.
| | - Yanping Harville
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
| | - Christian Herzog
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA
| | - Luis A Juncos
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA
| | - Nithin Karakala
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
| | - John M Arthur
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA
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Aron AW, Amatruda JG. Fractional Excretion of Sodium and Urea are Useful Tools in the Evaluation of AKI: CON. KIDNEY360 2023; 4:e728-e730. [PMID: 37384888 PMCID: PMC10371370 DOI: 10.34067/kid.0002512022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 07/01/2023]
Affiliation(s)
- Abraham W. Aron
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan G. Amatruda
- Division of Nephrology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
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The effect of two types of diet on apoptosis indexes, lipid profile and histopathological outcome in acute kidney injury during exercise. BMC Nephrol 2022; 23:315. [PMID: 36123655 PMCID: PMC9487158 DOI: 10.1186/s12882-022-02938-w] [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: 04/07/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Exercise and some pre-AKI diets have been shown to improve injury, apoptosis, and lipid profile. In this study, the effect of two different diets along with exercise training on acute kidney injury (AKI) was investigated. Materials and methods Laboratory rats were randomly divided into four groups of control, standard diet + exercise, exercise + calorie restriction (CR) and exercise + time restriction (TR). Each group was divided into two subgroups of AKI and no AKI. The animals received endurance training and diet regimens before AKI. Fasting blood glucose, serum creatinine, Bcl-2-associated X protein (Bax), B-cell lymphoma 2 (Bcl2) and histopathological outcome of renal tissue as well as serum lipid profile of animals were assessed 24 h after AKI. Results The percentage of changes in renal Bcl2 and Bax after AKI in the group with previous exercise was lower than the group without previous exercise (p < 0.01). After induction of AKI, serum lipid profile changed in non-exercised rats (p < 0.001). Also, after injury, fasting blood glucose levels increased in non-exercised rats (p < 0.05). After injury, the start of both CR and TR diets during exercise caused less change in Bcl2 and Bax of non-exercised rats compared to exercised rats (p < 0.001). CR diet along with exercise improved lipid profile, and also CR diet along exercise decreased fasting blood glucose levels (p < 0.001). Also, both the CR and TR diets during exercise caused fewer changes in histopathological outcome after AKI. Conclusion Exercise alone decreased changes in apoptotic and histopathological indexes, fasting blood glucose, as well as lipid profile of rats after AKI. Reduction of apoptosis and improvement of histopathological outcome after AKI appeared more when CR and TR diets were commenced during exercise. The reduction of lipid profile changes was more pronounced in the group that received CR diet during exercise.
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Cavanaugh C. Urine Sediment Exam Provides More Diagnostic Information in AKI than Novel Urinary Biomarkers: PRO. KIDNEY360 2022; 3:597-599. [PMID: 35721626 PMCID: PMC9136907 DOI: 10.34067/kid.0004872021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/09/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Corey Cavanaugh
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
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Sabet N, Soltani Z, Khaksari M, Raji-Amirhasani A. The effects of two different dietary regimens during exercise on outcome of experimental acute kidney injury. J Inflamm (Lond) 2022; 19:2. [PMID: 35236328 PMCID: PMC8889785 DOI: 10.1186/s12950-022-00299-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a syndrome characterized by rapid loss of excretory function of kidney. Both exercise and some diets have been shown to increase silent information regulator (SIRT1) expression leading to reduction of kidney injury. In this study, the effect of two different diets during exercise on kidney function, oxidative stress, inflammation and also SIRT1 in AKI was investigated. MATERIALS AND METHODS A number of rats were randomly divided into four groups; control without exercise, control with exercise, exercise + calorie restriction (CR), and exercise + time restriction (TR). Each group was divided into two subgroups of without AKI and with AKI (six rats in each group). Endurance exercise and diets were implemented before AKI. Serum urea and creatinine, urinary albumin, kidney malondialdehyde (MDA), total antioxidant capacity (TAC), transforming growth factor (TGF-β1), and SIRT1 levels, glomerular filtration rate (GFR) and relative kidney weight were measured before and 24 h after AKI induction. RESULTS After induction of kidney injury, serum urea and creatinine, urinary albumin, kidney MDA and TGF-β1 levels increased in rats with both previous exercise and no previous exercise, while GFR, and kidney TAC and SIRT1 levels significantly decreased. These changes after AKI were less in the group with previous exercise than in the group that had no exercise (p <0.001). The TR diet during exercise caused a less increase in serum urea (p <0.01) and creatinine (p <0.01), and urinary albumin (p <0.001) levels after the injury compared to the just exercise group. Also, both CR and TR diets during exercise caused less change in MDA (p <0.001) and TAC (p <0.05, p <0.001, respectively) levels compared to just exercise group. CONCLUSIONS The results showed that exercise alone had no effect on preventing function impairment of kidney, oxidative stress, inflammation and also SIRT1 alteration following AKI, although these indexes were less among those with exercise than those without exercise. However, when the CR and TR diets were implemented during exercise, strong renoprotective effects appeared, and the protective effect of TR diet was greater.
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Affiliation(s)
- Nazanin Sabet
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran.,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Soltani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. .,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Raji-Amirhasani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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10
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Raji-Amirhasani A, Khaksari M, Shahrokhi N, Soltani Z, Nazari-Robati M, Mahani FD, Hajializadeh Z, Sabet N. Comparison of the effects of different dietary regimens on susceptibility to experimental acute kidney injury: the role of SIRT1 and TGF-β1. Nutrition 2022; 96:111588. [DOI: 10.1016/j.nut.2022.111588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
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Soluble IL-33 receptor predicts survival in acute kidney injury. J Circ Biomark 2022; 11:28-35. [PMID: 35707675 PMCID: PMC9185730 DOI: 10.33393/jcb.2022.2386] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/16/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction: The prediction of acute kidney injury (AKI)-related outcomes remains challenging. Herein we prospectively quantified soluble ST2 (sST2), the circulating isoform of the IL-33 receptor, in hospitalized patients with AKI.
Methods: In-hospital subjects with AKI of various etiology were identified through the in-hospital AKI alert system of the Brandenburg University hospital. sST2 was measured within a maximum of 48 hours from the time of diagnosis of AKI. The following endpoints were defined: in-hospital death, dialysis, recovery of kidney function until demission.
Results: In total, 151 individuals were included in the study. The in-hospital mortality was 16.6%, dialysis therapy became mandatory in 39.7%, no recovery of kidney function occurred in 27.8%. sST2 was significantly higher in nonsurvivors (p = 0.024) but did not differ in the two other endpoints. The level of sST2 increased significantly with the severity of AKI. Further differences were detected in subjects with heart insufficiency (lower sST2), and in patients that required ICU treatment, or ventilatory therapy, or vasopressors (all higher).
Conclusions: The current study suggests sST2 as biomarker of “acute distress”: it predicts post-AKI survival and substantially increases in subjects with a higher degree of cumulative morbidity under acute circumstances (e.g., ICU therapy, vasopressor administration).
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Duff S, Irwin R, Cote JM, Redahan L, McMahon BA, Marsh B, Nichol A, Holden S, Doran P, Murray PT. Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness. Nephrol Dial Transplant 2021; 37:1668-1678. [PMID: 34491355 DOI: 10.1093/ndt/gfab263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. METHODS The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. RESULTS In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. CONCLUSIONS Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.
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Affiliation(s)
- Stephen Duff
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Ruairi Irwin
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jean Maxime Cote
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l, 'Université de Montréal, Montreal, Canada
| | - Lynn Redahan
- Division of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Brian Marsh
- Department of Intensive Care Medicine, University College Dublin, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alistair Nichol
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick T Murray
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
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13
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El-Khoury JM, Hoenig MP, Jones GRD, Lamb EJ, Parikh CR, Tolan NV, Wilson FP. AACC Guidance Document on Laboratory Investigation of Acute Kidney Injury. J Appl Lab Med 2021; 6:1316-1337. [PMID: 33973621 DOI: 10.1093/jalm/jfab020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a sudden episode of kidney damage or failure affecting up to 15% of hospitalized patients and is associated with serious short- and long-term complications, mortality, and health care costs. Current practices to diagnose and stage AKI are variable and do not factor in our improved understanding of the biological and analytical variability of creatinine. In addition, the emergence of biomarkers, for example, cystatin C, insulin-like growth factor binding protein 7, and tissue inhibitor of metalloproteinases 2, and electronic notification tools for earlier detection of AKI, highlights the need for updated recommendations to address these developments. CONTENT This AACC Academy guidance document is intended to provide laboratorians and clinicians up-to-date information regarding current best practices for the laboratory investigation of AKI. Topics covered include: clinical indications for further investigating potential AKI, analytical considerations for creatinine assays, the impact of biological variability on diagnostic thresholds, defining "baseline" creatinine, role of traditional markers (urine sodium, fractional excretion of sodium, fractional excretion of urea, and blood urea-to-creatinine ratio), urinary microscopic examination, new biomarkers, improving AKI-associated test utilization, and the utility of automated AKI alerts. SUMMARY The previous decade brought us a significant number of new studies characterizing the performance of existing and new biomarkers, as well as potential new tools for early detection and notification of AKI. This guidance document is intended to inform clinicians and laboratorians on the best practices for the laboratory investigation of AKI, based on expert recommendations where the preponderance of evidence is available.
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Affiliation(s)
- Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Melanie P Hoenig
- Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Edmund J Lamb
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - F Perry Wilson
- Program of Applied Translational Research, Yale School of Medicine, New Haven, CT, USA
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14
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The role of urinary kidney injury molecule-1 in monitoring the child with idiopathic microscopic hematuria. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.837889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Oksay SC, Dursun H, Neijmann ST, Hatipoglu S. Using urinary neutrophile gelatinase-associated lipocalin for prognosticate renal dysfunction in children with familial Mediterranean fever the study design: a pilot study. Adv Rheumatol 2021; 61:20. [PMID: 33795029 DOI: 10.1186/s42358-021-00178-4] [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: 10/09/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most important finding that affects the prognosis in Familial Mediterranean Fever is renal amyloidosis. The aim of the present study was to analyze neutrophil gelatinase-associated lipocalin levels in the urine, and to investigate whether it may be used as an early marker for renal involvement. METHODS Forty attack-free children followed by diagnosis of Familial Mediterranean Fever with age range of 5 and 18 years, and 38 healthy children with similar ages and genders were enrolled into the study. Hemogram, sedimentation, C-reactive protein, urine analysis, creatinine in the spot urine, microalbumin and urinary neutrophil gelatinase-associated lipocalin levels were analyzed and evaluated statistically in the patients and controls. RESULTS There was not any statistically significant difference between the patient and control groups for age, gender, height and body weight. Although there was not any clinical sign of attack in the patient group, sedimentation, C-reactive protein and fibrinogen levels were significantly higher than the control group (p = 0.002, p = 0.023, and p = 0.006, respectively). Similarly, urinary neutrophil gelatinase-associated lipocalin level and urinary creatinine ratio were significantly higher in the patient group (p = 0.0001, p = 0.011, respectively). We found a positive correlation between uNGAL level and uNGAL/uCr ratio and number of attacks per year in FMF patients (r = 0.743, p = 0.001 and r = 0.516, p = 0.001; respectively). CONCLUSIONS Detection of significantly higher levels of urinary neutrophil gelatinase-associated lipocalin level and urinary neutrophil gelatinase-associated lipocalin level to creatinine ratio were suggested as urinary neutrophil gelatinase-associated lipocalin level as a non-invasive marker for renal involvement better than microalbumin.
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Affiliation(s)
- Sinem Can Oksay
- Dr. Sadi Konuk Training and Research Hospital Department of Pediatrics, Health Science University, Istanbul, Turkey
| | - Hasan Dursun
- Dr. Sadi Konuk Training and Research Hospital Department of Pediatric Nephrology, Health Science University, Istanbul, Turkey. .,Okmeydani Training and Research Hospital Department of Pediatric Nephrology, Health Science University, Kaptan Paşa Mahallesi, Darülaceze Cad. No: 25 Okmeydani, 34384, Şişli/Istanbul, Turkey.
| | - Sebnem Tekin Neijmann
- Dr. Sadi Konuk Training and Research Hospital Department of Biochemistry, Health Science University, Istanbul, Turkey
| | - Sami Hatipoglu
- Dr. Sadi Konuk Training and Research Hospital Department of Pediatrics, Health Science University, Istanbul, Turkey
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Abstract
Biomarker panels have the potential to advance the field of critical care medicine by stratifying patients according to prognosis and/or underlying pathophysiology. This article discusses the discovery and validation of biomarker panels, along with their translation to the clinical setting. The current literature on the use of biomarker panels in sepsis, acute respiratory distress syndrome, and acute kidney injury is reviewed.
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Affiliation(s)
- Susan R Conway
- Division of Critical Care Medicine, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
| | - Hector R Wong
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Research Foundation, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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17
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Perazella MA. Is urine microscopy a useful early biomarker for cardiac surgeryrelated AKI? ACTA ACUST UNITED AC 2020; 42:1-3. [PMID: 32129787 PMCID: PMC7213936 DOI: 10.1590/2175-8239-jbn-2019-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Mark A Perazella
- Section of Nephrology, School of Medicine, Yale University, New Haven,, CT, United States
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18
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Duvignaud A, Jaspard M, Etafo IC, Serra B, Abejegah C, Gabillard D, Doutchi M, Alabi JF, Adedokun MA, Akinpelu AO, Oyegunle OO, Etafo J, Dede AO, Onyechi MN, Ireneh MU, Gbenga-Ayeni O, Fadiminiyi KG, Ehigbor PI, Ouattara E, Levy-Marchal C, Karcher S, N'guessan-Koffi L, Ahyi I, Amani E, Diabaté M, Siloué B, Schaeffer J, Augier A, Ogbaini-Emovon E, Salam AP, Horby P, Ahmed LA, Günther S, Adedosu AN, Anglaret X, Ayodeji OO, Malvy D. Lassa fever clinical course and setting a standard of care for future randomized trials: A protocol for a cohort study of Lassa-infected patients in Nigeria (LASCOPE). Travel Med Infect Dis 2020; 36:101557. [PMID: 31978611 DOI: 10.1016/j.tmaid.2020.101557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/28/2019] [Accepted: 01/16/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lassa Fever (LF), is a severe viral disease prevalent in Western Africa. It is classified as a priority disease by the World Health Organization (WHO). Ribavirin is the recommended therapy despite weak evidence of its efficacy. Promising therapeutic agents are becoming available for evaluation in human. Before launching therapeutic trials, we need data on the evolution of the disease under the best possible conditions of care. METHODS We have initiated a prospective study in Nigeria to better understand the clinical course and prognostic factors of LF while implementing high quality standardized care. Inclusion criteria are: suspected or confirmed LF and informed consent. Participants are followed 60 days from admission and receive free of charge standardized supportive care and biological monitoring, as well as intravenous ribavirin for those with confirmed LF. Data are collected using standardized case report forms (CRF). Primary and secondary outcomes are fatality and severe morbidity, with special focus on acute kidney dysfunction and pregnancy complications. Factors associated with outcomes will be investigated. RESULTS The cohort is planned for 3 years. Inclusions started in April 2018 at the Federal Medical Center Owo in Ondo State. A second site will open in Nigeria in 2020 and discussions are underway to open a site in Benin. 150 to 200 new participants are expected per year. CONCLUSIONS This cohort will: provide evidence to standardize LF case management; provide key inputs to design future clinical trials of novel therapeutics; and establish clinical research teams capable of conducting such trials in LF-endemic areas. STUDY REGISTRATION The LASCOPE study was registered on ClinicalTrial.gov (NCT03655561).
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Affiliation(s)
- Alexandre Duvignaud
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Marie Jaspard
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire; The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Ijeoma Chukwudumebi Etafo
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Béatrice Serra
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire; The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Chukwuyem Abejegah
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Delphine Gabillard
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Mahamadou Doutchi
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal; Department of Infectious Diseases, Centre Hospitalier National de Zinder, Zinder, Niger.
| | - Josephine Funmilola Alabi
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Moses Adeniyi Adedokun
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Adewale Oladayo Akinpelu
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Oyebimpe Ope Oyegunle
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Johnson Etafo
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Ayoleyi Omowunmi Dede
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Macdonald Nonso Onyechi
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Moronke Uzuajemeh Ireneh
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Olufunke Gbenga-Ayeni
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Kehinde Gbemisola Fadiminiyi
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Patience Iziegbe Ehigbor
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Eric Ouattara
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Claire Levy-Marchal
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Sophie Karcher
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Larissa N'guessan-Koffi
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Irmine Ahyi
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Elvis Amani
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Mamoudou Diabaté
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Bertine Siloué
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Justine Schaeffer
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Augustin Augier
- The Alliance for International Medical Action, Route de l'Aéroport, Rue NG 96 BP: 15530, Dakar, Senegal.
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, KM 87 Benin Auchi Rd, Irrua, Edo State, Nigeria.
| | - Alex Paddy Salam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7FZ, United Kingdom.
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7FZ, United Kingdom.
| | - Liasu Adeagbo Ahmed
- Department of Family Medicine, Owo Federal Medical Centre, Michael Adekun Ajasin Road, PMB, 1053, Owo, Ondo State, Nigeria.
| | - Stephan Günther
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany.
| | - Akinola Nelson Adedosu
- Viral Hemorrhagic Fever Laboratory, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Xavier Anglaret
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Oladele Oluwafemi Ayodeji
- Lassa Fever Response Team, Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria.
| | - Denis Malvy
- Inserm U1219, University of Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954 Abidjan 18, Abidjan, Côte d'Ivoire.
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Goldani JC, Poloni JA, Klaus F, Kist R, Pacheco LS, Keitel E. Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass. ACTA ACUST UNITED AC 2019; 42:18-23. [PMID: 31638137 PMCID: PMC7213937 DOI: 10.1590/2175-8239-jbn-2018-0133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/25/2019] [Indexed: 11/22/2022]
Abstract
Introduction: Acute kidney injury (AKI) occurs in about 22% of the patients undergoing
cardiac surgery and 2.3% requires renal replacement therapy (RRT). The
current diagnostic criteria for AKI by increased serum creatinine levels
have limitations and new biomarkers are being tested. Urine sediment may be
considered a biomarker and it can help to differentiate pre-renal
(functional) from renal (intrinsic) AKI. Aims: To investigate the microscopic urinalysis in the AKI diagnosis in patients
undergoing cardiac surgery with cardiopulmonary bypass. Methods: One hundred and fourteen patients, mean age 62.3 years, 67.5 % male, with
creatinine 0.91 mg/dL (SD 0.22) had a urine sample examined in the first 24
h after the surgery. We looked for renal tubular epithelial cells (RTEC) and
granular casts (GC) and associated the results with AKI development as
defined by KDIGO criteria. Results: Twenty three patients (20.17 %) developed AKI according to the serum
creatinine criterion and 76 (66.67 %) by the urine output criterion. Four
patients required RRT. Mortality was 3.51 %. The use of urine creatinine
criterion to predict AKI showed a sensitivity of 34.78 % and specificity of
86.81 %, positive likelihood ratio of 2.64 and negative likelihood ratio of
0.75, AUC-ROC of 0.584 (95%CI: 0.445-0.723). For the urine output criterion
sensitivity was 23.68 % and specificity 92.11 %, AUC-ROC was 0.573 (95%CI:
0.465-0.680). Conclusion: RTEC and GC in urine sample detected by microscopy is a highly specific
biomarker for early AKI diagnosis after cardiac surgery.
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Affiliation(s)
- João Carlos Goldani
- Departamento de Nefrologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - José Antônio Poloni
- Laboratório de Análises Clínicas Carlos Franco Voegeli, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabiano Klaus
- Departamento de Nefrologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Roger Kist
- Departamento de Nefrologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Larissa Sgaria Pacheco
- Departamento de Nefrologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Elizete Keitel
- Departamento de Nefrologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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de Almeida Thiengo D, Strogoff-de-Matos JP, Lugon JR, Graciano ML. Troponin I at admission in the intensive care unit predicts the need of dialysis in septic patients. BMC Nephrol 2018; 19:329. [PMID: 30453890 PMCID: PMC6245612 DOI: 10.1186/s12882-018-1129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/02/2018] [Indexed: 11/23/2022] Open
Abstract
Background In a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample. Methods All septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis < 24 h, normal left ventricular ejection fraction, and no previous coronary or kidney diseases. TnI was measured on day 1. Patients were followed by 30 days or until death. Results A total of 120 patients were included (51% male, 74 ± 13 years old). At ICU admission, 70 patients had TnI > 0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P < 0.0001) than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL; P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014). After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p < 0.0001). In a Cox regression model, after adjustment for gender, age, Charlson comorbidity index, serum creatinine, potassium, pH, brain natriuretic peptide and urine output, TnI > 0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69–7.18]). Conclusions TnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.
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21
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Wang JJ, Chi NH, Huang TM, Connolly R, Chen LW, Chueh SCJ, Kan WC, Lai CC, Wu VC, Fang JT, Chu TS, Wu KD. Urinary biomarkers predict advanced acute kidney injury after cardiovascular surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:108. [PMID: 29699579 PMCID: PMC5921971 DOI: 10.1186/s13054-018-2035-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) after cardiovascular surgery is a serious complication. Little is known about the ability of novel biomarkers in combination with clinical risk scores for prediction of advanced AKI. METHODS In this prospectively conducted multicenter study, urine samples were collected from 149 adults at 0, 3, 6, 12 and 24 h after cardiovascular surgery. We measured urinary hemojuvelin (uHJV), kidney injury molecule-1 (uKIM-1), neutrophil gelatinase-associated lipocalin (uNGAL), α-glutathione S-transferase (uα-GST) and π-glutathione S-transferase (uπ-GST). The primary outcome was advanced AKI, under the definition of Kidney Disease: Improving Global Outcomes (KDIGO) stage 2, 3 and composite outcomes were KDIGO stage 2, 3 or 90-day mortality after hospital discharge. RESULTS Patients with advanced AKI had significantly higher levels of uHJV and uKIM-1 at 3, 6 and 12 h after surgery. When normalized by urinary creatinine level, uKIM-1 in combination with uHJV at 3 h post-surgery had a high predictive ability for advanced AKI and composite outcome (AUC = 0.898 and 0.905, respectively). The combination of this biomarker panel (normalized uKIM-1, uHJV at 3 h post-operation) and Liano's score was superior in predicting advanced AKI (AUC = 0.931, category-free net reclassification improvement of 1.149, and p < 0.001). CONCLUSIONS When added to Liano's score, normalized uHJV and uKIM-1 levels at 3 h after cardiovascular surgery enhanced the identification of patients at higher risk of progression to advanced AKI and composite outcomes.
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Affiliation(s)
- Jian-Jhong Wang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.,NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan
| | - Nai-Hsin Chi
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Tao-Min Huang
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Rory Connolly
- School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Liang Wen Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chieh Jeff Chueh
- Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Wei-Chih Kan
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Vin-Cent Wu
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan. .,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ji-Tseng Fang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tzong-Shinn Chu
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kwan-Dun Wu
- NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Acute kidney injury (AKI) occurs frequently in the surgical intensive care unit and results in significant morbidity and mortality. AKI needs to be identified early and underlying causes treated or eliminated. Sepsis, major surgery such as coronary artery bypass, and hypovolemia are the most common causes and patients with underlying comorbidities have increased susceptibility. Treatment should begin by ensuring that patients are adequately resuscitated and all contributing causes are replaced or eliminated. After stabilization of hemodynamic status and elimination of contributing causes, treatment becomes largely supportive and may require the use of a renal replacement therapy.
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Affiliation(s)
- Robert A Maxwell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Chattanooga, TN, USA.
| | - Christopher Michael Bell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Chattanooga, TN, USA
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Md Ralib A, Mat Nor MB, Pickering JW. Plasma Neutrophil Gelatinase-Associated Lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis. Nephrology (Carlton) 2017; 22:412-419. [PMID: 27062515 DOI: 10.1111/nep.12796] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/25/2016] [Accepted: 04/03/2016] [Indexed: 12/14/2022]
Abstract
AIM Sepsis is the leading cause of intensive care unit (ICU) admission. Plasma Neutrophil Gelatinase Associated-Lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI) detection; however, it is also increased with inflammation and few studies have been conducted in non-Caucasian populations and/or in developing economies. Therefore, we evaluated plasma NGAL's diagnostic performance in the presence of sepsis and systemic inflammatory response syndrome (SIRS) in a Malaysian ICU cohort. METHODS This is a prospective observational study on patients with SIRS. Plasma creatinine (pCr) and NGAL were measured on ICU admission. Patients were classified according to the occurrence of AKI and sepsis. RESULTS Of 225 patients recruited, 129 (57%) had sepsis of whom 67 (52%) also had AKI. 96 patients (43%) had non-infectious SIRS, of whom 20 (21%) also had AKI. NGAL concentrations were higher in AKI patients within both the sepsis and non-infectious SIRS cohorts (both P < 0.0001). The diagnostic area under curve for AKI was 0.81 (95%CI: 0.74 to 0.87). The optimal cut-off was higher in sepsis compared to non-infectious SIRS patients (454 versus 176 ng/mL). Addition of NGAL to a clinical model comprising age, pCr, medical admission category and SAPS II score increased the mean risk of those with AKI by 4% and reduced the mean risk of those without AKI by 3%. CONCLUSIONS Acute kidney injury is more common with sepsis than non-infectious SIRS. Plasma NGAL was diagnostic of AKI in both subgroups. The optimal cut-off for diagnosing AKI was higher in sepsis than in non-infectious SIRS. Addition of plasma NGAL improved the clinical model used to diagnose AKI.
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Affiliation(s)
- Azrina Md Ralib
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia
| | - Mohd Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia
| | - John W Pickering
- Department of Medicine, University of Otago Christchurch, New Zealand
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Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption. Clin Chem Lab Med 2017; 55:1074-1089. [PMID: 28076311 DOI: 10.1515/cclm-2016-0973] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.
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Binnenmars SH, Hijmans RS, Navis G, de Borst MH. Biomarkers of Renal Function: Towards Clinical Actionability. Clin Pharmacol Ther 2017; 102:481-492. [DOI: 10.1002/cpt.765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/05/2017] [Accepted: 06/09/2017] [Indexed: 01/28/2023]
Affiliation(s)
- S Heleen Binnenmars
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology; Groningen The Netherlands
| | - RS Hijmans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology; Groningen The Netherlands
| | - G Navis
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology; Groningen The Netherlands
| | - MH de Borst
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology; Groningen The Netherlands
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George B, Wen X, Mercke N, Gomez M, O'Bryant C, Bowles DW, Hu Y, Hogan SL, Joy MS, Aleksunes LM. Profiling of Kidney Injury Biomarkers in Patients Receiving Cisplatin: Time-dependent Changes in the Absence of Clinical Nephrotoxicity. Clin Pharmacol Ther 2017; 101:510-518. [PMID: 28002630 PMCID: PMC5359028 DOI: 10.1002/cpt.606] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/05/2016] [Accepted: 12/11/2016] [Indexed: 12/29/2022]
Abstract
The success of cisplatin-containing regimens to treat solid tumors is limited, in part, by nephrotoxicity. In rodents, several urinary proteins have emerged that are sensitive indicators of cisplatin-induced kidney injury. We sought to characterize time-dependent changes in the urinary concentrations of 12 proteins, including kidney injury molecule-1 (KIM-1), calbindin, beta 2-microglobulin (β2M), and trefoil factor 3 (TFF3) after cisplatin therapy. Urine was collected at baseline, 3 days (range, 2-5 days), and 10 days (range, 9-11 days) from 57 patients with solid tumors receiving outpatient cisplatin therapy (≥25 mg/m2 ). Serum creatinine was largely unchanged after cisplatin infusion. However, compared with baseline values, several novel biomarkers were significantly increased in the urine, including β2M, which was threefold higher by day 3 (P < 0.0001). Urinary KIM-1 and TFF3 were elevated twofold by day 10 (P = 0.002 and P = 0.002, respectively), whereas calbindin levels were increased eightfold (P < 0.0001). We report novel time-dependent changes in the urinary excretion of noninvasive markers of subclinical kidney injury after cisplatin treatment.
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Affiliation(s)
- Blessy George
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA
| | - Xia Wen
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA
| | - Nickie Mercke
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 80045, USA
| | - Madeleine Gomez
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 80045, USA
| | - Cindy O'Bryant
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 80045, USA
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Daniel W Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Yichun Hu
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Susan L Hogan
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Melanie S Joy
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 80045, USA
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA
- Environmental and Occupational Health Sciences Institute, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA 8
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Stolker JM, Cohen DJ, Kennedy KF, Pencina MJ, Arnold SV, Kleiman NS, Spertus JA. Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:169-176. [DOI: 10.1016/j.carrev.2016.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth 2017; 19:687-698. [PMID: 27716701 PMCID: PMC5070330 DOI: 10.4103/0971-9784.191578] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication resulting with the higher morbid-mortality after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3-8-fold, length of stay in the Intensive Care Unit and hospital, and costs of care. Early diagnosis is critical for an optimal treatment of this complication. Just as the identification and correction of preoperative risk factors, the use of prophylactic measures during and after surgery to optimize renal function is essential to improve postoperative morbidity and mortality of these patients. Cardiopulmonary bypass produces an increased in tubular damage markers. Their measurement may be the most sensitive means of early detection of AKI because serum creatinine changes occur 48 h to 7 days after the original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 are most promising as an early diagnostic tool. However, the ideal noninvasive, specific, sensitive, reproducible biomarker for the detection of AKI within 24 h is still not found. This article provides a review of the different perspectives of the CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment. We searched the electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment, in order to provide an exhaustive review of the different perspectives of the CSA-AKI.
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Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM. Biomarkers in acute kidney injury - pathophysiological basis and clinical performance. Acta Physiol (Oxf) 2017; 219:554-572. [PMID: 27474473 DOI: 10.1111/apha.12764] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
Various biomarkers of acute kidney injury (AKI) have been discovered and characterized in the recent past. These molecules can be detected in urine or blood and signify structural damage to the kidney. Clinically, they are proposed as adjunct diagnostics to serum creatinine and urinary output to improve the early detection, differential diagnosis and prognostic assessment of AKI. The most obvious requirements for a biomarker include its reflection of the underlying pathophysiology of the disease. Hence, a biomarker of AKI should derive from the injured kidney and reflect a molecular process intimately connected with tissue injury. Here, we provide an overview of the basic pathophysiology, the cellular sources and the clinical performance of the most important currently proposed biomarkers of AKI: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinase 2 (TIMP-2) and calprotectin (S100A8/9). We also acknowledge each biomarker's advantages and disadvantages as well as important knowledge gaps and perspectives for future studies.
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Affiliation(s)
- E. V. Schrezenmeier
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
| | - J. Barasch
- Division of Nephrology; Columbia University College of Physicians and Surgeons; New York NY USA
| | - K. Budde
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Westhoff
- Medical Department I; Universitätsklinikum Marien Hospital Herne; Ruhr University of Bochum; Bochum Germany
| | - K. M. Schmidt-Ott
- Department of Nephrology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
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Parikh CR, Mansour SG. Perspective on Clinical Application of Biomarkers in AKI. J Am Soc Nephrol 2017; 28:1677-1685. [PMID: 28220028 DOI: 10.1681/asn.2016101127] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Several biomarkers of renal injury have been identified but the utility of these biomarkers is largely confined to research studies, whereas widespread clinical applicability is limited. This is partly because the use of serum creatinine as the comparator has several limitations and restricts the full interpretation of biomarker performance. To highlight the potential for clinical application of biomarkers, the most pertinent biomarker data are summarized here, using clinically relevant scenarios in which biomarkers could assist with diagnostic and management dilemmas. The paradigms proposed in this review aim to enhance the clinical diagnosis, management, and prognosis of AKI through the combined use of available clinical markers and novel inflammatory, injury, and repair biomarkers.
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Affiliation(s)
- Chirag R Parikh
- Program of Applied Translational Research, Department of Medicine, and .,Division of Nephrology, Department of Medicine, Yale University, School of Medicine, New Haven, Connecticut; and.,Division of Nephrology, Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Sherry G Mansour
- Program of Applied Translational Research, Department of Medicine, and.,Division of Nephrology, Department of Medicine, Yale University, School of Medicine, New Haven, Connecticut; and
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Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:299. [PMID: 27670788 PMCID: PMC5037640 DOI: 10.1186/s13054-016-1478-z] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. In this review, we outline the current definition of AKI and the potential pitfalls, and summarise the existing and future tools to investigate AKI in critically ill patients.
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Affiliation(s)
- Marlies Ostermann
- Department of Critical Care Medicine, King's College London, Guy's & St Thomas' Foundation Hospital, Westminster Bridge Road, London, UK.
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Medical University of Innsbruck, Anichstr. 35, Innsbruck, Austria.
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Chen C, Yang X, Lei Y, Zha Y, Liu H, Ma C, Tian J, Chen P, Yang T, Hou FF. Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome. Clin J Am Soc Nephrol 2016; 11:1536-1544. [PMID: 27538426 PMCID: PMC5012473 DOI: 10.2215/cjn.00910116] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES A major challenge in early treatment of acute cardiorenal syndrome (CRS) is the lack of predictors for progression of AKI. We aim to investigate the utility of urinary angiotensinogen and other renal injury biomarkers in predicting AKI progression in CRS. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS In this prospective, multicenter study, we screened 732 adults who admitted for acute decompensated heart failure from September 2011 to December 2014, and evaluated whether renal injury biomarkers measured at time of AKI diagnosis can predict worsening of AKI. In 213 patients who developed Kidney Disease Improving Global Outcomes stage 1 or 2 AKI, six renal injury biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), plasma neutrophil gelatinase-associated lipocalin, urinary IL-18 (uIL-18), urinary kidney injury molecule-1, and urinary albumin-to-creatinine ratio, were measured at time of AKI diagnosis. The primary outcome was AKI progression defined by worsening of AKI stage (50 patients). The secondary outcome was AKI progression with subsequent death (18 patients). RESULTS After multivariable adjustment, the highest tertile of three urinary biomarkers remained associated with AKI progression compared with the lowest tertile: uAGT (odds ratio [OR], 10.8; 95% confidence interval [95% CI], 3.4 to 34.7), uNGAL (OR, 4.7; 95% CI, 1.7 to 13.4), and uIL-18 (OR, 3.6; 95% CI, 1.4 to 9.5). uAGT was the best predictor for both primary and secondary outcomes with area under the receiver operating curve of 0.78 and 0.85. These three biomarkers improved risk reclassification compared with the clinical model alone, with uAGT performing the best (category-free net reclassification improvement for primary and secondary outcomes of 0.76 [95% CI, 0.46 to 1.06] and 0.93 [95% CI, 0.50 to 1.36]; P<0.001). Excellent performance of uAGT was further confirmed with bootstrap internal validation. CONCLUSIONS uAGT, uNGAL, and uIL-18 measured at time of AKI diagnosis improved risk stratification and identified CRS patients at highest risk of adverse outcomes.
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Affiliation(s)
- Chunbo Chen
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Xiaobing Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Ying Lei
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang Medical University, Guiyang, China
| | - Huafeng Liu
- Division of Nephrology, Institute of Nephrology, Guangdong Medical College, Zhanjiang, China
| | - Changsheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China; and
| | - Jianwei Tian
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Pingyan Chen
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Tiecheng Yang
- Division of Nephrology, The Futian Hospital, Guangdong Medical College, Shenzhen, China
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
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The Current State of the Diagnosis and Management of Acute Kidney Injury by Pediatric Critical Care Physicians. Pediatr Crit Care Med 2016; 17:e362-70. [PMID: 27500629 DOI: 10.1097/pcc.0000000000000857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Increasingly prevalent in pediatric intensive care, acute kidney injury imparts significant short- and long-term consequences. Despite advances in acute kidney injury research, clinical outcomes are worsening. We surveyed pediatric critical care physicians to describe the current state of acute kidney injury diagnosis and management in critically ill children. DESIGN Anonymous electronic questionnaire. PARTICIPANTS Pediatric critical care physicians from academic centers, the Pediatric Acute Lung Injury and Sepsis Investigators network, and/or the pediatric branch of Society of Critical Care Medicine. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 201 surveys initiated, 170 surveys were more than 50% completed and included in our results. The majority of physicians (74%) diagnosed acute kidney injury using serum creatinine and urine output. Acute kidney injury guidelines or criteria were used routinely by 54% of physicians; Risk, Injury, Failure, Loss, and End stage criteria were the most commonly used. Awareness of any acute kidney injury guideline or definition was associated with five-fold higher odds of using any guideline (odds ratio, 5.22; 95% CI, 1.84-14.83) and four-fold higher odds of being dissatisfied with available acute kidney injury biomarkers (odds ratio, 4.88; 95% CI, 1.58-15.05). Less than half of respondents recognized the limitations of serum creatinine. Physicians unaware of the limitations of serum creatinine had two-fold higher odds of being unaware of newer biomarker availability (odds ratio, 2.34; 95% CI, 1.14-4.79). Novel biomarkers were available to 37.6% of physicians for routine use. Physicians with access to novel biomarkers more often practiced in larger (odds ratio, 3.09; 95% CI, 1.18-8.12) and Midwestern (odds ratio, 3.38; 95% CI, 1.47-7.78) institutions. More physicians with access to a novel biomarker reported satisfaction with current acute kidney injury diagnostics (66%) than physicians without access (48%); this finding approached significance (p = 0.07). CONCLUSIONS Half of PICU attending physicians surveyed are not using recent acute kidney injury guidelines or diagnostic criteria in their practice. There is a positive association between awareness and clinical use of acute kidney injury guidelines. Serum creatinine and urine output are still the primary diagnostics; novel biomarkers are frequently unavailable.
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Biomarcadores en la lesión renal aguda: ¿ paradigma o evidencia? Nefrologia 2016; 36:339-46. [DOI: 10.1016/j.nefro.2016.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/25/2015] [Accepted: 01/21/2016] [Indexed: 12/12/2022] Open
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Urinary Strong Ion Difference as a Marker of Renal Dysfunction. A Retrospective Analysis. PLoS One 2016; 11:e0156941. [PMID: 27258049 PMCID: PMC4892615 DOI: 10.1371/journal.pone.0156941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/23/2016] [Indexed: 12/21/2022] Open
Abstract
Introduction The kidneys play a crucial role in the regulation of electrolytes and acid-base homeostasis. Urinary Strong Ion Difference (SIDu = NaU + KU—ClU) represents an important aspect of renal acid-base regulation. We evaluated the role of SIDu as a marker of renal dysfunction in critically ill patients. Materials and Methods Patients admitted to the Medical Intensive Care Unit with a diagnosis of AKI for whom concomitant urinary samples available for SIDu calculation were retrospectively reviewed and staged according to KDIGO criteria for 3 days from inclusion. Patients were classified as Recovered (R-AKI) or Persistent-AKI (P-AKI) whether they exited KDIGO criteria within the 3-day observation period or not. A control group with normal renal function and normal serum acid-base and electrolytes was prospectively recruited in order to identify reference SIDu values. Results One-hundred-and-forty-three patients with a diagnosis of AKI were included: 77 with R-AKI, and 66 with P-AKI. Thirty-six controls were recruited. Patients with P-AKI had more severe renal dysfunction and higher mortality than patients with R-AKI (SCr 2.23(IQR:1.68–3.45) and 1.81(IQR1.5–2.5) mg/dl respectively, p<0.001; 24-h UO 1297(950) and 2100(1094) ml respectively, p = 0.003); 30-d mortality, 39% and 13% respectively; p<0.001). SIDu significantly differed between groups, with rising values from controls to P-AKI groups (16.4(12), 30(24) and 47.3(21.5) mEq/l respectively, p<0.001). Discussion SIDu may be a simple and inexpensive tool in AKI patients’ evaluation. Further research is needed to evaluate the ability of SIDu to identify patients with renal dysfunction before derangements in serum creatinine or urine output are observed.
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Abstract
Acute kidney injury is strongly associated with increased mortality and other adverse outcomes. Medical researchers have intensively investigated novel biomarkers to predict short- and long-term outcomes of acute kidney injury in many patient care settings, such as cardiac surgery, intensive care units, heart failure, and transplant. Future research should focus on leveraging this relationship to improve enrollment for clinical trials of acute kidney injury.
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Affiliation(s)
- Jennifer A Schaub
- Program of Applied Translational Research, Yale University, New Haven, CT, USA
| | - Chirag R Parikh
- Program of Applied Translational Research, Yale University, New Haven, CT, USA
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Lameire N, Vanmassenhove J, Van Biesen W, Vanholder R. The cell cycle biomarkers: promising research, but do not oversell them. Clin Kidney J 2016; 9:353-8. [PMID: 27274818 PMCID: PMC4886923 DOI: 10.1093/ckj/sfw033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 12/14/2022] Open
Abstract
This review focuses on the most recent scientific and clinical information on the development and clinical applicability of the cell cycle biomarkers TIMP-2 and IGFBP-7 in the diagnosis and prognosis of patients at risk for and suffering from acute kidney injury (AKI). A number of evaluation studies have demonstrated that compared with existing biomarkers, urinary excretion of the product of both biomarkers, [TIMP-2]•[IGFBP-7], improved diagnostic performance in assessing the risk for AKI, predicting the need for renal replacement therapy, AKI-related complications and short- and long-term prognoses. The reference intervals for these biomarkers, measured by the recently approved NephroCheck test, have been determined in apparently healthy adults and those with stable chronic morbid conditions without AKI. This review recognizes that the combination of these two cell cycle arrest markers for the early detection of AKI is promising but concludes that its clinical impact is still unproved. Clinicians should understand the utility and limitations of this test before deciding whether to make it available at their institution.
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Affiliation(s)
- Norbert Lameire
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
| | - Jill Vanmassenhove
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
| | - Wim Van Biesen
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
| | - Raymond Vanholder
- Renal Division, Department of Medicine , University Hospital , 185, De Pintelaan, Gent 9000 , Belgium
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Kidney Injury Molecule-1 and Cardiovascular Diseases: From Basic Science to Clinical Practice. BIOMED RESEARCH INTERNATIONAL 2015; 2015:854070. [PMID: 26697493 PMCID: PMC4677159 DOI: 10.1155/2015/854070] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/27/2015] [Accepted: 11/04/2015] [Indexed: 01/09/2023]
Abstract
Despite the recent findings concerning pathogenesis and novel therapeutic strategies, cardiovascular disease (CVD) still stays the leading cause of morbidity and mortality in patients with renal dysfunction, especially acute kidney injury (AKI). Early detection of patients with impaired renal function with cardiovascular risk may help ensure more aggressive treatment and improve clinical outcome. Kidney injury molecule-1 (KIM-1) is a new, promising marker of kidney damage which is currently the focus of countless studies worldwide. Some recent animal and human studies established KIM-1 as an important marker of acute tubular necrosis (ATN) and reliable predictor of development and prognosis of AKI. Food and Drug Administration (FDA) in USA acclaimed KIM-1 as an AKI biomarker for preclinical drug development. Recent data suggest the importance of monitoring of KIM-1 for early diagnosis and clinical course not only in patients with various forms of AKI and other renal diseases but also in patients with cardiorenal syndrome, heart failure, cardiopulmonary bypass, cardiothoracic surgical interventions in the pediatric emergency setting, and so forth. The aim of this review article is to summarize the literature data concerning KIM-1 as a potential novel marker in the early diagnosis and prediction of clinical outcome of certain cardiovascular diseases.
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Demiselle J, Beloncle F, Mezdad TH, Augusto JF, Lerolle N. Stratégie diagnostique de l’insuffisance rénale aiguë en réanimation. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Effect of Dongchongxiacao (Cordyceps) therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography. J TRADIT CHIN MED 2015; 35:422-7. [PMID: 26427112 DOI: 10.1016/s0254-6272(15)30119-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the protective effects of Dongchongxiacao (Cordyceps) (DCXC) on contrast-induced nephropathy (CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography. METHODS A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rater (eGFR) was 60 mL/min · 1.73 in2, were divided randomly into three groups, basic treatment group (n = 41), standard DCXC therapy group (n = 39, 2-g corbrin capsules, 3 times/d, 3 days before and after angiography), and intensive DCXC therapy group (n = 40, 3-g corbrin capsules, 3 times/d, 3 days before and after angiography). Serum creatinine (cr) and eGFR were assessed at the time of admission to hospital, and on days 1, 2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipo- calin (NGAL), kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in eGFR. RESULTS CIN occurred in 11 of 120 patients (9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group (P < 0.05), with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group (P < 0.01). Compared with the basic treatment group, a lower proportion of patients in the DCXC treatment groups had an eGFR decrease of 25% or greater (P < 0.05); patients with an eGFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group (P < 0.01). Within 1 day of the procedure, urine levels of KIM-1, NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group (P < 0.05). CONCLUSION DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography, with intensive DCXC therapy being more effective.
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Cantley LG, Colangelo CM, Stone KL, Chung L, Belcher J, Abbott T, Cantley JL, Williams KR, Parikh CR. Development of a Targeted Urine Proteome Assay for kidney diseases. Proteomics Clin Appl 2015. [PMID: 26220717 DOI: 10.1002/prca.201500020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Since human urine is the most readily available biofluid whose proteome changes in response to disease, it is a logical sample for identifying protein biomarkers for kidney diseases. EXPERIMENTAL DESIGN Potential biomarkers were identified by using a multiproteomics workflow to compare urine proteomes of kidney transplant patients with immediate and delayed graft function. Differentially expressed proteins were identified, and corresponding stable isotope labeled internal peptide standards were synthesized for scheduled MRM. RESULTS The Targeted Urine Proteome Assay (TUPA) was then developed by identifying those peptides for which there were at least two transitions for which interference in a urine matrix across 156 MRM runs was <30%. This resulted in an assay that monitors 224 peptides from 167 quantifiable proteins. CONCLUSIONS AND CLINICAL RELEVANCE TUPA opens the way for using a robust mass spectrometric technology, MRM, for quantifying and validating biomarkers from among 167 urinary proteins. This approach, while developed using differentially expressed urinary proteins from patients with delayed versus immediate graft function after kidney transplant, can be expanded to include differentially expressed urinary proteins in multiple kidney diseases. Thus, TUPA could provide a single assay to help diagnose, prognose, and manage many kidney diseases.
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Affiliation(s)
- Lloyd G Cantley
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | | | - Kathryn L Stone
- W.M. Keck Foundation Biotechnology Laboratory, School of Medicine, Yale University, New Haven, CT, USA
| | - Lisa Chung
- W.M. Keck Foundation Biotechnology Laboratory, School of Medicine, Yale University, New Haven, CT, USA
| | - Justin Belcher
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Thomas Abbott
- W.M. Keck Foundation Biotechnology Laboratory, School of Medicine, Yale University, New Haven, CT, USA
| | - Jennifer L Cantley
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Kenneth R Williams
- W.M. Keck Foundation Biotechnology Laboratory, School of Medicine, Yale University, New Haven, CT, USA.,Department of Molecular Biophysics and Biochemistry, School of Medicine, Yale University, New Haven, CT, USA
| | - Chirag R Parikh
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA
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Varela CF, Greloni G, Schreck C, Bratti G, Medina A, Marenchino R, Pizarro R, Belziti C, Rosa-Diez G. Assessment of fractional excretion of urea for early diagnosis of cardiac surgery associated acute kidney injury. Ren Fail 2015; 37:327-31. [PMID: 26398357 DOI: 10.3109/0886022x.2015.1087800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine, but it is not widely used in clinical practice. Fractional excretion of urea (FeU) has been referred to as a useful tool to discriminate between prerenal and established AKI. The aim of our study is to evaluate the sensitivity and specificity of FeU, in the early diagnosis of AKI in patients undergoing CS. METHODS We performed a prospective study on adults undergoing CS. AKI was defined by AKIN criteria. Individuals suffering from CKD, were excluded. Sensitivity and specificity of FeU, fractional excretion of sodium (FeNa) and urine NGAL, measured at 1, 6 and 24 h following CS, were assessed. RESULTS We included 66 patients (26% female) aging 68 ± 11 years. AKI prevalence was 24% and mortality was 3.28%. Patients with AKI had a significantly lower FeU compared to those without AKI (23.89 ± 0.67% vs. 34.22 ± 0.58%; p < 0.05) 6 h after CS, but not at the 1- and 24-h time points. NGAL was also statistically significant between both groups. FeU showed a 75% sensitivity and 79.5% specificity; the AUC was 0.786. ROC analysis of FeU and NGAL yielded similar values (p = NS). CONCLUSION FeU is useful as an early biomarker to predict AKI after CS and it is comparable to the new biomarker NGAL.
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Affiliation(s)
- Carlos Federico Varela
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Gustavo Greloni
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Carlos Schreck
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Griselda Bratti
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Angel Medina
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Ricardo Marenchino
- b Servicio de Cirugía Cardiovascular del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina , and
| | - Rodolfo Pizarro
- c Servicio de Cardiología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Cesar Belziti
- c Servicio de Cardiología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Guillermo Rosa-Diez
- a Servicio de Nefrología del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
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Belcher JM. Acute Kidney Injury in Liver Disease: Role of Biomarkers. Adv Chronic Kidney Dis 2015; 22:368-75. [PMID: 26311598 DOI: 10.1053/j.ackd.2015.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 12/30/2022]
Abstract
Acute kidney injury (AKI) is a common complication in patients with advanced cirrhosis and is associated with significant mortality. The most common etiologies of AKI in this setting are prerenal azotemia, acute tubular necrosis, and hepatorenal syndrome. Despite the overall poor outcomes of patients with cirrhosis and AKI, potentially efficacious therapies exist but must be tailored to the specific AKI etiology. Unfortunately, determining the etiology of AKI in the setting of cirrhosis is notoriously difficult. Many of the standard diagnostic tools, such as urine microscopy and the fractional excretion of sodium, have traditionally been ineffective. Novel biomarkers of kidney tubular injury may be able to assist with differential diagnosis and the appropriate targeting of treatments by distinguishing structural from functional causes of AKI. In recent studies, both urinary neutrophil gelatinase-associated lipocalin and interleukin-18 have shown the ability to distinguish hepatorenal syndrome from prerenal azotemia and acute tubular necrosis. In addition, multiple biomarkers, including neutrophil gelatinase-associated lipocalin and interleukin-18, have demonstrated the ability to independently predict both progression of AKI and mortality. Critically, recent research also indicated that commonly available tests, fractional excretion of sodium and proteinuria, may also be able to distinguish etiologies of AKI in cirrhosis, but diagnostic cutoffs must be re-conceptualized specifically to this unique AKI setting.
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Whitaker RM, Stallons LJ, Kneff JE, Alge JL, Harmon JL, Rahn JJ, Arthur JM, Beeson CC, Chan SL, Schnellmann RG. Urinary mitochondrial DNA is a biomarker of mitochondrial disruption and renal dysfunction in acute kidney injury. Kidney Int 2015; 88:1336-1344. [PMID: 26287315 PMCID: PMC4675682 DOI: 10.1038/ki.2015.240] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/20/2015] [Accepted: 06/04/2015] [Indexed: 12/13/2022]
Abstract
Recent studies show the importance of mitochondrial dysfunction in the initiation and progression of acute kidney injury (AKI). However, no biomarkers exist linking renal injury to mitochondrial function and integrity. To this end, we evaluated urinary mitochondrial DNA (UmtDNA) as a biomarker of renal injury and function in humans with AKI following cardiac surgery. mtDNA was isolated from the urine of patients following cardiac surgery and quantified by quantitative PCR. Patients were stratified into no AKI, stable AKI, and progressive AKI groups based on Acute Kidney Injury Network (AKIN) staging. UmtDNA was elevated in progressive AKI patients and was associated with progression of patients with AKI at collection to higher AKIN stages. To evaluate the relationship of UmtDNA to measures of renal mitochondrial integrity in AKI, mice were subjected to sham surgery or varying degrees of ischemia followed by 24 h of reperfusion. UmtDNA increased in mice after 10-15 min of ischemia and positively correlated with ischemia time. Furthermore, UmtDNA was predictive of AKI in the mouse model. Finally, UmtDNA levels were negatively correlated with renal cortical mtDNA and mitochondrial gene expression. These translational studies demonstrate that UmtDNA is associated with recovery from AKI following cardiac surgery by serving as an indicator of mitochondrial integrity. Thus UmtDNA may serve as valuable biomarker for the development of mitochondrial-targeted therapies in AKI.
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Affiliation(s)
- Ryan M Whitaker
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - L Jay Stallons
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua E Kneff
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph L Alge
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer L Harmon
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer J Rahn
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John M Arthur
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Craig C Beeson
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sherine L Chan
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rick G Schnellmann
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
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Perazella MA. The urine sediment as a biomarker of kidney disease. Am J Kidney Dis 2015; 66:748-55. [PMID: 25943719 DOI: 10.1053/j.ajkd.2015.02.342] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/24/2015] [Indexed: 11/11/2022]
Abstract
The modern era of medicine has ushered in new diagnostic technologies to assist the clinician in evaluating patients with kidney disease. The birth of automated urine analysis technology and centralized laboratory testing has unfortunately made examination of urine sediment by physicians a rare event. At the same time, identifying novel urine biomarkers for kidney disease has become a research priority in nephrology, and the search for the "renal troponin" has progressed at a fast pace. Despite this, urine sediment examination remains a time-honored test that provides a wealth of information about the patient's kidney condition and performs favorably as a urinary biomarker. It alerts the clinician to the presence of kidney disease and provides diagnostic information that often identifies the compartment of kidney injury. In addition, sediment findings may guide therapy and assist in prognostication. As such, it is premature to abandon urine sediment examination. It may be more appropriate to combine urine sediment examination with new candidate biomarkers that enter clinical practice to create a "diagnostic panel" that provides clinicians with a useful battery of diagnostic tests. To accomplish this, we as nephrologists must encourage continued training and maintenance of competency in urine sediment examination.
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Affiliation(s)
- Mark A Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, CT.
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Stefaniak J, Schiefer J, Miller EJ, Krenn CG, Baron DM, Faybik P. Macrophage migration inhibitory factor as a potential predictor for requirement of renal replacement therapy after orthotopic liver transplantation. Liver Transpl 2015; 21:662-9. [PMID: 25762421 DOI: 10.1002/lt.24103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/08/2015] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) after orthotopic liver transplantation (OLT) is associated with a poor clinical outcome. Because there is no specific treatment for postoperative AKI, early recognition and prevention are fundamental therapeutic approaches. Concentrations of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) are elevated in patients with kidney disease. We hypothesized that plasma MIF concentrations would be greater in patients developing AKI after OLT compared with patients with normal kidney function. Twenty-eight patients undergoing OLT were included in the study. Kidney injury was classified according to AKI network criteria. Fifteen patients (54%) developed severe AKI after OLT, 11 (39%) requiring renal replacement therapy (RRT). On the first postoperative day, patients with severe AKI had greater plasma MIF concentrations (237 ± 123 ng/mL) than patients without AKI (95 ± 63 ng/mL; P < 0.001). The area under the receiver operating characteristic (ROC) curve for predicting severe AKI was 0.87 [95% confidence interval (CI), 0.69-0.97] for plasma MIF, 0.61 (95% CI, 0.40-0.79) for serum creatinine (sCr), and 0.90 (95% CI, 0.72-0.98) for delta serum creatinine (ΔsCr). Plasma MIF (P = 0.02) and ΔsCr (P = 0.01) yielded a better predictive value than sCr for the development of severe AKI. Furthermore, the area under the ROC curve to predict the requirement of RRT was 0.87 (95% CI, 0.68-0.96) for plasma MIF, 0.65 (95% CI, 0.44-0.82) for sCr, and 0.72 (95% CI, 0.52-0.88) for ΔsCr. Plasma MIF had a better predictive value than sCr for the requirement of RRT (P = 0.02). In conclusion, postoperative plasma MIF concentrations were elevated in patients who developed severe AKI after OLT. Furthermore, plasma MIF concentrations showed a good prognostic value for identifying patients developing severe AKI or requiring postoperative RRT after OLT.
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Affiliation(s)
- Joanna Stefaniak
- Department of Anesthesia, General Intensive Care, and Pain Management, Medical University of Vienna, Vienna, Austria
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Bucholz EM, Whitlock RP, Zappitelli M, Devarajan P, Eikelboom J, Garg AX, Philbrook HT, Devereaux PJ, Krawczeski CD, Kavsak P, Shortt C, Parikh CR. Cardiac biomarkers and acute kidney injury after cardiac surgery. Pediatrics 2015; 135:e945-56. [PMID: 25755241 PMCID: PMC4379461 DOI: 10.1542/peds.2014-2949] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To examine the relationship of cardiac biomarkers with postoperative acute kidney injury (AKI) among pediatric patients undergoing cardiac surgery. METHODS Data from TRIBE-AKI, a prospective study of children undergoing cardiac surgery, were used to examine the association of cardiac biomarkers (N-type pro-B-type natriuretic peptide, creatine kinase-MB [CK-MB], heart-type fatty acid binding protein [h-FABP], and troponins I and T) with the development of postoperative AKI. Cardiac biomarkers were collected before and 0 to 6 hours after surgery. AKI was defined as a ≥ 50% or 0.3 mg/dL increase in serum creatinine, within 7 days of surgery. RESULTS Of the 106 patients included in this study, 55 (52%) developed AKI after cardiac surgery. Patients who developed AKI had higher median levels of pre- and postoperative cardiac biomarkers compared with patients without AKI (all P < .01). Preoperatively, higher levels of CK-MB and h-FABP were associated with increased odds of developing AKI (CK-MB: adjusted odds ratio 4.58, 95% confidence interval [CI] 1.56-13.41; h-FABP: adjusted odds ratio 2.76, 95% CI 1.27-6.03). When combined with clinical models, both preoperative CK-MB and h-FABP provided good discrimination (area under the curve 0.77, 95% CI 0.68-0.87, and 0.78, 95% CI 0.68-0.87, respectively) and improved reclassification indices. Cardiac biomarkers collected postoperatively did not significantly improve the prediction of AKI beyond clinical models. CONCLUSIONS Preoperative CK-MB and h-FABP are associated with increased risk of postoperative AKI and provide good discrimination of patients who develop AKI. These biomarkers may be useful for risk stratifying patients undergoing cardiac surgery.
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Affiliation(s)
- Emily M. Bucholz
- School of Medicine, and,Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | | | - Michael Zappitelli
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Prasad Devarajan
- Department of Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John Eikelboom
- Division of Cardiac Surgery, Population Health Research Institute, and,Medicine, and
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, and,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
| | | | | | - Catherine D. Krawczeski
- Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, California; and
| | - Peter Kavsak
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Colleen Shortt
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chirag R. Parikh
- Department of Internal Medicine,,Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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Zhao K, Lin Y, Li YJ, Gao S. Efficacy of short-term cordyceps sinensis for prevention of contrast-induced nephropathy in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention. Int J Clin Exp Med 2014; 7:5758-5764. [PMID: 25664103 PMCID: PMC4307550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
Contrast-induced nephropathy (CIN) is one of the major causes of hospital-acquired acute renal failure. The pathophysiological mechanism of CIN remains unknown. There has been little evidence regarding the effects of Traditional Chinese Medicine (TCM) on CIN. Cordyceps sinensis (CS), a traditional Chinese herb, has been widely used clinically for the prevention of the progression of renal failure. We performed a prospective, randomized controlled trial to investigate the role of CS in the prevention of CIN in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). The 150 ACS patients were randomly assigned to three groups, basic treatment group (n=51), standard CS therapy group (n=49, corbrin capsule 2 g, 3 times/d were used 3 days before and after angiography), and intensive CS therapy group (n=50, corbrin capsule 3 g, 3 times/d were used 3 days before and after angiography). Renal function was assessed at the time of hospital admission and on days 1, 2, and 3 after PCI. CIN occurred in 13 of 150 patients (8.67%). The incidence of CIN was lower in the CS treatment groups than in the basic treatment group (P<0.05), and a significant decrease in the incidence of CIN in the intensive CS therapy group was shown (P<0.01). In conclusion, prophylactic treatment with CS during the peri-procedural stage in ACS patients undergoing elective PCI has a preventive role against CIN, and intensive CS therapy could be more effective.
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The definition of acute kidney injury and its use in practice. Kidney Int 2014; 87:62-73. [PMID: 25317932 DOI: 10.1038/ki.2014.328] [Citation(s) in RCA: 453] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/24/2014] [Accepted: 02/27/2014] [Indexed: 01/04/2023]
Abstract
Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. RIFLE was modified for pediatric use (pRIFLE). They were developed using both evidence and consensus. Small rises in serum creatinine are independently associated with increased mortality, and hence are incorporated into the current definition of AKI. The recent definition from the international KDIGO guideline merged RIFLE and AKIN. Systematic review has found that these definitions do not differ significantly in their performance. Health-care staff caring for children or adults should use standard criteria for AKI, such as the pRIFLE or KDIGO definitions, respectively. These efforts to standardize AKI definition are a substantial advance, although areas of uncertainty remain. The new definitions have enabled the use of electronic alerts to warn clinicians of possible AKI. Novel biomarkers may further refine the definition of AKI, but their use will need to produce tangible improvements in outcomes and cost effectiveness. Further developments in AKI definitions should be informed by research into their practical application across health-care providers. This review will discuss the definition of AKI and its use in practice for clinicians and laboratory scientists.
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