Analysis Of Acute Kidney Injury Research Articles

TCT-374 Propensity Score Matched Analysis of Acute Kidney Injury Following Percutenous Coronary Intervention with Trans-Radial versus Trans-Femoral Approach

TCT-374 Propensity Score Matched Analysis of Acute Kidney Injury Following Percutenous Coronary Intervention with Trans-Radial versus Trans-Femoral Approach

Proteome analysis of acute kidney injury – Discovery of new predominantly renal candidates for biomarker of kidney disease

The main bottleneck in studies aiming to identify novel biomarkers in acute kidney injury (AKI) has been the identification of markers that are organ and process specific. Here, we have used different tissues from a controlled porcine renal ischemia/reperfusion (I/R) model to identify new, predominantly renal biomarker candidates for kidney disease. Urine and serum samples were analyzed in pre-ischemia, ischemia (60min) and 4, 11 and 16h post-reperfusion, and renal cortex samples after 24h of reperfusion. Peptides were analyzed on the Q-Exactive™. In renal cortex proteome, we observed an increase in the synthesis of proteins in the ischemic kidney compared to the contralateral, highlighted by transcription factors and epithelial adherens junction proteins. Intersecting the set of proteins up- or down-regulated in the ischemic tissue with both serum and urine proteomes, we identified 6 proteins in the serum that may provide a set of targets for kidney injury. Additionally, we identified 49, being 4 predominantly renal, proteins in urine. As prove of concept, we validated one of the identified biomarkers, dipeptidyl peptidase IV, in a set of patients with diabetic nephropathy. In conclusion, we identified 55 systemic proteins, some of them predominantly renal, candidates for biomarkers of renal disease. Biological significanceThe main bottleneck in studies aiming to identify novel biomarkers in acute kidney injury (AKI) has been the identification of markers that are predominantly renal. In fact, putative biomarkers for this condition have also been identified in a number of other clinical scenarios, such as cardiovascular diseases, chronic kidney failure or in patients being treated in intensive care units from a number of conditions. Here we propose a comprehensive, sequential screening procedure able to identify and validate potential biomarkers for kidney disease, using kidney ischemia/reperfusion as a paradigm for a kidney pathological event.

A 13-Year Retrospective Analysis of Acute Kidney Injury Requiring Renal Replacement Therapy in Non Renal Solid Organ Transplantation.

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality and progression toward chronic kidney disease (CKD). A few studies analyzed the impact of AKI in non renal solid organ transplant (NRSOT) recipients. The aim of this study was a 13-year retrospective analysis of AKI in NRSOT recipients identifying its clinical relevance on outcome and progression toward CKD. We analyzed (2001-2013) the percentage of NRSOT in the AKI population treated by RRT in our University Hospital. For each NRSOT recipient, we evaluated RIFLE, SOFA and the severity index ATN_ISS at RRT start. The percentage of AKI requiring RRT in the NRSOT population and for distinct transplanted organ (liver, heart or lung graft) was studied. Renal function (eGFR) was evaluated at the end of observation (30 days). We treated by RRT 2648 critically ill patients with AKI for a total of 20932 sessions performed: 291/2648 (10.99%) were NRSOT recipients. In the study period, 1673 liver, 317 heart and 34 lung transplantations were performed. We treated by RRT 174/1673 (10.4 %) liver, 83/317 (26.2 %) heart and 34/110 (30.9%) lung transplanted patients. NRSOT patients’ characteristics were: age 59.8±7.6 yrs, male 67.7%, serum creatinine 3.88±1.27 mg/dl, SOFA 12.8±3.1, RIFLE (Risk 12%, Injury 17.2%, Failure 70.8%) and ATN_ISS score 0.8±0.11. The prevalent cause of AKI was sepsis (44%). Mortality rate of NRSOT patients treated by RRT was 44.3% (129/291), 42.5% (74/174) for liver, 49.4% (41/83) for heart and 41.2% (14/34) for lung recipients, respectively. AKI was a complication of the early post-transplantation period since the need for RRT occurred in the first 30 days after surgery in 69.1% of NRSOT recipients (64.9% for liver, 60.2% for heart and 82.3% for lung, respectively). In survivors, mean serum creatinine at the end of the study period was 2.37±0.82 mg/dl (1.88±0.94 mg/dl in liver, 2.42±0.75 mg/dl in heart and 2.81±0.92 mg/dl in lung graft recipients, respectively). Our retrospective analysis revealed an increased incidence of AKI mainly due to sepsis in the NRSOT population. The occurrence of AKI requiring RRT in the first 30 days after transplantation was associated with a worse outcome and with progression toward CKD in survivors.

Retrospective Analysis of Acute Kidney Injury in Non Renal Solid Organ Transplant Recipients: Incidence, Outcome and Impact on Residual Renal Function

Retrospective Analysis of Acute Kidney Injury in Non Renal Solid Organ Transplant Recipients: Incidence, Outcome and Impact on Residual Renal Function

Acute Kidney Injury in Children Undergoing Correction of Congenital Heart Disease

Objective To assess risk factors of acute kidney injury in congenital cardiac disease following cardiac surgery with cardiopulmonary bypass in children. Methods A 50% postoperative creatinine increase was regarded as the criterion of acute kidney injury. 124 children aged 3 years or little undergoing cardiac surgery were divided into three groups: (1) negative AKI (-); (2) AKI (+) with an increase in postoperative creatinine from 150% to 200%; and (3) AKI (++) with an increase in postoperative creatinine by more than 200%. Demographics, and preoperative, intraoperative, and postoperative variables were evaluated for associations with AKI using univariate and multiple logistic regression analysis. Results Several variables, including mortality, preoperative albumin and creatinine levels, cardiopulmonary bypass duration, and postoperative creatinine levels, were significant differences among the three groups (P < 0.05). Multiple regression analysis demonstrated that three risk factors, age (OR, 0.962; 95% CI, 0.925 to 1.000; P = 0.046), intraoperative red blood cell transfusion (OR, 1.003; 95% CI, 1.001 to 1.005; P = 0.030), and cardiopulmonary bypass duration (OR, 1.024; 95% CI, 1.016 to 1.032; P = 0.000) were independently associated with AKI after cardiac surgery. Conclusions This study showed that younger age, incremental intraoperative red blood cell transfusion, and prolonged cardiopulmonary bypass duration were independently associated with acute kidney injury after cardiac surgery. The type of congenital cardiac disease should be included in the analysis of acute kidney injury.

Clinical analysis of acute kidney injury in children with renal diseases

Acute kidney injury (AKI) was recently proposed for early recognition of renal function impairment and prompt interventions. Previous study revealed that AKI was highly associated with the prognosis. However, there was rare report of AKI in renal diseases, especially in children cohorts. Therefore, we performed the prospective clinical research in children with renal diseases in our hospital, aiming to study the prevalence, the clinical characteristics and the short-term prognosis of AKI. The study was designed as a prospective, single-center observational study. (1) the primary diagnosis was primary nephrotic syndrome (NS), Henoch-Schoenlein purpura nephritis (HSPN) or lupus nephritis (LN), (2) the duration from the onset of the renal diseases to the admission was less than 3 months. The serum creatinine and urine output of the subjects would be prospectively monitored. AKI was defined by the adult criteria and stratified by Acute Kidney Injury Network (AKIN) criteria. The patients were followed up at 6 months and 12 months after enrollment. Between October 2007 and April 2009, a total of 95 children were included, including 65 cases with NS, 15 HSPN and 15 LN. Mean age was (8.9 ± 3.9) years (range 2 - 16 years). Thirty-three of the 95 patients (34.7%) fulfilled the AKI criteria, 13 patients (13.7%) were diagnosed as acute renal failure (ARF). All the AKI in children with LN and HSPN presented with serum creatinine elevation. However, 65.4% of AKI in NS presented with decreasing urine output, only 19.2% accompanied with increasing creatinine, with higher stages of urine output. Regarding the etiology, only 26.9% of AKI in NS had definite cause, most of which resulted from side-effect of cyclosporine, hypovolemia or tubule-interstitial damage, independent of glomerular diseases. In contrast, the AKI in LN and HSPN were exclusively caused by glomerular diseases. The length and costs of hospitalization of AKI group were significantly higher than non-AKI [length of hospitalization (d), 28(6 to 94) vs. 21(7 to 100), Z = -1.971, P = 0.049; cost of hospitalization (yuan), 12 035.7 (1561.7 to 94 783.1) vs. 8594.3 (1390.1 to 98 876.5), Z = -1.993, P = 0.046]. There was no significant difference in the serum creatinine at 6-month and 12-month follow-up between AKI group and non-AKI [6-month, (60.4 ± 91.8) µmol/L vs. (42.8 ± 12.2) µmol/L, t = 0.937, P = 0.358; 12-month, (48.7 ± 18.1) µmol/L vs. (47.7 ± 14.2) µmol/L, t = 0.197, P = 0.845]. The prevalence of AKI (34.7%) was higher than that of ARF (13.7%) in children with renal diseases. Most of the AKI in NS resulted from non-glomerular diseases. In contrast, most AKI in LN and HSPN were caused by underlying glomerular diseases. The length and costs of hospitalization were significantly higher in AKI group. However, there was no significant difference in serum creatinine between AKI and non-AKI group in the follow-up at 6 months and 12 months. Further investigations on criteria for the diagnosis of AKI in children with renal diseases are still needed.

Proteomic analysis of acute kidney injury: Biomarkers to mechanisms

Acute kidney injury (AKI) is a devastating clinical condition, both in terms of mortality and costs, and is occurring with increasing incidence. Despite better clinical care, the outcomes of AKI have changed little in the last 50 years. This lack of progress is due in part to a lack of early diagnostic biomarkers and a poor understanding of the disease mechanisms. This review will focus on the rapid progress being made in both the understanding of AKI and the promising panel of early biomarkers for AKI that have come out of both direct proteomic analysis of body fluids of AKI patients and more targeted proteomic approaches using clues from other methods such as transcriptomics. This review concludes with a discussion of the future of proteomics and personalized medicine in AKI and the challenges presented in translating these exciting proteomic results to the clinic.

Analysis of Acute Kidney Injury in Pediatric Patients with Stem Cell Transplantation

Analysis of Acute Kidney Injury in Pediatric Patients with Stem Cell Transplantation