Changes In Serum Creatinine Levels Research Articles

A Review for the Practicing Clinician: Hepatorenal Syndrome, a Form of Acute Kidney Injury, in Patients with Cirrhosis.

The hepatorenal syndrome type of acute kidney injury (HRS-AKI), formerly known as type 1 hepatorenal syndrome, is a rapidly progressing renal failure that occurs in many patients with advanced cirrhosis and ascites. Accumulating evidence has led to a recent evolution of diagnostic criteria for this serious complication of end-stage liver disease. The aim of this review is to provide an overview of disease-related characteristics and therapeutic management of patients with HRS-AKI. Relevant literature was compiled to support discussion of the pathophysiology, diagnosis, prognosis, associated conditions, prevention, treatment, and management of HRS-AKI. Onset of HRS-AKI is characterized by sudden severe renal vasoconstriction, leading to an acute reduction in glomerular filtration rate and rapid, potentially life-threatening, renal deterioration. Although our understanding of disease pathophysiology continues to evolve, etiology of HRS-AKI likely involves systemic hemodynamic changes caused by liver disease, inflammation, and damage to renal parenchyma. There is currently no gold standard for diagnosis, which typically involves a clinical workup, abdominal imaging, and laboratory assessments. The current consensus definition of HRS-AKI includes proposed diagnostic criteria based on changes in serum creatinine levels tailored for high sensitivity, and rapid detection to accelerate diagnosis and treatment initiation. The only potential cure for HRS-AKI is liver transplantation; however, vasoconstrictive agents and other supportive measures are used as needed to help maintain survival for patients who are awaiting or are ineligible for transplantation. The severity of HRS-AKI, complex pathology, limited treatment options, and range of associated conditions pose significant challenges for both patients and care providers.

Comparative efficacy of three regimens (cyclosporine, tacrolimus, and cyclophosphamide) combined with steroids for the treatment of idiopathic membranous nephropathy

Introduction and objectivesTo investigate the efficacy of combined immunosuppressive regimens of cyclosporine (CsA), tacrolimus (TAC), or cyclophosphamide (CTX) combined with steroids in the treatment of idiopathic membranous nephropathy (IMN). Materials and methodsA total of 150 biopsy-proven IMN patients were divided into three groups: CTX, TAC, and CsA groups (50 cases each). Patients received a selected regimen for 48 weeks. The efficacy (remission rate, 24h urinary protein, and serum albumin and creatinine) and safety (adverse events) profiles of administered regimens were evaluated at 12, 24 and 48 weeks. ResultsAt 12 weeks, the response rates for CsA, TAC, and CTX groups were 14%, 50%, and 22%, respectively. This increased to 74%, 84%, and 82%, respectively at 48 weeks. During follow-up, 24h urinary protein significantly reduced from baseline in all regimens (P<0.05), while serum albumin increased in TAC and CTX groups after 12 weeks (P<0.05), and CsA group at 48 weeks (P<0.05). No significant changes in serum creatinine levels were noted in all three regimens (P>0.05). Safety was comparable in all groups, with lower respiratory tract infection being the most frequent adverse event. ConclusionsThe combined regimens (i.e., TAC, CsA, and CTX) are effective in the treatment of patients with IMN at 48 weeks, while TAC and CTX might be more beneficial in terms of shortened time to remission and increased complete response rate.

Serum creatinine as a biomarker for dystrophinopathy: a cross-sectional and longitudinal study

BackgroundDystrophinopathy, a common neuromuscular disorder, includes Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Many researches are currently ongoing to develop curative approaches, which results in an urgent need for biomarkers of disease progression and treatment response. This study investigated whether the serum creatinine (SCRN) level can be used as a biomarker of disease progression in dystrophinopathy.MethodsWe enrolled 377 male patients with dystrophinopathy and 520 male non-dystrophinopathy controls in a cross-sectional study. From this cohort, 113 follow-up patients were enrolled in a longitudinal study. Patients’ demographic information, motor function, muscle fatty infiltration, and muscle dystrophin levels were evaluated. We investigated correlations between these parameters and SCRN levels, and determined changes in SCRN levels with maturation and with motor function changes.ResultsOur results showed SCRN levels correlated with motor function (FDR < 0.001) and timed test results (FDR between < 0.001–0.012), as well as with muscle fatty infiltration (FDR < 0.001) and dystrophin levels (FDR = 0.015 and 0.001). SCRN levels increased with maturation in control individuals; it slowly increased with maturation in patients with BMD but decreased generally with maturation in patients with DMD. The longitudinal study further demonstrated that SCRN levels were associated with motor function.ConclusionsThese findings indicated that the SCRN level is a promising biomarker for assessing disease progression in dystrophinopathy and could be used as a potential outcome measure in clinical trials.

July 2021 at a glance: focus on blood volume distribution, haemodynamics and adherence to therapy.

July 2021 at a glance: focus on blood volume distribution, haemodynamics and adherence to therapy.

Traditional weight loss and dukan diets as to nutritional and laboratory results

Traditional weight loss and dukan diets as to nutritional and laboratory results

STUDY OF CLINICAL PROFILE OF COMMUNITY-ACOUIRED ACUTE KIDNEY INJURY DEFINED USING RIFLE CRITERIA IN IGIMS PATNA

Aim: To examine the progression between stages of the classication, and to relate this classication to the length of stay and mortality in a large cohort of critically ill patients. Material and methods:A total of 5,383 patients was evaluated. We classied patients according to the maximum RIFLE class (class R, class I or class F) reached during their hospital stay. The RIFLE class was determined based on the worst of either glomerular ltration rate criteria or urine output criteria. We used the change in serum creatinine level and urine output to classify patients according to the RIFLE criteria. Result:Increasing severity of acute kidney injury was associated with an increasing length of ICU stay and hospital stay, and higher mortality. Patients with maximum RIFLE class R, class I and class F had hospital mortality rates of 8.6%, 11.7% and 26.8%, respectively, compared with 5.5% for patients without acute kidney injury. Conclusion:ICU population, newly developed RIFLE classication was associated with increased hospital mortality.

Changes in Estimated Glomerular Filtration Rate in Naive HIV Patients with Fixed Drugs Combination Tenofovir Treatment in First 3 Months

The treatment HIV/AIDS uses ARVs, one of which is FDC tenofovir. FDC tenofovir is associated with changes in kidney function. This study aimed to determine changes in serum creatinine levels and eGFR in naive HIV patients who received FDC tenofovir therapy for 3 months. This prospective longitudinal study included naive HIV patients who received tenofovir. Serum creatinine levels and eGFR was measured before administration of tenofovir and after 3 months administration of tenofovir. Among 30 patients, the subject consisted 20 (66,7%) males and 10 (33.3%) females. The median age was 37 with range 17-57 years. The mean serum creatinine before tenofovir treatment 0.89 ± 0.25 mg/dL and after 3 months treatment mean ± SD 0.92 ± 0.28 mg/dL. The mean eGFR before administration of tenofovir treatment 89.37 ± 33.54 ml/min/1.73m2 and after 3 months the mean ± SD 88.31 ± 33.56 ml/min/1.73m2. There were no significant changes in serum creatinine and eGFR after 3 months administration of tenofovir (p = 0.441; p = 0.771, respectively). Serum creatinine and eGFR were not change after administration of tenofovir in naive HIV patients.

Perioperative acute kidney injury following major abdominal surgery.

Major abdominal surgery is associated with significant morbidity, not least the development of acute kidney injury. As a common perioperative complication, acute kidney injury is associated with increased length of stay, increased risk of perioperative infection and the potential development of chronic kidney disease. Moreover, the development of acute kidney injury is independently associated with an increased risk of death. Perioperative acute kidney injury is not a single entity, but describes a clinical syndrome with multiple causes including physical causes related to the surgical procedure, ischaemia-reperfusion injury and the use of potential nephrotoxins. Currently, acute kidney injury is defined by changes in serum creatinine level and urine output criteria, which although robust in heterogenous populations, may not perform as accurately in the perioperative period. This article discusses these issues including the potential role of novel biomarkers for early detection of perioperative acute kidney injury, as well as the use of predictive modelling. Treatment is mainly supportive but evidence suggests that more targeted therapy may lead to improved outcomes.

O045 / #673: EVALUATION OF THE PERFORMANCE OF VASOACTIVE VENTILATION RENAL SCORE IN PREDICTING THE DURATION OF MECHANICAL VENTILATION AND INTENSIVE CARE HOSPITALIZATION AFTER PEDIATRIC CARDIAC SURGERY

Aims & Objectives: Various methods have been used to evaluate the recovery process after cardiac surgery in children. In here, we aimed to evaluate the vasoactive ventilation renal (VVR) score. Methods: Patients who underwent congenital heart surgery between November 2016 - March 2019 were evaluated prospectively. VVR score was calculated as follows: VIS + ventilation index + (change in serum creatinine level based on baseline value X 10). The VVR score, VIS and serum lactate levels of all patients were recorded at the time of admission, the highest value in the first 24 hours and 48th hour. The relationship between the duration of mechanical ventilation monitoring and ICU stay was evaluated by ROC analysis and threshold values were calculated. Results: The median age of the 94 patients included in the study was 1.1 (range 0.2-17) year, and 12 patients had single ventricular physiology. In the time period corresponding to each study point, the VVR score was higher in area under the ROC curve (AUC) compared to VIS and serum lactate levels, and the 48th hour VVR score was highest in the ROC analysis (AUC 0.851, 95% confidence interval). 0.761-0942 / ICU hospital stay; AUC 0.946, 95% confidence interval 0.885-1 / mechanical ventilation time). The 48th hour VVR score was 9.1 (sensitivity 87%, specificity 97.1%) for the duration of mechanical ventilation, and 6.7 (sensitivity 70%, specificity 92%) for ICU stay. Conclusions: The VVR score is a new and effective predictor of the duration of mechanical ventilation and ICU stay in postoperative congenital heart surgery patients.

Biosynthesis and Hypoglycemic Potential of Chitosan Nano-selenium In Experimentally Induced Diabetic In Rats

The present study investigated the effects of selenium nanoparticles (SeNPs) at dose 2 mg/kg body weight in streptozotocin (STZ) induced diabetes in a rat model at dose 50 mg/kg body weight. Rats administered SeNPs orally in normal and experimentally induced diabetic rats for 35 days and glibenclamide (Glib)at the dose rate of 20 mg/kg was used as a reference drug. Blood samples were collected at the end of experimental. administration of SeNPs was significantly decreased blood glucose levels and enhanced serum insulin concentration, Result showed decrease liver function enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), all groups results showed non-significant changes in serum creatinine levels, decrease cardiac function enzymes creatine kinase-MB (CK-MB). Result also showed significant decrease in the activity level of α-amylase. Also, Glib administration also exhibited a significant improvement in diabetic animals after 35 days of treatment. This study suggests that SeNPs capped with chitosan can alleviate hyperglycemia and showing synergistic effect in STZ-induced diabetic rats and these protection may be possibly by eliciting insulin-mimetic activity or SeNPs showed enhancement of the elimination of the diabetes-induced oxidative stress injuries.

A single-centre experience of febuxostat as a second-line urate-lowering therapy.

The purpose of this study was to describe the local experience in terms of drug efficacy and safety using a new xanthine oxidase inhibitor, febuxostat, as a second-line urate-lowering therapy (ULT) in gout patients with normal renal function and chronic kidney disease. This cross-sectional study included all gout patients who attended the rheumatology clinic from January 2013 to June 2018 and had received febuxostat as a second-line ULT. Analysis focused on the proportion of gout patients who achieved target serum urate (sUA) of <360 μmol/L, duration taken to achieve target sUA, and febuxostat dosage at achievement of target sUA. Safety assessments included comparison of serum creatinine, estimated glomerular filtration rate (eGFR), and serum alanine aminotransferase (ALT) at baseline, at achievement of target sUA, and at 12-monthly intervals. Majority (90.9%) of patients achieved target sUA. Median duration required to achieve target sUA was 5.5 months with IQR (interquartile range) of 8.5. Five (22.7%) patients achieved target sUA within one month of therapy with febuxostat 40 mg per day. Eleven (55%) patients achieved target sUA within six months and 16 (80%) by 12 months. Equal proportion of patients achieved target sUA with febuxostat 40 mg per day and 80 mg per day, respectively. There was no significant difference in the changes in serum creatinine level, eGFR and ALT from baseline and at achievement of target sUA, nor at 12-monthly intervals throughout the duration of febuxostat therapy. Apart from three patients who developed hypersensitivity reactions to febuxostat, no other adverse events were reported. A significant proportion of gout patients with CKD managed to achieve target sUA with a lower dose of febuxostat at 40 mg per day and it is reasonable to maintain this dose for up to six months before considering dose escalation.

The effect of admission and pre-admission serum creatinine as baseline to assess incidence and outcomes of acute kidney injury in acute medical admissions.

Acute kidney injury (AKI) in hospital-admitted patients is a common complication associated with increased mortality. The diagnosis of AKI relies on the ascertainment of peak increase in serum creatinine (SCr). This study evaluated the incidence of AKI using the increase from mean 7-365 days pre-admission (AKIpre) and admission (AKIadm) SCr levels, and examined the associations of AKI and changes in SCr levels with all-cause mortality. A total of 2436 patients admitted to a tertiary hospital were recruited and followed-up for a median of 47.70 (interquartile range 18.20) months. AKI incidence and severity were defined according to the Kidney Disease: Improving Global Outcomes-AKI Guidelines. Follow-up data were collected from the Hospital Episode Statistics and Office of National Statistics. Mortality was evaluated during a short- (30 days), mid- (1 year) and long-term (4 years) period. No difference in the AKI rates using AKIpre and AKIadm (12.5% versus 12.2%; P = 0.695) or in the AKI severity (P = 0.261) was evident. Agreement between the two definitions was modest (Kappa-statistic = 0.596, P < 0.001). Patients with AKIpre or AKIadm had increased all-cause mortality compared with those without AKI during all follow-up periods. In fully adjusted regression analysis, AKIpre [hazard ratio (HR) = 2.226, 95% confidence interval (CI) 1.140-4.347; P = 0.027] and AKIadm (HR = 2.105, 95% CI 1.090-4.064; P = 0.027) remained associated with 30-day mortality. Results for the 1- and 4-year periods were similar. Increases of >4.00 μmol/L and >6.06% from pre-admission or >6.00 μmol/L and >17.24% from admission SCr levels presented increased mortality risk during follow-up. Use of admission or pre-admission SCr provides similar incidence rates, but they diagnose different sets of patients. Even minor increases in SCr, below those required for the classification of AKI, were associated with increased mortality. These findings can help the clinicians to identify patients at higher risk for adverse outcomes.

Efficacy and safety of CT-guided microwave ablation for stage T1a renal cell carcinoma in patients with a solitary kidney

Objective To retrospectively evaluate early clinical outcomes of percutaneous microwave ablation (MWA) for stage T1a renal cell carcinomas (RCCs) in solitary kidney patients. Materials and methods 15 solitary kidney patients with 16 stage T1a N0M0 biopsy-proved RCCs underwent CT-guided percutaneous microwave ablation between October 2016 and July 2020. The patients were followed up with contrast-enhanced computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. Serum creatinine levels of each patient pre MWA, 1 day after MWA and the most recent record were collected. Technical effectiveness, local recurrence, survival rates and complications were accessed. Results Complete ablation was achieved in all 16 tumors (100%) including 13 clear cell carcinomas and 3 papillary carcinomas. Within the follow-up time (median: 24 months) no tumor recurrence or major complication was detected. No significant change in serum creatinine level was noted. The cancer-specific survival rate was 100% (15 of 15), and 1-, 2-, and 3-year overall survival rates were 100%, 93.3%, and 93.3%, respectively. Conclusion Percutaneous MWA is an effective and safe treatment option for stage T1a RCCs in solitary kidney patients; it can achieve high complete ablation rate in selected lesions of appropriate size and location.

In-hospital acute kidney injury and atrial fibrillation: incidence, risk factors, and outcome

Background The incidence and the risk factors of in-hospitalized acute kidney injury (AKI) in patients hospitalized for atrial fibrillation (AF) were unclear. Methods The Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project is an ongoing registry and quality improvement project, with 240 hospitals recruited across China. We selected 4527 patients hospitalized for AF registered in the CCC-AF from January 2015 to January 2019. Patients were divided into the AKI and non-AKI groups according to the changes in serum creatinine levels during hospitalization. Results Among the 4527 patients, the incidence of AKI was 8.0% (361/4527). Multivariate logistic analysis results indicated that the incidence of in-hospital AKI in patients with AF on admission was 2.6 times higher than that in patients with sinus rhythm (OR 2.60, 95% CI 1.77–3.81). Age (per 10-year increase, OR 1.22, 95% CI 1.07–1.38), atrial flutter/atrial tachycardia on admission (OR 2.16, 95% CI 1.12–4.15), diuretics therapy before admission (OR 1.48, 95% CI 1.07–2.04) and baseline hemoglobin (per 20 g/L decrease, OR 1.21, 95% CI 1.10–1.32) were independent risk factors for in-hospital AKI. β blockers therapy given before admission (OR 0.67, 95% CI 0.51–0.87) and non-warfarin therapy during hospitalization (OR 0.71, 95% CI 0.53–0.96) were associated with a decreased risk of in-hospital AKI. After adjustment for confounders, in-hospital AKI was associated with a 34% increase in risk of major adverse cardiovascular (OR 1.34, 95% CI 1.02–1.90, p = 0.023). Conclusions Clinicians should pay attention to the monitoring and prevention of in-hospital AKI to improve the prognosis of patients with AF.

Impact of Therapeutic Drug Monitoring on Once-Daily Regimen of Amikacin in Patients With Urinary Tract Infection: A Prospective Observational Study

Amikacin is a semisynthetic antibiotic used in the treatment of gram-negative bacterial infections and has a narrow therapeutic index. Although therapeutic drug monitoring is recommended for amikacin, it is not routinely performed because of the use of a less toxic once-daily regimen. Only few studies have evaluated the role of therapeutic drug monitoring in patients treated with amikacin. The objective of our study was to find an association between the pharmacokinetic parameters of amikacin and the time required for a clinical cure, creatinine clearance, and frequency of ototoxicity in patients with urinary tract infection treated for 7 or more days. A prospective study was conducted on patients with urinary tract infections who were administered amikacin for 7 or more days. Blood samples were obtained from the patients to measure the maximum drug concentration (Cmax) and trough concentration (Ctrough). Minimum inhibitory concentration (MIC) values were determined for patients with positive urine cultures. Serum creatinine levels were estimated every 3 days. The auditory assessment was performed using pure tone audiometry at baseline and weekly until the patients were discharged. Levels of amikacin were analyzed using a validated liquid chromatography-tandem mass spectrometry method. Of 125 patients analyzed, the median time required for a clinical cure was less in the group of patients who achieved a Cmax/MIC ratio ≥8 than it was in those who did not achieve this level [7 versus 8 days (P = 0.02)]. The Ctrough of amikacin was associated with the change in serum creatinine level (P = 0.01) and the incidence of nephrotoxicity (P = 0.004). In patients receiving short-term amikacin therapy, Cmax/MIC value can be used to predict the time required for a clinical cure. Ctrough can be used to predict the occurrence of nephrotoxicity in patients receiving amikacin therapy.

Sacubitril/valsartan improves heart failure functional class, left ventricular systolic and diastolic function and neurohumoral status in patients with anthracycline-induced cardiomyopathy

Abstract Anthracycline-induced cardiomyopathy (AC-CMP) is more resistant or even refractory to conventional heart failure (HF) treatments and has a higher mortality rate as compared to HF associated with other diseases. Sacubitril/valsartan (S/V) significantly reduces cardiovascular mortality and hospitalization rate in HF patients with reduced left ventricular ejection fraction (HFrEF). There is lack of evidence of S/V efficacy and safety in patients with AC-CMP. We aimed to assess the efficacy and tolerability of S/V in patients with AC-CMP. Methods We enrolled 20 patients with anthracycline-induced HFrEF who met the indication criteria for S/V. Median age was 61 [51.5; 67], 100% women, 8 (40%) hypertensive, 1 (5%) diabetic. Seventeen (85%) patients had breast and 3 (15%) hematological cancers. Median time from anthracycline therapy was 3 [1; 11] years. Surgery due to cancer and radiation therapy were performed in 15 (75%) cases. All patients had been receiving ACE inhibitors or angiotensin II receptor blockers and were switched to S/V. 85% of patients were treated with beta-blockers, 60% – mineralocorticoid antagonists, 50% – loop diuretics. The exam (at admission and after 6 months) included 6-MWT, echo/speckle tracking, creatinine, potassium and NTproBNP level. Results Eleven (55%) patients achieved the target dose of S/V. The mean S/V dose was 289±149.1 mg. Symptomatic hypotension, hyperpotassemia or creatinine level elevation were the reasons for S/V dose reduction in 8, 1 and 2 patients, respectively. S/V wasn't withdrawn in any patient. No hospitalization due to HF or need for loop diuretics increase occurred during the follow-up. After 6 months 6-MWD increased from 416 [347.5; 477.5] to 465 [395; 513.5] m, p=0.0004. NYHA functional class improved in 50% of patients. We revealed LVEDVI decrease (61.7 [55.9; 71.6] to 57.1 [53.4; 60.1] ml/m2 p=0.002), LVEF and GLS increase (39 [34.7; 41] to 45 [39; 47]%, p=0.001 and 11 [8.7; 13.9] to 13.4 [11.9; 15.5]%, p=0.002, respectively), LAVI decrease (40.7 [32; 43.9] to 31.3 [28.6; 37.4] ml/m2, p=0.003), E/A and E/e ratios decrease (1.37 [0.7; 2.23] to 0.69 [0.64; 0.83], p=0.04, and 13 [11.3; 17.8] to 10.7 [6.9; 13.6], p=0.01, respectively). NTproBNP blood level declined from 1659 [1090; 2316] to 377 [206.8; 920] pg/ml, p&amp;lt;0.001. There was change in serum creatinine level but in normal ranges (from 70.3 [66.8; 80; 6] to 77 [68.6; 96.3] micromol/l, p=0.02). No significant changes in potassium level were observed. Conclusions In this pilot study S/V was well tolerated in patients with AC-CMP, but cardiologic assessment was needed for accurate dose adjustment. Therapy with S/V was associated with improvement in HF functional class and LV systolic and diastolic function as well as neurohumoral status in patients with AC-CMP. Funding Acknowledgement Type of funding source: None

Evaluation of Serum Cystatin C as an Early Biomarker of Acute Kidney Injury in Patients with Acute Pancreatitis.

IntroductionAcute pancreatitis (AP) is an inflammatory process of pancreas with varying degree of involvement of regional tissues. The aim of this study was to investigate the potential use of serum cystatin C (Cys-C) for the early and accurate diagnosis of acute kidney injury (AKI) in patients of AP.Materials and methodsThis was a prospective study conducted in 1 year. Total of 215 cases of AP fulfilling the inclusion criteria were enrolled in this study. Patients suffering from chronic pancreatitis, neoplasm, chronic liver disease, and chronic kidney disease were excluded from the study. Diagnosis of AP was based on the Atlanta classification 2012. All patients were classified into a non-AKI group (n = 152) and an AKI group (n = 38) according to the dynamic changes in serum creatinine levels. Serum Cys-C was measured by particle-enhanced immune nephelometric assay.ResultsBy univariate logistic regression analysis, body mass index (BMI) (OR = 1.44, 95% CI: 1.23–1.68; p < 0.001), blood urea (OR = 1.15, 95% CI: 1.06–1.23; p < 0.001), Cys-C (OR = 1.04, 95% CI: 1.01–1.07; p < 0.05), serum calcium (OR = 0.59, 95% CI: 0.41–0.86; p < 0.05), and serum lactate dehydrogenase (LDH) (OR = 1.001, 95% CI: 1.0–1.001; p < 0.05) were the significant indicators for AKI in patients with AP. Using multivariate logistic regression analysis, urinary albumin and Cys-C were independent and significant indicators of AKI in patients with AP (OR = 1.026, 95% CI: 1.01–1.07; p < 0.01). Receiver operating characteristic (ROC) curve of serum Cys-C, for AKI in patient with AP could be identified with a sensitivity of 92.06% at specificity of 96.0% [area under the curve (AUC) = 0.96, 95% CI: 0.92–0.98] by baseline serum Cys-C (cutoff value = >32.32 mg/L).ConclusionIncrease of baseline serum Cys-C was associated with AKI in patients with AP.How to cite this articlePatel ML, Shyam R, Bharti H, Sachan R, Gupta KK, Parihar A. Evaluation of Serum Cystatin C as an Early Biomarker of Acute Kidney Injury in Patients with Acute Pancreatitis. Indian J Crit Care Med 2020;24(9):777–782.

COVID-19 infection and the kidney.

Despite initial reports, renal involvement, including acute kidney injury, has emerged as a serious complication of COVID-19 disease, particularly in critically ill patients. The reported prevalence varies considerably, which may reflect reporting practices, although differences in pre-existing comorbidities and socioeconomic factors, and differences between ethnic groups, almost certainly contribute. Renal involvement may present as an active urinary sediment or as changes in serum creatinine levels and urine output leading to acute kidney injury. In common with acute kidney injury complicating critical illness, the cause is often multifactorial and often presents as part of a multiorgan dysfunction syndrome. Treatment is, in the main, supportive, with kidney replacement therapy required in nearly 25% of reported cases. Few data currently exist as to the long-term burden of COVID-19-associated acute kidney injury but evidence suggests that only approximately one-third of patients are discharged with recovered renal function.

Phase 3 Trial of RNAi Therapeutic Givosiran for Acute Intermittent Porphyria

BackgroundUp-regulation of hepatic delta-aminolevulinic acid synthase 1 (ALAS1), with resultant accumulation of delta-aminolevulinic acid (ALA) and porphobilinogen, is central to the pathogenesis of acute attacks and chronic symptoms in acute hepatic porphyria. Givosiran, an RNA interference therapy, inhibits ALAS1 expression.MethodsIn this double-blind, placebo-controlled, phase 3 trial, we randomly assigned symptomatic patients with acute hepatic porphyria to receive either subcutaneous givosiran (2.5 mg per kilogram of body weight) or placebo monthly for 6 months. The primary end point was the annualized rate of composite porphyria attacks among patients with acute intermittent porphyria, the most common subtype of acute hepatic porphyria. (Composite porphyria attacks resulted in hospitalization, an urgent health care visit, or intravenous administration of hemin at home.) Key secondary end points were levels of ALA and porphobilinogen and the annualized attack rate among patients with acute hepatic porphyria, along with hemin use and daily worst pain scores in patients with acute intermittent porphyria.ResultsA total of 94 patients underwent randomization (48 in the givosiran group and 46 in the placebo group). Among the 89 patients with acute intermittent porphyria, the mean annualized attack rate was 3.2 in the givosiran group and 12.5 in the placebo group, representing a 74% lower rate in the givosiran group (P<0.001); the results were similar among the 94 patients with acute hepatic porphyria. Among the patients with acute intermittent porphyria, givosiran led to lower levels of urinary ALA and porphobilinogen, fewer days of hemin use, and better daily scores for pain than placebo. Key adverse events that were observed more frequently in the givosiran group were elevations in serum aminotransferase levels, changes in serum creatinine levels and the estimated glomerular filtration rate, and injection-site reactions.ConclusionsAmong patients with acute intermittent porphyria, those who received givosiran had a significantly lower rate of porphyria attacks and better results for multiple other disease manifestations than those who received placebo. The increased efficacy was accompanied by a higher frequency of hepatic and renal adverse events. (Funded by Alnylam Pharmaceuticals; ENVISION ClinicalTrials.gov number, NCT03338816.)

Biomarkers of acute kidney injury and their role in clinical patient management

Acute kidney injury (AKI) is a common public health problem and has a significant impact on cardiovascular disease, mortality and increased hospital costs. Also, AKI can progress to chronic kidney disease (CKD). Therefore, early diagnosis is very important for AKI. Serum creatinine (SCr) is a well-known biomarker in the diagnosis of AKI. However, changes in SCr levels are insufficient in early diagnosis so, new biomarkers are needed. Because of that, the search for biomarkers for the early detection of AKI is an ongoing process. In recent years, early diagnosis, prognostic and predictive biomarkers have been discovered to replace or support SCr in the diagnosis of AKI. New biomarkers can help early diagnosis and effective management of AKI. Since there are many biomarkers, when and under which condition these biomarkers should be used cause confusion. In this review, we aimed to construct and ease to use classification of these AKI biomarkers and summarize the current literature. We have divided the biomarkers into two main categories: renal and non-renal origin. Then, we have classified the biomarkers of renal origin as glomerular, tubular and unknown renal site. We have also described the clinical use of these biomarkers for diagnosis and prognosis.