Detection Of Acute Renal Failure Research Articles

Feasibility and Clinical Experience of Arterial-urinary Oxygen (PaO2–PuO2) Gradient Monitoring for Early Detection of Acute Renal Failure in COVID-19 Patient: A Clinical Case Series

Feasibility and Clinical Experience of Arterial-urinary Oxygen (PaO2–PuO2) Gradient Monitoring for Early Detection of Acute Renal Failure in COVID-19 Patient: A Clinical Case Series

Early detection of acute renal failure by serum cystatin C in type 2 diabetes patients in Parul Sevashram hospital at Waghodia, Vadodara

Early detection of acute renal failure by serum cystatin C in type 2 diabetes patients in Parul Sevashram hospital at Waghodia, Vadodara

Signal Detection of Acute Renal Failure Following the Use of SGLT-2 Inhibitors: Stratified Analysis and Time Trend Analysis in Japan and the United States.

The results of previous studies that have used databases to investigate the associations between sodium-glucose-cotransporter-2 (SGLT-2) inhibitors and acute renal failure (ARF) have differed, and the impact of biases such as the Weber effect and stimulated reporting has not been fully examined. This study aimed to determine the associations between SGLT-2 inhibitors and ARF using signal detection, the effects on signals of regulatory agency alerts for ARF, and the publication of prominent studies by measuring changes in signals over time. Data registered in the Food and Drug Administration's Adverse Event Reporting System from January 2013 to March 2020 were downloaded, signals were detected, and reporting odds ratios (RORs) were calculated for each country of occurrence (Japan/the United States). Quarterly changes in the number of reports and RORs were examined. Although an association between SGLT-2 inhibitor use and ARF was suggested in the United States, this study did not suggest such an association in Japan. The number of reports and RORs fluctuated when regulatory alerts and prominent studies were published, and events affecting the number of reports and RORs varied by country. This study revealed the difference in the associations between SGLT-2i and ARF in Japan and the United States. Additionally, the signal was identified to be influenced by alerts and the publication of studies. Therefore, these results should be interpreted cautiously as there could be a possibility of overestimation due to alert biases and publication of studies.

Changing serum creatinine in the detection of acute renal failure and recovery following radiocontrast studies among acutely ill inpatients: Reviewing insights regarding renal functional reserve gained by large-data analysis

A rise in serum creatinine (SCr) is widely used for the detection and definition of evolving acute kidney injury (AKI). Yet, it takes time for SCr to re-adjust in response to changes in glomerular filtration rate (GFR), and subtle transient changes in GFR may remain concealed. Additionally, it cannot differentiate altered glomerular hemodynamics and pre-renal failure from true renal tissue injury, necessitating additional clinical and laboratory diagnostic tools.While these features limit the usefulness of SCr and subsequently estimated GFR (eGFR) at a single time point for the individual patient, their overall pattern of changes along time in a large cohort of hospitalized patients may provide a powerful perspective regarding the detection and assessment of shifting kidney function in this population. Herein we review our experience running large data analyses, evaluating patterns of day-to-day changes in SCr among inpatients, occurring around the exposure to iodinated radiocontrast agents. These large data evaluations helped substantiating the existence of contrast-induced nephropathy in patients with advanced renal failure, underscoring the impact of predisposing and confounding factors. It also provides novel insights regarding a phenomenon of "acute kidney functional recovery” (AKR), and illustrate that the incidence of AKI and AKR along the scale of baseline kidney function co-associates and is inversely proportional to kidney function. This can be attributed to renal functional reserve, which serves as a buffer for up-and-down changes in GFR, forming the physiologic explanation for concealed subclinical AKI.

Serum KIM-1 and Cyctatin levels as predictors of acute kidney injury in asphyxiated neonates

Introduction: Asphyxia may lead to serious complications among them acute kidney injury (AKI) is the most common. Early diagnosis of AKI can help prevent impaired acid-base, fluid and electrolytes balance that may lead to life-threatening complications. The current study has aimed to assess efficacy of KIM-1 and Cystatin-C in early diagnosis of AKI among asphyxiate neonates. Methods: This is a case-control study conducted on 45 asphyxiate neonates, which 24 were in the control group and 23 in the case group.Creatinine, KIM-1 and Cystatine-C were measured for participants within 8- and 4 days after birth and compared between cases and controls. Results: The mean level of Cr-Standardized KIM1 8 hours and 4 days after birth was significantly higher in case group compared to the control (p-value 0.67 ng/ml allows to predict kidney failure in newborns with 57.1‌% sensitivity and 86.4‌% specificity. Conclusion: Our study showed that high-specificity Kim-1 is a good biomarker for early detection of acute renal failure in asphyxiated infants, but similar expectations of cystatin cannot be expected for at least the first 8 hours after birth.

Biomarkers in the detection of acute renal failure associated with cardiac surgery

Biomarkers in the detection of acute renal failure associated with cardiac surgery

Comparative Efficacy of Serum Creatinine and Microalbuminuria in Detecting Early Renal Injury in Asphyxiated Babies in Calabar, Nigeria

Background: Microalbuminuria and serum creatinine are markers of acute kidney injury. Birth asphyxia is responsible for 50% of all newborn deaths and acute non-oliguric kidney injury is one of such complications. This study was undertaken to determine the efficacy of serum creatinine and microalbuminuria for the detection of early renal lesion in severely asphyxiated babies in Calabar, Nigeria. Materials and Method: This prospective cross-sectional investigational study was undertaken among severely asphyxiated babies admitted into the newborn units of the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Standard method for blood collection and determination of urea, electrolytes were used. Micral-test strips were used on samples negative only for albumin after using urine dipstick. Color comparison was done with the standardized color scale on test strip container after 5 minutes. Results: Fifty term newborn babies were enrolled, their serum electrolytes, creatinine and creatinine clearance were essentially normal. Six (12%) babies had positive microalbuminuria, while 44(88%) had negative microalbuminuria with specificity and negative predictive values of 100% and 88% respectively. Conclusion: Microalbuminuria was not useful for early detection of acute renal failure in babies with severe birth asphyxia, but further studies are recommended.

Neutrophil gelatinase-associated lipocalin (NGAL) as a potential biomarker for early detection of acute renal failure

Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker that can potentially be used for the detection of acute renal failure earlier and more accurately than current standard examinations, such as serum levels of creatinine and urea which are less sensitive and less specific. The objective of this research was to assess the ability of NGAL as a biomarker of acute renal failure by comparing the levels of serum urea and creatinine in rats with induced acute renal failure. Twelve male Wistar rats (Rattus norvegicus), 2 months of age with a body weight (BW) of 150–200 g, were allocated into two groups. Group I (n = 2), as the control group, were injected with sterile distilled water 10 mL/kg BW intramuscularly and group II (n = 10) were injected with 50 % glycerol 10 mL/kg BW intramuscular, the rats in all group had been fasting 12 h before injection. In group II, two rats were selected at each time point (0, 6, 12, 24 and 48 h after injection) bloods collected for analysis of urea and creatinine concentration and identification of NGAL and they were necropsied and the kidney removed for histopathological analysis and NGAL identification. The levels of creatinine and urea were analysed by independent t test. Identification of NGAL was conducted by one-step reverse transcriptase polymerase chain reaction and sequencing. Results showed that the glycerol injection significantly elevated the levels of urea at 6, 12 and 24 h compared to the control group (p < 0.05). Creatinine levels were significantly increased at 24 h compared to the control group (p < 0.05). The expression of NGAL in kidney and blood samples could be detected at 6, 12 and 24 h after induction. In conclusion, the blood NGAL could be detected before increasing of creatinine levels and could be used as an early detection of acute renal failure.

Clinical Analysis of 48 cases with Acute Renal Failure in Primary Nephrotic Syndrome

Objective To analyze the clinical manifestations, pathological type, ARF publication mechanism, treatment and prognosis of the primary nephrotic syndrome (PNS) with acute renal failure (ARF).Methods Retrospectively analyzed the clinical manifestations, the pathogenesis of ARF and its treatment and prognosis of those 48 patients with primary nephrotic syndrome (PNS) complicated with ARF in the Nephrology Institute of our hospital. Results 48 patients had the same clinical manifestations; the main pathological types are minimal change and minor change. After 4-to-20-days' treatment, all patients urine output was upto 1030～4300 ml; the average urine volume within 24h was (1800±500) ml. Most patients' renal function returned to normal, and the treatment effective rate was 83.33%. According to the clinical remission criteria, 35 patients with PNS got complete remission; 5 cases got partial remission; 8 patients got no remission; complete remission and partial remission time was 17 ～ 115 d, and the average time was(60.2± 31.3) d. Conclusion The main pathogenesis of PNS with ARF is tubulointerstitialy damage and renal tubular lumen protein tube blockage caused by sudden ARF. According to PNS clinical history and manifestations, its diagnosis is not difficult. The treatment key is the early detection of ARF and correcting the reversible factors of both PNS and ARF; thus PNS complicated with ARF will have a better prognosis. Key words: Primary nephrotic syndrome; Acute renal failure; Clinical performance; Treatment way

Serum Neutrophil Gelatinase-Associated Lipocalin Correlates With Kidney Function in Heart Allograft Recipients

The value of neutrophil gelatinase-associated lipocalin (NGAL) as a novel marker for early detection of acute renal failure has been highlighted recently. The aim of this study was to assess whether serum NGAL correlated with kidney function in heart allograft recipients. We evaluated serum NGAL, creatinine, and estimated glomerular filtration rate (GFR) in 164 heart allograft recipients on triple therapy. Heart transplant recipients showed significantly higher NGAL values than the control group. Kidney function was estimated using CKD-EPI, Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault formula, 24-hour creatinine clearance, and serum creatinine. Kidney function was significantly impaired among heart transplant recipients compared with healthy volunteers. On univariate analysis serum NGAL strongly correlated with serum creatinine ( r = .70, P < .001), estimated GFR (CKD-EPI, r = −.57, P < .001, MDRD r = .56, P < .001, Cockcroft-Gault, r = −.56, P < .001), 24-hour creatinine clearance ( r = .43, P < .001), and cystatin C ( r = .74, P < .001). In contrast, it was moderately correlated with red blood cell count ( r = −.39, P < .01), hemoglobin level ( r = −.42, P < .01), NT-proBNP ( r = .25, P < .01), and only weakly with New York Heart Association class ( r = .21, P < .05), time after transplantation ( r = .21, P < .05), or age ( r = .19, P < .05) upon multiple regression analysis, the best predictor of serum NGAL was estimated GFR (beta −0.87, P < .0001), explaining 89% of the NGAL concentrations. Even a successful heart transplantation is associated with kidney injury as reflected by elevated serum NGAL and reduced estimated GFR. Therefore, NGAL needs to be investigated as a potential early marker for impaired kidney function/injury, especially among patients with risk factors for renal damage, i.e., hypertension or diabetes, other than heart pathology.

Serum neutrophil gelatinase‐associated lipocalin correlates with kidney function in renal allograft recipients

The value of neutrophil gelatinase-associated lipocalin (NGAL) as a novel marker for early detection of acute renal failure has been highlighted recently. The aim of this study was to assess whether serum NGAL correlates with kidney function in kidney allograft recipients. Serum NGAL, creatinine, and estimated glomerular filtration rate (GFR) were evaluated in 100 kidney allograft recipients on triple therapy: calcineurin inhibitor, mycophenolate mofetil or azathioprine, prednisone and healthy volunteers. Kidney transplant recipients had significantly higher NGAL than the control group. Serum NGAL in univariate analysis was strongly correlated with serum creatinine (r = 0.78). Estimated GFR (r = -0.69), on the other hand, was moderately correlated with white blood cell count (r = 0.43) and only weakly with other parameters. In multiple regression analysis, the best predictor of serum NGAL was eGFR (beta -0.69), with other predictors being white blood cell count (beta 0.25) and high sensitivity C-reactive protein (hsCRP) (beta 0.23) explaining 82% of NGAL concentration. Even a successful kidney transplantation is associated with kidney injury as reflected by elevated serum NGAL and lowered eGFR. Therefore, NGAL needs to be investigated as a potential early marker for impaired kidney function/kidney injury, especially in patients with other risk factor for kidney damage, i.e., hypertension or diabetes.

Neutrophil Gelatinase-Associated Lipocalin and Cystatin C Could Predict Renal Outcome in Patients Undergoing Kidney Allograft Transplantation: A Prospective Study

Urinary neutrophil gelatinase-associated lipocalin (NGAL) may represent an early, predictive biomarker of delayed graft function due to ischemia-reperfusion injury. Unfortunately, creatinine is an unreliable indicator of acute changes in kidney function. NGAL was proposed as a novel early marker for detection of acute renal failure. Therefore, the aim of the study was to assess whether NGAL and cystatin C predicted outcomes among 41 consecutive patients undergoing kidney transplantation. Serum NGAL and cystatin C were evaluated before, as well as 1, 3, 6, and 10 days after kidney transplantation using commercially available kits. Serum creatinine was assessed at each time. We observed a significant fall in serum NGAL as early as 1 day following kidney transplantation. Serum cystatin C decreased significantly 3 days after transplantation. Before transplantation, serum NGAL was related to creatinine and cystatin C. At each time point, serum NGAL was related positively to serum creatinine, cystatin C, and negatively to urine volume. In patients with delayed graft function, there was no fall in serum NGAL or cystatin C. Our findings may have important implications for the clinical management of patients undergoing kidney transplantation. The “window of opportunity” to distinguish between acute rejection and calcineurin inhibitor nephrotoxicity is narrow in delayed graft function. Time is limited to introduce proper treatment after the initiating insult. Therefore, NGAL needs to be investigated as a potential early marker for delayed graft function, especially in the settings of early dialysis treatment or antirejection therapy.

NGAL (neutrophil gelatinase-associated lipocalin) and L-FABP after percutaneous coronary interventions due to unstable angina in patients with normal serum creatinine

The value of NGAL (neutrophil gelatinase-associated lipocalin) and L-FABP (liver-type fatty acid binding protein) has been highlighted as a novel biomarker of detection of acute renal failure in children after cardiac surgery. Interventional cardiologists are being asked more frequently to perform percutaneous coronary intervention (PCI) and contrast nephropathy is its potentially serious complication. We aimed to prospectively assess NGAL and L-FABP in patients with normal serum creatinine undergoing PCI due to unstable angina. We measured serum NGAL, urinary NGAL and L-FABP using commercially available kits before and after 2, 4, 12, 24 and 48 hours following PCI in 25 patients. We found a significant rise in serum NGAL after 2 and 4 hours. Urinary NGAL and urinary L-FABP followed the same pattern. Both markers increased significantly after 4 hours and remained elevated up to 48 hours after PCI. Serum creatinine did not change significantly during the study period. NGAL and L-FABP may represent a sensitive early biomarkers of renal impairment after PCI. Persistently increased urinary NGAL and L-FABP may suggest renotubular damage in this population.

Serum cystatin C in mouse models: a reliable and precise marker for renal function and superior to serum creatinine

Serum creatinine (SCR) and blood urea nitrogen (BUN) determine the glomerular filtration rate (GFR) improperly in acute renal failure. Serum cystatin C (CYS) has the potential to be a more precise marker for GFR. The aim of this study was to compare the sensitivity of SCR, BUN and CYS with respect to the detection of acute renal failure in mice. In an ischaemia reperfusion (I/R) injury model, mice suffered 60-min left kidney ischaemia and right nephrectomy. In a nephrectomy model, mice were nephrectomized to a different extent: from unilateral (3/6Nx) to bilateral nephrectomy (BiNx). Blood samples were collected 2, 12 or 24 h post-op. SCR, BUN and CYS increased significantly in the I/R-model in comparison to sham mice and 3/6Nx mice at 12 and 24 h post-op (SCR P = 0.009; BUN P < 0.001 and CYS P < 0.004). There were no significant differences in all three markers between 3/6Nx and sham-operated mice. In graded nephrectomy, BUN and CYS showed already significantly the loss of kidney in 4/6Nx mice 12 h post-op [BUN (mg/dl): sham 26.4 +/- 3.5, 4/6Nx 52.3 +/- 13.4, P < 0.01; CYS (mg/l): sham 0.08 +/- 0.03, 4/6Nx 0.15 +/- 0.04, P < 0.01], whereas SCR was only significantly increased in 5/6Nx and BiNx mice 24 h post-op [SCR (mg/dl): sham 0.39 +/- 0.05, 4/6Nx 0.52 +/- 0.07, P = 0.13, 5/6Nx 1.00 +/- 0.29, P < 0.01]. In the longitudinal experiment, CYS showed the renal damage significantly earlier and to a larger extent (2 h: SCR 57 +/- 15%, BUN 40 +/- 16%, CYS 295 +/- 143%, P <0.001). CYS can be used as a reliable and precise marker for renal function in mouse models. CYS is more sensitive than SCR, and it shows renal damage earlier than SCR and BUN.

Urinary IL-18: A marker of contrast-induced nephropathy following percutaneous coronary intervention?

Objectives Contrast-induced nephropathy (CIN) is a complication that is underestimated in clinical practice after cardiac catheterization. Recently, the value of interleukin (IL)-18 as a novel biomarker for the detection of acute renal failure has been highlighted. In the present study, we sought to investigate whether urine IL-18 may be an early diagnostic marker of CIN. Design and methods We performed a nested case-control study using a hospital based cohort of all patients ( n = 157) admitted for elective PCI for stable angina to the Uludag University School of Medicine between February 2007 and June 2007. We identified 15 patients (9.5%) with CIN. Controls were matched with cases at an attempted 2.5:1 ratio by age and gender. Urinary IL-18 values were measured before as well as 24 and 72 h after the PCI. Results No statistically significant differences in urine IL-18 were detected between cases ( n = 15) and controls ( n = 36) or between the patient samples obtained before PCI and after the invasive procedure in both study groups. Conclusions These findings argue against the hypothesis that urine IL-18 may be clinically useful as a biomarker of CIN after radiological procedures requiring intravascular administration of iodinated contrast media. Further studies with larger sample sizes are needed to validate our findings.

Could Neutrophil-Gelatinase-Associated Lipocalin and Cystatin C Predict the Development of Contrast-Induced Nephropathy after Percutaneous Coronary Interventions in Patients with Stable Angina and Normal Serum Creatinine Values?

The value of neutrophil-gelatinase-associated lipocalin (NGAL) was highlighted as a novel biomarker for the detection of acute renal failure. We tested the hypothesis whether NGAL could represent an early biomarker of contrast-induced nephropathy (CIN) in 100 patients with normal serum creatinine values undergoing percutaneous coronary interventions (PCI). In addition, we assessed serum and urinary NGAL in relation to cystatin C, estimated glomerular filtration rate, and serum and urinary creatinine in these patients. We measured urinary and serum NGAL values before and 2, 4, 8, 24, and 48 h after the PCI. We found a significant rise in serum NGAL levels 2, 4, and 8 h after the PCI and in urinary NGAL values 4, 8, and 24 h after a PCI procedure. Cystatin C rose significantly 24 h after the procedure. The prevalence of CIN was 11%. The NGAL levels were significantly higher 2 h after the PCI (serum NGAL) or 4 h after the PCI (urinary NGAL), whereas the cystatin C values were higher only 8 and 24 h after a PCI procedure in patients with CIN. In multivariate analysis, only serum creatinine was a predictor of serum NGAL before a PCI. NGAL may represent a sensitive early biomarker of renal impairment after PCI. Serum creatinine level, the presence of diabetes, and the duration of the PCI may affect serum NGAL values and kidney function following a PCI procedure.

Neutrophil-Gelatinase-Associated Lipocalin and Renal Function after Percutaneous Coronary Interventions

Background/Aims: The value of neutrophil-gelatinase-associated lipocalin (NGAL), a novel biomarker in the detection of acute renal failure in children after cardiac surgery, has been highlighted in previous studies. The incidence of percutaneous coronary intervention (PCI) increases, which may possibly result in increased incidences of contrast nephropathy, its potentially serious complication. Therefore, the aim of our study was to assess prospectively NGAL in patients undergoing elective PCI in relation to serum creatinine. Methods: NGAL was assessed in the serum and urine using commercially available kits. Results: We measured urinary and serum NGAL before, and 2, 4, 12, 24 and 48 h after PCI. We found a significant rise in serum NGAL 2 and 4 h after PCI, and a rise in urinary NGAL 4 and 12 h after PCI. Before PCI, serum NGAL was significantly associated with serum creatinine, urea, urinary NGAL, hemoglobin, hematocrit, albumin, age and presence of diabetes. In multivariate analysis, serum creatinine was the only predictor of serum NGAL. Serum NGAL 2 h after PCI correlated with serum creatinine, duration of PCI, HbA1c, hematocrit, hemoglobin and urinary NGAL. In multivariate analysis, the only predictors of serum NGAL 2 h after PCI were serum creatinine, time of PCI and HbA1c. Serum NGAL before PCI was significantly higher in diabetics than in non-diabetics. Conclusions: NGAL may represent a sensitive early biomarker of renal impairment after PCI. Serum creatinine, duration of PCI, but not type and amount of contrast agent, and appropriate treatment of diabetes, reflected by HbA1c, predict a rise in serum NGAL and kidney function following PCI.

Early Detection of Acute Renal Failure by Serum Cystatin C

Early Detection of Acute Renal Failure by Serum Cystatin C

Early Detection of Acute Renal Failure by Serum Cystatin C

No AccessJournal of UrologyUrological Survey: Adrenal and Renal Physiology, and Medical Renal Disease1 Sep 2005Early Detection of Acute Renal Failure by Serum Cystatin C W. Scott McDougalM.D. W. Scott McDougalW. Scott McDougal More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)68497-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Early Detection of Acute Renal Failure by Serum Cystatin C." The Journal of Urology, 174(3), pp. 1024–1025 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 3September 2005Page: 1024-1025 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information W. Scott McDougal More articles by this author Expand All Advertisement PDF downloadLoading ...

One step forward in the early detection of acute renal failure

One step forward in the early detection of acute renal failure