Detection Of Acute Renal Failure Research Articles

Early detection of acute renal failure by serum cystatin C: A new opportunity for a hepatologist

Acute renal failure (ARF) is associated with high mortality. Presently, no specific therapy for ARF exists. Therefore, early detection of ARF is critical to prevent its progression. However, serum creatinine, the standard marker to detect ARF, demonstrates major limitations. We prospectively evaluated whether serum cystatin C detected ARF earlier than serum creatinine. In 85 patients at high risk to develop ARF, serum creatinine and cystatin C were determined daily. ARF was defined according to the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and ESRD (RIFLE) classification when creatinine increased by >/= 50% (R-criteria), by >/= 100% (I-criteria), or by >/= 200% (F-criteria). In analogy, ARF was detected when cystatin C increased by >/= 50%, by >/= 100%, or by >/= 200%. Forty-four patients developed ARF and 41 served as controls. In ARF by R-, I-, and F-criteria, the increase of cystatin C significantly preceded that of creatinine. Specifically, serum cystatin C increased already by >/= 50% 1.5 +/− 0.6 days earlier compared to creatinine. Serum cystatin C demonstrated a high diagnostic value to detect ARF as indicated by area under the curve of the ROC analysis of 0.82 and 0.97 on the two days before the R-criteria was fulfilled by creatinine. Cystatin C detected ARF according to the R-criteria with a sensitivity of 55% and 82% on these days, respectively. Cystatin C also performed excellently, detecting ARF defined by the I- and F-criteria two days prior to creatinine, and moderately well predicting renal replacement therapy in the further course of ARF. Additionally, low T(3)- or T(3)/T(4) syndrome, glucocorticoid deficiency and excess did not affect cystatin C levels, adding to its usefulness in critically ill patients with ARF. Serum cystatin C is a useful detection marker of ARF, and may detect ARF one to two days earlier than creatinine. (Kidney Int 2004;66:1115-1122)

Early detection of acute renal failure by serum cystatin C

Acute renal failure (ARF) is associated with high mortality. Presently, no specific therapy for ARF exists. Therefore, early detection of ARF is critical to prevent its progression. However, serum creatinine, the standard marker to detect ARF, demonstrates major limitations. We prospectively evaluated whether serum cystatin C detected ARF earlier than serum creatinine. In 85 patients at high risk to develop ARF, serum creatinine and cystatin C were determined daily. ARF was defined according to the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and ESRD (RIFLE) classification when creatinine increased by >/=50% (R-criteria), by >/=100% (I-criteria), or by >/=200% (F-criteria). In analogy, ARF was detected when cystatin C increased by >/=50%, by >/=100%, or by >/=200%. Forty-four patients developed ARF and 41 served as controls. In ARF by R-, I-, and F-criteria, the increase of cystatin C significantly preceded that of creatinine. Specifically, serum cystatin C increased already by >/=50% 1.5 +/- 0.6 days earlier compared to creatinine. Serum cystatin C demonstrated a high diagnostic value to detect ARF as indicated by area under the curve of the ROC analysis of 0.82 and 0.97 on the two days before the R-criteria was fulfilled by creatinine. Cystatin C detected ARF according to the R-criteria with a sensitivity of 55% and 82% on these days, respectively. Cystatin C also performed excellently, detecting ARF defined by the I- and F-criteria two days prior to creatinine, and moderately well predicting renal replacement therapy in the further course of ARF. Additionally, low T(3)- or T(3)/T(4) syndrome, glucocorticoid deficiency and excess did not affect cystatin C levels, adding to its usefulness in critically ill patients with ARF. Serum cystatin C is a useful detection marker of ARF, and may detect ARF one to two days earlier than creatinine.

Acute renal failure: recognition and treatment in ward patients.

Nurses play a key role in the prevention and early detection of acute renal failure (ARF). This article provides an overview of patients in general ward settings who are at greatest risk of developing ARF and outlines the appropriate nursing interventions to assist diagnosis, prevention and management of this condition.

Tubular proteinuria and enzymuria following open heart surgery.

We investigated the effect of cardiac surgery on a marker of tubular damage, an enzyme called neutral endopeptidase (NEP), and on a marker of tubular function, retinol binding protein (RBP). Markers of tubular damage or function are useful in the early detection of acute renal failure and help identify the risk factors for this disease. We also examined if colloid interfered with NEP measurement. A controlled prospective cohort study. A teaching cardio-thoracic unit in London, England. Thirty-four patients underwent cardiac surgery. Eight patients waiting for cardiac surgery acted as controls. Twenty-five patients had coronary artery bypass graft, four patients had valve replacements, one patient had a coronary artery bypass graft with a valve replacement and one patient had a left ventricular aneurysm repair. Neutral endopeptidase was measured in all the patients and controls. In separate subgroups RBP ( n=5) and Gelofusine use ( n=12) were recorded. Urine samples were collected pre-operatively, 3 h, 1 and 4 days post-operatively. NEP rose significantly ( p<0.05) after cardiac surgery compared with the control population. RBP also rose significantly ( p<0.05) after cardiac surgery. NEP correlated with RBP 3 h post-operatively ( p<0.05, r(2)=0.97). There was no correlation between the amount of Gelofusine given and NEP excretion. Excretion of NEP and RBP were both increased after cardiac surgery. Colloid did not affect the excretion of NEP, although in other studies it has affected the excretion of RBP. This may make NEP excretion a better index of acute and impending renal damage following cardiac surgery.

Which Amino-Acids do Serum and Hemofiltrate of Critically Ill Patients with Acute Renal Failure Contain?

The removal of amino acids during continuous renal replacement therapies induces clinical problems. Previous studies on animals have shown nephroprotective (glycine, alanine) or negative effects (lysine) on renal function in occurrence of acute renal failure. Disturbed metabolism in acute renal failure needs adequate parenteral nutrition. On the other hand, experience with continuous renal replacement therapies of metabolic crises in inborn errors of metabolism indicate a good control of disturbed amino acid metabolism. The aim of our study was to find amino acids, that might play an important role in the pathogenesis, prognosis and detection of acute renal failure and severe illness, so far only estimated by lactic acid. Thirty-three probes (serum and hemofiltrate) were taken from patients, suffering with acute renal failure caused by septic shock, severe pancreatitis and hepatorenal syndrome, one hour after the beginning of extracorporal circulation, the conditions of treatment were standardized. The material was deproteinized and studied by the amino acid analyzer LBK 4251 Apha Plus (Pharmacia, Stockholm, Sweden), while the lactic acid concentration was determined in a standard laboratory. Proline, glycine, alanine, methionine and histidine showed a close relationship to the lactic acid levels, but these amino acids were an essential part of parenteral nutrition. A statistical relationship was also established in (amino acids with amide groups) asparagine, glutamine, citrulline, cystathionine and phosphoethanolamine. The mean values of most of the amino acids were higher than normal, but standard deviations were increased. The presence of these amino acids in hemofiltrate and the good sieving coefficients could mean that the better prognosis of critically ill patients in continuous renal replacement therapies may also be due to continuous control of amino acid levels (especially with amide groups).

Evaluation of Acute Renal Failure with Magnetic Resonance Imaging Using Gradient-Echo and Gd-DTPA

Detection of acute renal failure (ARF) using fast-scan magnetic resonance imaging (MRI) with Gd-DTPA was studied in a dog model. ARF was produced in five dogs by infusion of norepinephrine (0.75 micrograms/kg/min) into the renal arteries for 40 minutes. MRI was performed 1 hour later and compared with baseline (pre-ARF) MRI. There was no significant difference in the ratios of signal intensity-vs.-time curves from 0 to 35 seconds after injection of Gd-DTPA. However, a difference between the outer and inner medulla was significant in the time period of 5 to 20 minutes after Gd-DTPA injection. These later signal intensity differences by fast-scan (gradient-echo) technique may be useful in the evaluation of ARF.