Acute Kidney Injury Monitoring Research Articles

A clinical risk score for predicting acute kidney injury in sepsis patients receiving normal saline in Northern Thailand: a retrospective cohort study.

Normal saline is commonly used for resuscitation in sepsis patients but has a high chloride content, potentially increasing the risk of acute kidney injury (AKI). This study evaluated risk factors and developed a predictive risk score for AKI in sepsis patients treated with normal saline. This retrospective cohort study utilized the medical and electronic health records of sepsis patients who received normal saline between January 2018 and May 2020. Predictors of AKI used to construct the predictive risk score were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the receiver operating characteristic curve (AUROC) and the expected-to-observed (E/O) ratio. Internal validation was conducted using bootstrapping techniques. AKI was reported in 211 of 735 patients (28.7%). Eight potential risk factors, including norepinephrine, the Acute Physiology and Chronic Health Evaluation II score, serum chloride, respiratory failure with invasive mechanical ventilation, nephrotoxic antimicrobial drug use, history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use, history of liver disease, and serum creatinine were used to create the NACl RENAL-Cr score. The model demonstrated good discrimination and calibration (AUROC, 0.79; E/O, 1). The optimal cutoff was 2.5 points, with corresponding sensitivity, specificity, positive predictive value, and negative predictive value scores of 71.6%, 72.5%, 51.2%, and 86.4%, respectively. The NACl RENAL-Cr score, consisting of eight critical variables, was used to predict AKI in sepsis patients who received normal saline. This tool can assist healthcare professionals when deciding on sepsis treatment and AKI monitoring.

Prevalence, risk factors, and outcomes of acute kidney injury in a pediatric cardiac intensive care unit: A cross-sectional study.

Acute kidney injury (AKI) is a common complication in pediatric cardiac intensive care unit (CICU). This study aims to identify the prevalence, risk factors, and outcomes of AKI in pediatrics admitted to a CICU unit of a tertiary hospital. We retrospectively gathered the data of 253 randomly selected patients admitted to the CICU unit from March 2018 to March 2022. Data were collected from EHRs. We used the Kidney Disease Improving Global Outcomes (KDIGO) criteria for identifying AKI in patients. Overall, AKI prevalence was 22.9% in our population. In the multivariable analysis, vancomycin intake (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.15-3.84), angiography (OR: 4.38, 95% CI: 1.28-14.93), and mechanical ventilation (OR: 2.08, 95% CI: 1.02-4.23) were independent risk factors of AKI development and patients with AKI had a higher in-hospital mortality rate (OR: 5.81, 95% CI: 2.55-13.19), higher need for cardiopulmonary resuscitation(OR: 3.08, 95% CI: 1.17-8.09), and longer ICU length of stay(OR: 6.49, 95% CI: 3.31-9.67). Furthermore, furosemide administration was associated with lower risk of developing AKI (OR: 0.52, 95% CI: 0.27-0.97). AKI is common and is associated with worse outcomes in patients with congenital heart disease. Our results emphasize the importance of early identification and monitoring of AKI in the pediatric CICU setting.

Chinese clinical practice guideline for acute kidney injury

Acute kidney injury (AKI), a common and severe disease, is associated with a high risk of developing chronic kidney disease (CKD) and end-stage renal disease (ESRD), which is a global health burden with high morbidity and mortality. Although many foreign clinical practice guidelines have standardized the management and treatment of AKI, there is a lack of overall guidance for AKI which is suitable for our national conditions. Thus, an expert group in related fields were organized by the National Clinical Research Center for Kidney Diseases and Chinese Nephrologist Association to collaborate to complete the Chinese Clinical Practice Guideline for Acute Kidney Injury based on the latest existing evidence-based medical evidence both domestically and internationally. The guideline systematically introduces the definition and epidemiological feature, diagnosis and monitoring of AKI, pharmacological approaches to prevent or treat AKI, and management of renal replacement therapy, management of AKI on special populations, and the outcome and prognosis of AKI, aiming to provide reasonable recommendations for all level clinicians in China.

Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box.

Urine biochemistry (UB) remains a controversial tool in acute kidney injury (AKI) monitoring, being considered to be of limited value both in terms of AKI diagnosis and prognosis. However, many criticisms can be made to the studies that have established the so called “pre-renal paradigm” (used for decades as the essential physiological basis for UB assessment in AKI) as well as to more recent studies suggesting that UB has no utility in daily clinical practice. The aim of this article is to describe our hypothesis on how to interpret simple and widely recognized urine biochemical parameters from a novel perspective, propose the rationale for their sequential assessment and demonstrate their usefulness in AKI monitoring, especially in the critical care setting.

The renal artery pulsatility index enables real-time monitoring of acute kidney injury after digestive surgery

BackgroundPostoperative acute kidney injury after digestive surgery can be a critical problem that causes morbidity or mortality. Although serum creatinine reflects the renal function, it takes time to measure, and only severe renal failure induces an increase in creatinine. We tried to calculate the renal artery pulsatility index as a parameter to enable the real-time monitoring of acute kidney injury, which can be measured by routine bedside ultrasonography. This study aimed to evaluate the accuracy of the renal artery pulsatility index for the early detection of acute kidney injury after digestive surgery. MethodsOne hundred consecutive patients who underwent digestive surgery in a single institution from March to July 2018 were included. The renal artery pulsatility index was measured at 4 time points (preoperative day, postoperative day 1, postoperative day 4, and postoperative day 7). Perioperative acute kidney injury I was defined as a >0.3 mg/dL increase in serum creatinine and a serum creatinine level of >1.0 mg/dL at any postoperative time point. The association of the renal artery pulsatility index with perioperative acute kidney injury was analyzed. ResultsThe preoperative renal artery pulsatility index (average 1.4) was significantly high in aged patients and those with diabetes mellitus, hypertension, or chronic kidney disease. Furthermore, a high preoperative renal artery pulsatility index (cut-off: 1.6) was a predictor of perioperative acute kidney injury (n = 13). Moreover, the postoperative renal artery pulsatility index significantly increased in acute kidney injury cases. ConclusionThe renal artery pulsatility index was strongly correlated with acute kidney injury in the perioperative period. It appears to be an effective and less invasive procedure for the real-time monitoring that enables the early detection of acute kidney injury after digestive surgery.

A novel electrochemical kidney injury molecule-1 (KIM-1) immunosensor based covalent organic frameworks-gold nanoparticles composite and porous NiCo2S4@CeO2 microspheres: The monitoring of acute kidney injury

Acute kidney injury is among the most severe health problems today, with the greatest fatality ratios. The kidney injury molecule-1 (KIM-1) is considered to be a potential biomarker for diagnosis of the acute kidney injury. Herein, a sensitive, selective, and swift sandwich-type electrochemical KIM-1 immunosensor was fabricated based on porous NiCo2S4@CeO2 microspheres as a signal amplifier and covalent organic frameworks-gold nanoparticles (COFs-AuNPs) composite as an electrochemical sensor platform. The affinity of amino-gold between capture antibody and COFs-AuNPs composite led to immobilization of the capture antibody. The secondary antibody was then conjugated to NiCo2S4@CeO2 microspheres via electrostatic interactions. Transmission electron microscopy (TEM), scanning electron microscopy (SEM), fourier-transform infrared spectroscopy (FTIR), x-ray diffraction (XRD) and x-ray photoelectron spectroscopy (XPS) techniques were performed to characterize the as-prepared materials. Some electrochemical characterization techniques including cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS) and differential pulse voltammetry (DPV) were employed to gradually characterize the constructed immunosensor. The detection limit (LOD) of KIM-1 in plasma samples was calculated as 2.00 fg mL−1, making it an effective tool for the monitoring of acute kidney injury.

The role of the clinical laboratory in the detection and monitoring of acute kidney injury

Acute kidney injury (AKI) is a common syndrome presenting in multiple clinical settings and is frequently associated with serious short and long term adverse outcomes, which not only have impact on the patient but also on the health service increasing hospitalisation time and the costs related to the treatment. Early diagnosis and identification of the aetiology are essential for the management of the patients. During the last ten years, significant advances have been made towards the definition of this syndrome. The current consensus definitions of AKI include both changes in serum creatinine concentration and urine output. Although proposal have been made for the inclusion of novel biomarkers in the diagnostic workup of AKI as independent diagnostic markers these are not currently included in these definitions. In this review we will focus on these definitions and we will try to highlight their strengths and limitations in diagnosis and staging of AKI. Moreover, we will try to highlight the contribution of the clinical laboratory in AKI diagnosis in both the clinical and research settings.

Influencing factors and interpretation of the clinical laboratory assay result of acute kidney injury

More and more laboratory indicators including serum creatinine, serum cystatin C, urinary microalbumin, N-acetyl- beta- D- Glucosaminidase (NAG), kidney injury molecule 1 (KIM-1), neutrophil gelatinase- associated lipocalin (NGAL), interleukin 18 (IL-18) and L type fatty acid binding protein (L-FABP) are used to diagnose and monitor acute kidney injury (AKI). However, the clinical applicability and limitations of these indicators, as well as the detection effect factors and biological variation on the diagnosis and monitoring of AKI are very important, especially how to combine the detection effect factors and biological variation to interpret test result is attached great importance by the laboratory personnel.(Chin J Lab Med, 2016, 39: 879-884) Key words: Acute kidney injury; Creatinine; Cystatin C

Novel biomarkers of acute kidney injury and chronic kidney disease

Abstract Introduction Nowadays, laboratory evaluation of renal damage is based on conventional poorly-sensitive and poorly-specific markers, such as serum creatinine, urea and electrolyte levels. This stimulated continuous research on novel biochemical markers suitable for diagnosis and monitoring of acute kidney injury (AKI) and chronic kidney disease (CKD). Aim The aim of this paper was to review available evidence regarding novel biomarkers of kidney damage. Material and methods The review of available literature was conducted, using search terms ‘kidney damage biomarker’ and ‘kidney injury biomarker.’ Results and discussion Cystatin C, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-type fatty acid binding protein, selected urinary enzymes (e.g. N-acetyl-β-glucosidase) and low-molecular-weight proteins (e.g. β-2 microglobulin) seem to be the most promising biomarkers of both AKI and CKD. In turn, asymmetric dimethylarginine, inflammatory/fibrosis parameters (e.g. monocyte chemoattractant protein, transforming growth factor-β1) and Klotho-FGF23 axis raise most interest as the most selective markers of CKD. Conclusions Owing continuing progress in nephrology laboratory diagnostics, novel biomarkers of kidney damage are likely to be introduced in routine clinical practice.

Urine biochemistry assessment in critically ill patients: controversies and future perspectives.

In the past, urine biochemistry was a major tool in acute kidney injury (AKI) management. Classic papers published some decades ago established the values of the urine indices which were thought to distinguish "pre-renal" (functional) AKI attributed to low renal perfusion and "renal" (structural) AKI attributed to acute tubular necrosis (ATN). However, there were a lot of drawbacks and limitations in these studies and some recent articles have questioned the utility of measuring urine electrolytes especially because they do not seem to adequately inform about renal perfusion nor AKI duration (transient vs. persistent). At the same time, the "pre-renal" paradigm has been consistently criticized because hypoperfusion followed by ischemia and ATN does not seem to explain most of the AKI developing in critically ill patients and distinct AKI durations do not seem to be clearly related to different pathophysiological mechanisms or histopathological findings. In this new context, other possible roles for urine biochemistry have emerged. Some studies have suggested standardized changes in the urine electrolyte composition preceding increases in serum creatinine independently of AKI subsequent duration, which might actually be due to intra-renal microcirculatory changes and activation of sodium-retaining mechanisms even in the absence of impaired global renal blood flow. In the present review, the points of controversy regarding urine biochemistry assessment were evaluated as well as future perspectives for its role in AKI monitoring. An alternative approach for the interpretation of measured urine electrolytes is proposed which needs further larger studies to be validated and incorporated in daily ICU practice.

Diallyl disulfide attenuates acetaminophen-induced renal injury in rats

This study investigated the protective effects of diallyl disulfide (DADS) against acetaminophen (AAP)-induced acute renal injury in male rats. We also investigated the effects of DADS on kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), which are novel biomarkers of nephrotoxicity in renal tissues, in response to AAP treatment. The following four experimental groups were evaluated: (1) vehicle control, (2) AAP (1,000 mg/kg), (3) AAP&DADS, and (4) DADS (50 mg/kg/day). AAP treatment caused acute kidney injury evidenced by increased serum blood urea nitrogen (BUN) levels and histopathological alterations. Additionally, Western blot and immunohistochemistry analysis showed increased expression of KIM-1 and NGAL proteins in renal tissues of AAP-treated rats. In contrast, DADS pretreatment significantly attenuated the AAP-induced nephrotoxic effects, including serum BUN level and expression of KIM-1 and NGAL proteins. Histopathological studies confirmed the renoprotective effect of DADS. The results suggest that DADS prevents AAP-induced acute nephrotoxicity, and that KIM-1 and NGAL may be useful biomarkers for the detection and monitoring of acute kidney injury associated with AAP exposure.

Sequential Serum Phosphate and Urinary Biochemical Changes in Postoperative Systemic Inflammatory Response Syndrome: Potential Additional Diagnostic Tools in Acute Kidney Injury

Systemic inflammatory response syndrome (SIRS) is frequent after major surgery and may lead to multiple organ failure. Many classical parameters such as leukocytes and platelets count, lactate and c-reactive protein are measured sequentially during SIRS in order to quantify the severity of the inflammatory/metabolic stress. Blood urea nitrogen and creatinine are usually assessed to evaluate renal function since acute kidney injury (AKI) is a frequent complication of SIRS. The aim of this case report is to describe sequential serum phosphate and sodium and potassium measurement in urine in parallel with AKI development and recovery. The aim is to suggest that these parameters may help in AKI monitoring in the context of SIRS.

Urine biochemistry in the early postoperative period after cardiac surgery: role in acute kidney injury monitoring.

We have recently suggested that sequential urine electrolyte measurement in critically ill patients may be useful in monitoring kidney function. Cardiac surgery is one of the leading causes of acute kidney injury (AKI) in the intensive care unit (ICU). In this paper, we describe the sequential behavior of urine electrolytes in three patients in the early (first 60 hours) postoperative period after cardiac surgery according to AKI status: no AKI, transient AKI, and persistent AKI. We have found that the patient with no AKI had stable and high concentrations of sodium (NaU) and chloride (ClU) in sequential spot samples of urine. AKI development was characterized in the other two patients by decreases in NaU and ClU, which have started early after ICU admission. Transient AKI was marked by also transient and less severe decreases in NaU and ClU. Persistent AKI was marked by the less favorable clinical course with abrupt and prolonged declines in NaU and ClU values. These electrolytes in urine had a behavior like a “mirror image” in comparison with that of serum creatinine. We suggest that sequential urine electrolytes are useful in monitoring acute kidney injury development in the early postoperative period after cardiac surgery.