Prognosis Of Acute Kidney Injury Research Articles

Incidence, risk factors, and prognosis of acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma: a prospective cohort study.

Transcatheter arterial chemoembolization (TACE) is an effective first-line therapy for intermediate stage hepatocellular carcinoma (HCC). Acute renal injury may be induced after transarterial chemoembolization because of iodinated radiocontrast medium, but its incidence, risk factors, and prognosis remain unclear. This prospective study enrolled 166 HCC patients with a total of 316 TACE treatments. The incidence, risk factors, and prognosis of acute kidney injury (AKI) were examined. The incidence of post-TACE AKI was 21.84% (69/316) according to Barrett and Parfrey criteria, whereas 7.59% (24/316) according to acute kidney injury network (AKIN) criteria. Multivariate logistic regression analysis showed that serum total bilirubin (TB) (>13.5 μmol/L; odds ratio [OR]: 1.871 95% confidence interval [CI]: 1.044-3.352; P = 0.035) and hemoglobin (HGB) level (<120 g/L; OR: 1.823, 95% CI: 1.019-3.264; P = 0.043) were associated with the development of AKI after TACE procedure in accordance to Barrett and Parfrey criteria. Meanwhile, age (>55 years; OR: 3.456, 95% CI: 1.107-10.790; P = 0.033), post-TACE AKI history (OR: 7.108, 95% CI: 1.387-36.434, P = 0.019), and serum aminotransferase level (>55 U/L; OR: 4.420, 95% CI: 1.792-10.906; P = 0.001) were associated with the development of AKI after TACE procedure in accordance to AKIN criteria. Total hospitalization cost was significantly higher (P = 0.034) in the patients with AKI after TACE procedure according to Barrett and Parfrey criteria. A post-TACE AKI diagnosis was associated with mortality in any definition used (P = 0.034 and P = 0.001 for Barrett and Parfrey and AKIN criteria, respectively). The present study showed that the incidence of post-TACE AKI was high in HCC patients (i.e., 7.59-21.84%) depending on criteria used. HGB (<120 g/L), serum TB (>13.5), and aminotransferase level (>55 U/L), age (>55 years) and post-TACE AKI history may be predictors of post-TACE AKI in HCC patients. The development of post-TACE AKI was associated with the risk of renal replacement treatment, prolonged renal insufficiency, or mortality according to AKIN criteria.

The main etiologies of acute kidney injury in the newborns hospitalized in the neonatal intensive care unit.

Introduction:Acute kidney injury (AKI) is one of the most common diseases among the newborns hospitalized in the neonatal intensive care units (NICUs), which is usually resulted from predisposing factors including sepsis, hypovolemia, asphyxia, respiratory distress syndrome (RDS), and heart failure. The goal of this study was to assess main etiologies, relevant risk factors, and early outcome of neonatal AKI.Materials and Methods:In a cross- sectional study, 49 consecutive neonates hospitalized in NICU of Besat hospital with diagnosis of AKI from October 2009 to October 2011 were investigated through census sampling method. AKI was diagnosed based on urine output and serum creatinine levels.Results:The prevalence of AKI was 1.54% (49 out of 3166 newborns hospitalized in NICU) with the female: male was 7:1. Thirty-nine patients (79.5%) were full-term neonates. Oliguria was observed in 38 (77.5%) patients. Sepsis was the most common predisposing factor for AKI in 77.5% of patients (n = 38) accompanied with the highest mortality rate among other factors (30.5%). Other leading causes of AKI included hypovolemia secondary to dehydration, followed by hypoxia secondary to RDS, patent ductus arteriosus, posterior urethral valve, asphyxia, and renal venous thrombosis. A positive relationship was observed between neonates' age, sex, urine output, and also between serum creatinine levels with initiation of dialysis. The mortality rate among the newborns hospitalized with AKI was 36.7%. Eighteen (36.7%) newborns were treated with peritoneal dialysis (PD) of whom 10 patients (55.6%) died, 31 patients were managed conservatively of whom five neonate died (25.9%).Discussion:Prognosis of AKI in the oliguric neonates requiring PD is very poor. It is thus recommended to prevent AKI by predicting and rapid diagnosis of AKI in patients with potential risk factors and also by early and effective treatment of such factors in individuals with AKI.

Study of Clinical Profile and Prognostic Factors of Acute Kidney Injury (AKI) In Tertiary Referral Centre in Marathwada

Mortality in acute kidney injury (AKI) remains impressively high despite technical and medical advances made following the advent of dialysis. Previous studies of prognosis in AKI have analyzed the influence of demographic factors, severity of AKI, nature of diseases causing AKI, coexisting diseases, treatment received and complications. Several other factors also affect prognosis of AKI viz. oliguria, a rise in serum creatinine greater than 3 mg%, older debilitated patients, multiorgan failure, associated comorbid conditions, need of dialysis, suspected or proven sepsis. Hence cases of AKI were studied at tertiary health centre in Marathwada region of Maharashtra to study the clinical profile and factors affecting the prognosis of acute kidney injury.

Acute Kidney Injury after Major Abdominal Surgery: A Retrospective Cohort Analysis

Background. We analyzed the incidence, risk factors, and prognosis of acute kidney injury (AKI) in a cohort of patients undergoing major abdominal surgery. Methods. A total of 450 patients were retrospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dl or by an increase in SCr ≥ 50% and/or by a decrease in urine output to 0.5 ml/kg/hour for 6 hours, in the first 48 hours after surgery. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P value <0.05 was considered significant. Results. One hundred one patients (22.4%) had postoperative AKI. Age (adjusted odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05), nonrenal Revised Cardiac Risk Index score (adjusted OR 1.9, 95% CI 1.3–3.1, P = 0.003), intraoperative erythrocytes transfusions (adjusted OR 2.2, 95% CI 1.4–3.5, P <.0001), and nonrenal Simplified Acute Physiology Score II (adjusted OR 1.03, 95% CI 1.01–1.06, P = 0.0191) were associated with postoperative AKI. AKI was associated with increased in-hospital mortality (20.8% versus 2.3%, P <.0001; unadjusted OR 11.2, 95% CI 4.8–26.2, P <.0001; adjusted OR 3.7, 95% CI 1.2–11.7, P = 0.024). Conclusion. AKI was common in patients undergoing major abdominal surgery and was associated with in-hospital mortality.

Frequency and prognosis of acute kidney injury in burned patients

Frequency and prognosis of acute kidney injury in burned patients

Procalcitonin Levels Predict Acute Kidney Injury and Prognosis in Acute Pancreatitis: A Prospective Study

BackgroundAcute kidney injury (AKI) has been proposed as a leading cause of mortality for acute pancreatitis (AP) patients admitted to the intensive care unit (ICU). This study investigated the predictive value of procalcitonin (PCT) for AKI development and relevant prognosis in patients with AP, and compared PCT’s predictive power with that of other inflammation-related variables.MethodsBetween January 2011 and March 2013, we enrolled 305 cases with acute pancreatitis admitted to ICU. Serum levels of PCT, serum amyloid A (SAA), interleukin-6 (IL-6), and C reactive protein (CRP) were determined on admission. Serum PCT was tested in patients who developed AKI on the day of AKI occurrence and on either day 28 after occurrence (for survivors) or on the day of death (for those who died within 28 days).ResultsSerum PCT levels were 100-fold higher in the AKI group than in the non-AKI group on the day of ICU admission (p<0.05). The area under the receiver-operating characteristic (ROC) curve of PCT for predicting AKI was 0.986, which was superior to SAA, CRP, and IL-6 (p<0.05). ROC analysis revealed all variables tested had lower predictive performance for AKI prognosis. The average serum PCT level on day 28 (2.67 (0.89, 7.99) ng/ml) was significantly (p<0.0001) lower than on the day of AKI occurrence (43.71 (19.24,65.69) ng/ml) in survivors, but the serum PCT level on death (63.73 (34.22,94.30) ng/ml) was higher than on the day of AKI occurrence (37.55 (18.70,74.12) ng/ml) in non-survivors, although there was no significant difference between the two days in the latter group (p = 0.1365).ConclusionSerum PCT is superior to CRP, IL-6, and SAA for predicting the development of AKI in patients with AP, and also can be used for dynamic evaluation of AKI prognosis.

Acute kidney injury network classification system for evaluation of acute kidney injury in patients with severe traumatic brain injury

Objective To evaluate the incidence,severity,risk tactors and impact to prognosis of acute kidney injury (AKI) in patients with severe traumatic brain injury (sTBI) by using acute kidney injury network (AKIN) classification system.Methods A retrospective analysis was carried out in 136 patients with sTBI hospitalized between January 2007 and May 2011.Demographic data,admission evaluation (whether with hernia or not on admission,systolic pressure and mean arterial blood pressure,serum creatinine and urea nitrogen,and blood glucose),outcome at 6 months post-injury and mortality were collected.Renal function was assessed using AKIN criteria.The patients were divided into two groups based on the presence or absence of AKI (non-AKI group and AKI group).According to the severity of AKI,AKI group was further classified as AKI grade 1 group,AKI grade 2 group and AKI grade 3 group.The differences among groups were analyzed.Results According to AKIN classification system,31 (23％) out of the 136 patients were diagnosed as being with AKI,including 21 cases (68％) in AKI grade 1 group and 10 cases (32％) in AKI grade 2 and 3 groups.The patients at older age and with lower Glasgow coma scale (GCS) on admission,higher levels of serum creatinine and blood urea nitrogen on admission were prone to AKI.As compared with TBI patients with normal renal function,TBI patients associated with AKI had higher mortality and worse outcome.Conclusions AKI is a common complication of patients with sTBI.AKIN classification system can early diagnose AKI in sTBI patients and may contribute to improvement of the outcome. Key words: Brain injuries; Renal insufficiency ; Prognosis

Analysis of risk factors for acute renal injury in infants and young children after cardiopulmonary bypass

Objective To identify the risk facts for acute kidney injury (AKI) in infants and young children after cardiac surgery with cardiopulmonary bypass (CPB).Methods Data of 161 patients aged ≤3 years undergoing CPB were reviewed retrospectively from September,2012 to January,2013.According to the definition of AKI,they were divided into two groups:AKI group and non-AKI group.After univariate analysis,a binary logistic regression analysis was used to evaluate the independent risk factors in AKI after CPB.The predictive capability of risk factors for AKI was estimated by using an area under the receiver operating characteristic (ROC) curve.Results (1) Of them,23 (14.3％) patients were subjected to AKI after cardiac surgery.(2) Univariate analysis showed that age,body weight,preoperative serum concentration of cystatin C,duration of CPB time,duration of aortic cross-clamp,postponed sternum closure,RACHS-1,postoperative serum creatinine (Scr),postoperative serum cystatin C,inotropic score(IS),postoperative mechanical ventilation time,postoperative pulmonary hypertension,and postoperative nosocomial pneumonia were related to the development of AKI (P ＜ 0.05).Logistic regression analysis showed that the independent risk factors for AKI were postoperative serum cystatin C ≥ 1.02 mg/L (Odd Ratio:8.947),body weight ≤ 5 kg (OR:6.567) and Scr ≥ 35.6 μmoL/L (OR:5.387).Value for the ROC curve was 0.937.Conclusions (1) High risk population might be found out through preoperative evaluation of age,body weight and serum cystatin C before CPB.(2) The present results strongly suggest that postoperative serum cystatin C,body weight and postoperative Scr are risk factors of AKI after CPB,thereby making reliable and early diagnosis and prognosis of AKI. Key words: Infant ; Cardiopulmonary bypass ; Acute kidney injury ; Cystatin C ; Risk factor

Risk factors and short-term prognosis of acute kidney injury in elderly patients

To explore the risk factors and short-term outcomes of acute kidney injury (AKI) in elderly patients. A total of 232 elderly AKI patients at Chinese PLA General Hospital from June 2008 to December 2009 were enrolled. They were divided into two groups according to their outcomes at 28 days and at 29 days to 3 months after AKI respectively. Their clinical data were analyzed to explore the risk factors and their effects on the outcomes of AKI. There were 215 males and 17 females with an average age of (86.7 ± 5.3) years. Thirty-eight cases (16.4%) died within 28 days after AKI and 57 (24.6%) died within 3 months. Infection (43.1%) was the major cause of AKI. The other causes included hypovolemia (19.0%), use of nephrotoxic drugs (16.8%) and cardiovascular events (15.1%) respectively. Logistic regression analysis revealed that low body mass index (BMI), oliguria, mechanical ventilation, hypoalbuminemia and peak serum level of creatinine (Scr >246.5 µmol/L) were the prognostic factors of AKI in those patients dying within 28 days after AKI (P < 0.05). Low BMI, hypoalbuminemia and high blood level of urea nitrogen (BUN) were the prognostic factors of AKI in those patients dying within 29 days to 3 months after AKI (P < 0.05). Infection, hypovolemia, use of nephrotoxic drugs and cardiovascular events are common causes of AKI in elderly patients.Low BMI, oliguria, mechanical ventilation, hypoalbuminemia, high level of BUN and peak level of Scr ( > 246.5 µmol/L) are the prognostic factors of AKI in elderly patients.

Novel Urinary Biomarkers in Detecting Acute Kidney Injury, Persistent Renal Impairment, and All-Cause Mortality Following Decongestive Therapy in Acute Decompensated Heart Failure

BackgroundNew urinary biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18), are proposed to allow a more reliable early diagnosis and prognosis of acute kidney injury (AKI) in acute decompensated heart failure (ADHF). Our aim was to compare the predictive value of urinary NGAL, KIM-1, and IL-18 for the occurrence of AKI, persistent renal impairment, and mortality in ADHF. Methods and ResultsEighty-three patients admitted for ADHF were analyzed. Urinary creatinine (Cr), NGAL, KIM-1, and IL-18 were measured at baseline. Serum Cr was measured daily during the next 4 days and again at outpatient follow-up after 6 months. Mortality data were prospectively collected. Urinary NGAL, KIM-1, and IL-18 were modestly correlated with each other (Spearman ρ ≤0.61) and poorly correlated with estimated glomerular filtration rate (eGFR; Spearman ρ ≤0.28). None predicted AKI, defined as a 25% decrease in eGFR, during the index hospitalization, but urinary IL-18/Cr was the strongest predictor of persistently elevated serum Cr ≥0.3 mg/dL after 6 months compared with baseline (area under the receiver operating characteristic curve 0.674; P = .013). Urinary IL-18 was also significantly associated with all-cause mortality (hazard ratio 1.48, 95% confidence interval 1.16–1.87; P = .001). ConclusionsLike urinary NGAL, urinary KIM-1 and IL-18 are relatively modest predictors of AKI in ADHF. Among these novel renal biomarkers examined, further investigations regarding the prognostic value of urinary IL-18 are warranted.

Akutes Nierenversagen

New guidelines of the "Kidney Disease: Improving Global Outcome" (KDIGO) working group standardize the definition of acute kidney injury (AKI) and acute kidney disease (AKD) allowing the assessment of prognosis and efficacy of prophylactic and therapeutic measures in different patient cohorts. The degree of severity and the duration of acute kidney injury are critical factors for the development of chronic kidney disease and mortality. The achievement of optimal fluid volumes is a cornerstone in the treatment during the early phase of AKI, while volume overload should be avoided in the late phase of established AKI. Recently employed biomarkers are promising for the early detection and prognosis of AKI, but cannot yet be used as routine tests. Microscopic urinalysis, a very old and cost-effective diagnostic measure, provides valuable informations about the severity and the course of AKI.

A Retrospective Study of Acute Kidney Injury in Cats and Development of a Novel Clinical Scoring System for Predicting Outcome for Cats Managed by Hemodialysis

Information regarding acute kidney injury (AKI) in cats is limited, and there are no reliable tools to objectively assess disease severity and predict outcome. To assess clinical signs, clinicopathologic abnormalities, etiology, and outcome of cats with AKI, and to develop models using clinical metrics and empirically derived scores to predict outcome. One hundred and thirty-two client-owned cats. Retrospective study. Bivariate logistic regression analyses were performed to identify variables predictive of 30-day survival. Continuous variables outside the reference range were divided into quartiles to yield quartile-specific odds ratios (OR) for survival. Models were developed incorporating weighting factors assigned to each quartile based on the OR. A predictive score for each model was calculated for each cat by summing all weighting factors. A second, multivariable logistic regression model was created from actual values of the same variables. Receiver operating characteristic curve analyses were performed to determine the models' performance. Models were further tested using a subset of cases not used in initial assessment. Fifty five of 132 cats (42%) remained dialysis-independent for at least 30 days after discharge, and the remaining 77 cats either died (n = 37, 28%) or were euthanized (n = 40, 30%). The most common etiology was ureteral obstruction (n = 46, 35%). Higher scores were associated with decreased probability of survival (P < .001). Models correctly classified outcomes in 75-77% of the cases and 84-89% of the cases in the subsequent evaluation. Models can provide objective guidance in assessing AKI prognosis and severity, but should be validated in other cohorts of cats.

Renal Function–Based Contrast Dosing Predicts Acute Kidney Injury Following Transcatheter Aortic Valve Implantation

This study sought to assess whether the volume of contrast media (CM) influences the occurrence of acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI). The volume of CM has been shown to be associated with increasing risk of AKI; however, in a high-risk elderly TAVI population, the predictive value and optimal threshold of CM dose on AKI remain uncertain. Data of 415 consecutive transfemoral TAVI patients (age 83.6 ± 6.8 years, logistic EuroSCORE 23.0 ± 12.2%) were analyzed. AKI was defined by Valve Academic Research Consortium criteria. Based on a previous formula, the ratio of CM to serum creatinine (SCr) and body weight (BW) (CM × SCr/BW) was calculated as defining the degree of CM use. The association between CM dose and incidence of AKI, as well as predictive factors and prognosis of AKI, were investigated. AKI occurred in 63 patients (15.2%). Cumulative 1-year mortality showed significant differences between the AKI and non-AKI groups (47.9% vs. 15.7%, p < 0.001). Mean CM × SCr/BW ratio was higher in the AKI group than in the non-AKI group (4.1 ± 2.9 vs. 2.9 ± 1.6, p < 0.001). By multivariate analysis, CM × SCr/BW per 1.0 increase, ejection fraction <40%, and transfusion were associated with the occurrence of AKI (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.03 to 1.20; p = 0.017, OR: 3.01; 95% CI: 1.49 to 5.00; p = 0.001, OR: 2.73; 95% CI: 1.54 to 6.15; p = 0.001, respectively). A threshold value of CM × SCr/BW for predicting AKI was statistically identified as 2.7. Although mechanisms of AKI following TAVI are multifactorial, the present study identified a relationship between CM dose increment and high prevalence of AKI. Therapeutic efforts not to exceed the threshold value may reduce the risk of AKI.

The histone deacetylase, SIRT1, contributes to the resistance of young mice to ischemia/reperfusion-induced acute kidney injury

Acute kidney injury (AKI) is a critical condition with a mortality rate as high as 50% and significantly contributes to the burden of end-stage renal disease (ESRD) requiring renal replacement therapy. The incidence and prognosis of AKI have been shown to vary with patient age, with younger individuals being more resistant to AKI. In mice, clamping the renal artery for 45 min causes substantial kidney damage in 4-month-old animals but only mild renal injury in 2-month-old animals. Here, younger mice were found to express higher levels of the NAD(+)-dependent histone deacetylase SIRT1 in the kidney. A small molecule SIRT1 activator, SRT-1720, markedly improved renal tubular pathology and overall renal function in adult mice following ischemia/reperfusion. Genetic ablation of one allele (SIRT1(+/-)) significantly enhanced the level of kidney damage relative to that in wild-type (SIRT1(+/+)) mice. The mechanisms underlying the protective effect of SIRT1 included the suppression of cell apoptosis. Hence, our results suggest that SIRT1 might be a novel therapeutic target for ischemia/reperfusion-induced kidney damage.

Incidence, predictors, and prognosis of acute kidney injury after transcatheter aortic valve implantation: A summary of contemporary studies using Valve Academic Research Consortium definitions

Incidence, predictors, and prognosis of acute kidney injury after transcatheter aortic valve implantation: A summary of contemporary studies using Valve Academic Research Consortium definitions

NGAL and Metabolomics: The Single Biomarker to Reveal the Metabolome Alterations in Kidney Injury

Conditions affecting kidney structure and function can be considered acute or chronic, depending on their duration. Acute kidney injury (AKI) is one of a number of acute kidney diseases and consists of an abrupt decline in kidney function after an injury leading to functional and structural changes. The widespread availability of enabling technologies has accelerated the rate of novel biomarker discovery for kidney injury. The introduction of novel biomarkers in clinical practice will lead to better preventative and therapeutic interventions and to improve outcomes of critically ill patients. A number of biomarkers of functional change and cellular damage are under evaluation for early diagnosis, risk assessment, and prognosis of AKI. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as the most promising biomarker of kidney injury; this protein can be measured by commercially available methods in whole blood, plasma, serum, and urine. Concomitantly, metabolomics appears to be a snapshot of the chemical fingerprints identifying specific cellular processes. In this paper, we describe the role of NGAL for managing AKI and the potential benefits deriving from the combined clinical use of urine NGAL and metabolomics in kidney disease.

150: The incidence, risk factors and prognosis of acute kidney injury (AKI) according to the valve academic research consortium (VARC) definition after transcatheter aortic valve implantation (TAVI)

Few data are currently available about patients characteristics and procedural features associated with AKI after TAVI using the new recommended VARC definition. 99 patients underwent TAVI (1 procedural death, 78.8% transfemoral, 12.1% trans-apical/aortic and 9.1% subclavian access) between February 2009 and September 2011 at Rennes university hospital. Creatinine level was assessed daily at least up to 72 hours after TAVI. Patients’ characteristics, procedural features and outcomes according to VARC definitions were studied to evaluate determinants and prognostic impact of AKI. AKI occurred in 22 patients (22.2%). Among them, 5 were AKI 2 (5.1%), 8 were AKI 3 (9.1%) including 4 who needed dialysis (4%). At baseline, compared to no AKI or AKI 1, AKI 2 or 3 patients had a higher prevalence of moderate or severe chronic kidney disease (p=0.046) and ≥ grade 2 mitral regurgitation (p=0.03). During the post TAVI hospitalization, AKI 2 or 3 was associated to a higher rate of death from any cause (p=0.0009), major bleeding, acute heart failure (both p=0.002), infectious complications (p=0.0008) and longer total and ICU hospitalization duration (p=0.0004 and <0.0001 respectively). AKI 2 or 3 patients had a higher rate of 30-days and 6 months death from any cause (p=0.005 and p=0.0002 respectively) but only because of the deaths occurring during the initial hospitalization. Only AKI 3 was associated with a higher risk of 6-months NYHA class III or IV (p=0.016). AKI 2 or 3 as defined by the VARC criteria were associated with a higher risk of post procedural death because of their association with other major post procedural complications. AKI 3 was associated with a higher risk of short term worse functional outcomes. Figure 1: Time-to-event curv No AKI or AKI 1 N= 85 AKI 2 or 3 N=13 p value Age-yr 79.0 ±10.2 80.5±6.7 0.63 Logistic EuroSCORE 19.8±12.2 19.3±10.2 0.89 Left ventricular ejection fraction-% 48.2±14.4 58.1±12.5 0.02 Aortic valve area-cm 2 0.68±0.15 0.71±0.22 0.56

Value of power Doppler ultrasound to evaluate acute kidney injury

To explore the value of power Doppler ultrasound (PDU) in the evaluation of acute kidney injury(AKI). Renal blood flow of 40 AKI cases was monitored by power Doppler ultrasound and 4-level semiquantitative PDU score method employed. All cases were divided into 3 groups by PDU score. AKI stage and duration were compared. And the co-variables of death and (continuous renal replacement therapy) CRRT days (> 3) were also analyzed by Logistic regression analysis. A total of 40 AKI case were recruited. The 3-score group (n = 13)has lower mortality in intensive care unit and at 28 days than the 2-score group (n = 15) and the 1-score group (n = 12). The number of stage-3 AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 1, 4, 9 correspondingly, χ(2) = 16.103, degree of freedom = 4, P = 0.003). The number of persistent AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 3, 9, 10 correspondingly, P < 0.05). Age, APACHEII score and PDU score (< 3) were closely correlated with death while age, APACHEII score, level of serum creatinine and PDU score (< 3) with CRRT days (> 3) (P < 0.05). PDU may be used to monitor renal hemodynamics in AKI patients and its score helps clinicians to evaluate the severity and prognosis of AKI.

The Role of Novel Biomarkers in Early Diagnosis and Prognosis of Acute Kidney Injury in Newborns

Acute kidney injury (AKI) refers to the rapid loss of renal function. In clinical practice, AKI is common among hospitalized patients of all age groups including neonates and remains an important cause of morbidity and mortality due to its late diagnosis and therefore delayed therapeutic intervention. Although the precise incidence of AKI in newborn is unknown, several studies have reported that 8 to 24% of all critically ill newborns in neonatal intensive care units may develop the condition. We aim at reviewing the existing literature on novel serum and urinary biomarkers and discuss their role in the early diagnosis and prognosis of AKI in newborns. Specifically, this review will focus on cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in serum and on CysC, NGAL, kidney injury molecule-1, and IL-18 in urine.

Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) poses a significant risk of acute kidney injury (AKI). Little is known of the impact of TAVI and AKI on long-term kidney function and health cost. We explored the predictive factors and prognostic implications of AKI following TAVI. Single-centre retrospective analysis of 52 elderly patients undergoing TAVI was conducted. The primary endpoint was renal outcome which included the incidence of AKI and 12-month renal function after TAVI. Secondary endpoints were mortality, the length of hospital stay (LOS) and cost. AKI occurred in 15/52 (28.8%) patients (mean age 84 ± 6) and three patients (6%) required dialysis. Patients with AKI (AKI+) had greater comorbidity (diabetes and cerebrovascular disease) and a trend towards reduced estimated glomerular filtration rate (eGFR) at baseline compared with those without AKI (56.6 vs AKI-: 65.7 mL/min per 1.73 m(2) , P = 0.07). Following TAVI, AKI- patients experienced an immediate improvement in eGFR, which remained significantly higher at all time points compared with AKI+ patients (70.4 vs 46.9 at 6 months and 73.7 vs 53.0 at 12 months, P < 0.001). Cumulative mortality for AKI+versus AKI- group was 26.7% and 2.7% (P = 0.006). LOS doubled (P < 0.001) and average hospitalization cost per patient was 1.5 times higher in the AKI+ group (P < 0.001). Independent predictors of AKI were peri-procedural blood transfusion (OR: 2.4, 95% CI: 2.0-3.1), trans-apical approach (OR: 9.3, 95% CI: 4.3-23.7) and hypertension (OR: 6.4, 95% CI: 2.9-17.3). AKI developed in 28.8% of patients after TAVI and was associated with procedural technique and transfusion requirement, and an increased LOS and mortality. However, most patients achieved a significant and sustained improvement in eGFR.