Early diagnosis of acute kidney injury by urinary YKL-40 in critically ill patients in ICU: a pilot study

2020 ◽  
Vol 52 (2) ◽  
pp. 351-361 ◽  
Author(s):  
Eman Salah Albeltagy ◽  
Abeer Mohammed Abdul-Mohymen ◽  
Doaa Refaat Amin Taha
Keyword(s):  
Acute Kidney Injury ◽  
Pilot Study ◽  
Early Diagnosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury

Myo-Inositol Oxygenase as a Predictor of Acute Kidney Injury in Critically ill Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hayem M Aref ◽  
Haitham Ezzat ◽  
Hussein S Hussein ◽  
Mona E Asaad
Keyword(s):  
Acute Kidney Injury ◽  
Early Diagnosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Control Group ◽  
Specific Enzyme ◽  
Diagnostic Sensitivity And Specificity ◽  
Time Of Admission ◽  
Potential Use

Abstract Background Acute kidney injury (AKI) affects 45% of critically ill patients, resulting in increased morbidity and mortality. The diagnostic standard, plasma creatinine, is nonspecific and may not increase until days after injury. Aim of the work to assess myo inositol oxygenase as noval marker in early detection of acute kidney injury critically ill patients. Patients and Methods In this prospective study, 40 critically ill patients were followed up in ICU up regarding development of Aki in ICU according to KDIGO definition. They were categorized into two subgroups; 20 patients developed AKI in and 20 patients who did not develop AKI. In addition, a control group of 20 individuals in Ain Shams Hospital during the period from 2018 to 2019, we did myoinositol oxygenase level test at time of admission and repeated in patients group which develop AKI within 24-48 hours. Results MIOX for the diagnosis of AKI When the cut-off value was taken as above 800, the diagnostic sensitivity and specificity of MIOX for AKI were 100%). For creatinine, at the cut-off value of above 0.9, the sensitivity for AKI were found 90% and specificity for AKI were found 65%. Conclusion The measurement of serum MIOX is valuable for the diagnosis of AKI. Further research is needed for the evaluation of the potential use of MIOX as a kidney-specific enzyme in the early diagnosis of AKI.

Comparing Continuous Venovenous Hemodiafiltration and Peritoneal Dialysis in Critically Ill Patients with Acute Kidney Injury: A Pilot Study

2011 ◽  
Vol 31 (4) ◽  
pp. 422-429 ◽  
Author(s):  
Jacob George ◽  
Sandeep Varma ◽  
Sajeev Kumar ◽  
Jose Thomas ◽  
Sreepa Gopi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Pilot Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Continuous Venovenous Hemodiafiltration ◽  
Group A ◽  
Group B

BackgroundThere are few reports on the role of peritoneal dialysis in critically ill patients requiring continuous renal replacement therapies.MethodsPatients with acute kidney injury and multi-organ involvement were randomly allotted to continuous venovenous hemodiafiltration(CVVHDF, group A) or to continuous peritoneal dialysis (CPD, group B). Cause and severity of renal failure were assessed at the time of initiating dialysis. Primary outcome was the composite correction of uremia, acidosis, fluid overload, and hyperkalemia. Secondary outcomes were improvement of sensorium and hemodynamic instability, survival, and cost.ResultsGroups A and B comprised 25 patients each with mean ages of 45.32 ± 17.53 and 48.44 ± 17.64 respectively. They received 21.68 ± 13.46 hours and 66.02 ± 69.77 hours of dialysis respectively ( p = 0.01). Composite correction was achieved in 12 patients of group A (48%) and in 14 patients of group B (56%). Urea and creatinine clearances were significantly higher in group A (21.72 ± 10.41 mL/min and 9.36 ± 4.93 mL/min respectively vs. 22.13 ± 9.61 mL/min and 10.5 ± 6.07 mL/min, p < 0.001). Acidosis was present in 21 patients of group A (84%) and in 16 of group B (64%); correction was better in group B ( p < 0.001). Correction of fluid overload was faster and the amount of ultrafiltrate was significantly higher in group A (20.31 ± 21.86 L vs. 5.31 ± 5.75 L, p < 0.001). No significant differences were seen in correction of hyperkalemia, altered sensorium, or hemodynamic disturbance. Mortality was 84% in group A and 72% in group B. Factors that influenced outcome were the APACHE (Acute Physiology and Chronic Health Evaluation) II score ( p = 0.02) and need for ventilatory support ( p < 0.01). Cost of disposables was higher in group A than in group B [INR7184 ± 1436 vs. INR3009 ± 1643, p < 0.001 (US$1 = INR47)].ConclusionsBased on this pilot study, CPD may be a cost-conscious alternative to CVVHDF; differences in metabolic and clinical outcomes are minimal.

scholarly journals Plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) – Early Biomarker for Acute Kidney Injury in Critically Ill Patients

2015 ◽  
Vol 1 (4) ◽  
pp. 154-161 ◽  
Author(s):  
Grigorescu Bianca ◽  
Fodor Raluca ◽  
Mihaly Veres ◽  
Monica Orlandea ◽  
Judita Badea ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Early Diagnosis ◽  
Creatinine Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Likelihood Ratios ◽  
Roc Curve Analysis ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Abstract Introduction: NGAL (Neutrophil Gelatinase Associated Lipocalin) is a biomarker recently introduced into clinical practice for the early diagnosis of acute kidney injury (AKI). The aim of this study was to correlate the plasmatic NGAL value determined at admission with clinical progression and severity of AKI in critically ill patients. Material and method: Thirty two consecutive critically ill adult patients at risk of developing AKI (trauma, sepsis), admitted in Intensive Care Unit of the Clinical County Emergency Hospital Mures, between January to March 2015 were enrolled in the study. For each patient included in the study plasma NGAL levels were determined on admission, and these were correlated with the degree of AKI development (according to AKIN criteria) at 48 hours and 5 days post admission. The discriminatory power of NGAL, creatinine, creatinine clearance and corrected creatinine (depending on water balance) were determined using the ROC (receiver-operating characteristic) and likelihood ratios. Results: ROC curve analysis showed a better discriminatory capacity in terms of early diagnosis of AKI for NGAL (AUC=0.81 for NGAL, AUC=0.59 for creatinine, AUC=0.62 for corrected creatinine, AUC=0.29 for creatinine clearance). The value of likelihood ratio was also significantly higher for NGAL (3.01±2.73 for NGAL, 1.27±1.14 for creatinine, 1.78±1.81 for corrected creatinine, and 0.48±0.33 for creatinine clearance). Conclusions: NGAL biomarker has a better discrimination capacity for early prediction of acute kidney injury compared to previously used markers.

scholarly journals The Use of Plasma and Urine Neutrophil Gelatinase Associated Lipocalin (NGAL) and Cystatin C in Early Diagnosis of Septic Acute Kidney Injury in Critically Ill Patients

2013 ◽  
Vol 34 (4) ◽  
pp. 237-246 ◽  
Author(s):  
Müge Aydoğdu ◽  
Gül Gürsel ◽  
Banu Sancak ◽  
Serpil Yeni ◽  
Gülçin Sarı ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Early Diagnosis ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Urinary Ngal ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Septic Acute Kidney Injury ◽  
Neutrophil Gelatinase

Aim: To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients.Methods: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge.Results: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively).Conclusion: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.

scholarly journals Pilot Study of the Pharmacokinetics of Cefotaxime in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

2016 ◽  
Vol 60 (6) ◽  
pp. 3587-3590 ◽  
Author(s):  
Joost B. Koedijk ◽  
Corinne G. H. Valk-Swinkels ◽  
Tom A. Rijpstra ◽  
Daan J. Touw ◽  
Paul G. H. Mulder ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Pilot Study ◽  
Plasma Level ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Kidney Injury

The objective of this study was to describe the pharmacokinetics of cefotaxime (CTX) in critically ill patients with acute kidney injury (AKI) when treated with continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). This single-center prospective observational pilot study was performed among ICU-patients with AKI receiving ≥48 h concomitant CRRT and CTX. CTX was administered intravenously 1,000 mg (bolus) every 6 h for 4 days. CRRT was performed as continuous venovenous hemofiltration (CVVH). Plasma concentrations of CTX and its active metabolite desacetylcefotaxime (DAC) were measured during CVVH treatment. CTX plasma levels and patient data were used to construct concentration-time curves. By using this data, the duration of plasma levels above 4 mg/liter (four times the MIC) was calculated and analyzed. Twenty-seven patients were included. The median CTX peak level was 55 mg/liter (range, 19 to 98 mg/liter), the median CTX trough level was 12 mg/liter (range, 0.8 to 37 mg/liter), and the median DAC plasma level was 15 mg/liter (range, 1.5 to 48 mg/liter). Five patients (19%) had CTX plasma levels below 4 mg/liter at certain time points during treatment. In at least 83% of the time any patient was treated with CTX, the CTX plasma level stayed above 4 mg/liter. A dosing regimen of 1,000 mg of CTX given four times daily is likely to achieve adequate plasma levels in patients with AKI treated with CVVH. Dose reduction might be a risk for suboptimal treatment.

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