scholarly journals Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation

2018 ◽  
Vol 105 (4) ◽  
pp. 1094-1101 ◽  
Author(s):  
Faeq Husain-Syed ◽  
Fiorenza Ferrari ◽  
Aashish Sharma ◽  
Tommaso Hinna Danesi ◽  
Pércia Bezerra ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Functional Reserve ◽  
Cardiac Operation ◽  
Renal Functional Reserve

scholarly journals Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

2021 ◽  
Vol 10 (14) ◽  
pp. 3113
Author(s):  
Kinga Musiał
Keyword(s):  
Acute Kidney Injury ◽  
Surrogate Marker ◽  
Kidney Injury ◽  
Tubuloglomerular Feedback ◽  
Everyday Practice ◽  
Special Focus ◽  
Functional Reserve ◽  
Renal Functional Reserve ◽  
Acute Kidney Disease ◽  
Pediatric Acute Kidney Injury

Pediatric acute kidney injury (AKI) is a major cause of morbidity and mortality in children undergoing interventional procedures. The review summarizes current classifications of AKI and acute kidney disease (AKD), as well as systematizes the knowledge on pathophysiology of kidney injury, with a special focus on renal functional reserve and tubuloglomerular feedback. The aim of this review is also to show the state-of-the-art in methods assessing risk and prognosis by discussing the potential role of risk stratification strategies, taking into account both glomerular function and clinical settings conditioned by fluid overload, urine output, or drug nephrotoxicity. The last task is to suggest careful assessment of eGFR as a surrogate marker of renal functional reserve and implementation of point-of-care testing, available in the case of biomarkers like NGAL and [IGFBP-7] × [TIMP-2] product, into everyday practice in patients at risk of AKI due to planned invasive procedures or treatment.

scholarly journals Renal Functional Reserve and Renal Recovery after Acute Kidney Injury

2014 ◽  
Vol 127 (1-4) ◽  
pp. 94-100 ◽  
Author(s):  
Aashish Sharma ◽  
Marìa Jimena Mucino ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Functional Reserve ◽  
Renal Functional Reserve

scholarly journals Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery

2018 ◽  
Vol 34 (2) ◽  
pp. 308-317 ◽  
Author(s):  
Faeq Husain-Syed ◽  
Fiorenza Ferrari ◽  
Aashish Sharma ◽  
Tommaso Hinna Danesi ◽  
Pércia Bezerra ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Functional Reserve ◽  
Renal Functional Reserve ◽  
Clinical Recovery

Renal functional reserve: from physiological phenomenon to clinical biomarker and beyond

2020 ◽  
Vol 319 (6) ◽  
pp. R690-R702 ◽  
Author(s):  
Alemayehu H. Jufar ◽  
Yugeesh R. Lankadeva ◽  
Clive N. May ◽  
Andrew D. Cochrane ◽  
Rinaldo Bellomo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Amino Acids ◽  
Acute Kidney Injury ◽  
Amino Acid ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Functional Reserve ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Renal Functional Reserve

Glomerular filtration rate (GFR) is acutely increased following a high-protein meal or systemic infusion of amino acids. The mechanisms underlying this renal functional response remain to be fully elucidated. Nevertheless, they appear to culminate in preglomerular vasodilation. Inhibition of the tubuloglomerular feedback signal appears critical. However, nitric oxide, vasodilator prostaglandins, and glucagon also appear important. The increase in GFR during amino acid infusion reveals a “renal reserve,” which can be utilized when the physiological demand for single nephron GFR increases. This has led to the concept that in subclinical renal disease, before basal GFR begins to reduce, renal functional reserve can be recruited in a manner that preserves renal function. The extension of this concept is that once a decline in basal GFR can be detected, renal disease is already well progressed. This concept likely applies both in the contexts of chronic kidney disease and acute kidney injury. Critically, its corollary is that deficits in renal functional reserve have the potential to provide early detection of renal dysfunction before basal GFR is reduced. There is growing evidence that the renal response to infusion of amino acids can be used to identify patients at risk of developing either chronic kidney disease or acute kidney injury and as a treatment target for acute kidney injury. However, large multicenter clinical trials are required to test these propositions. A renewed effort to understand the renal physiology underlying the response to amino acid infusion is also warranted.

scholarly journals A call to action to evaluate renal functional reserve in patients with COVID-19

2020 ◽  
Vol 319 (5) ◽  
pp. F792-F795
Author(s):  
Vincenzo Cantaluppi ◽  
Gabriele Guglielmetti ◽  
Sergio Dellepiane ◽  
Marita Marengo ◽  
Ravindra L. Mehta ◽  
...  
Keyword(s):  
Renal Function ◽  
Ventilatory Support ◽  
Kidney Tissue ◽  
Kidney Injury ◽  
World Health ◽  
Upper Respiratory Tract ◽  
Therapeutic Approaches ◽  
Functional Reserve ◽  
Call To Action ◽  
Renal Functional Reserve

Coronavirus disease 2019 (COVID-19) poses an unprecedented challenge to world health systems, substantially increasing hospitalization and mortality rates in all affected countries. Being primarily a respiratory disease, COVID-19 is mainly associated with pneumonia or minor upper respiratory tract symptoms; however, different organs can sustain considerable (if not terminal) damage because of coronavirus. Acute kidney injury is the most common complication of COVID-19-related pneumonia, and more than 20% of patients requiring ventilatory support develop renal failure. Additionally, chronic kidney disease is a major risk factor for COVID-19 severity and mortality. All these data demonstrate the relevance of renal function assessment in patients with COVID-19 and the need of early kidney-directed diagnostic and therapeutic approaches. However, the sole assessment of renal function could be not entirely indicative of kidney tissue status. In this viewpoint, we discuss the clinical significance and potential relevance of renal functional reserve evaluation in patients with COVID-19.

scholarly journals Renal Functional Reserve Is Related to the Nondipping Phenotype and to the Exercise Heart Rate Response in Patients with Essential Hypertension and Preserved Renal Function

2020 ◽  
Vol 45 (5) ◽  
pp. 737-747
Author(s):  
Katerina Damianaki ◽  
Michel Burnier ◽  
Kyriakos Dimitriadis ◽  
Costas Tsioufis ◽  
Dimitrios Petras
Keyword(s):  
Heart Rate ◽  
Renal Function ◽  
Essential Hypertension ◽  
Vascular Reactivity ◽  
Stress Test ◽  
Kidney Injury ◽  
Exercise Heart Rate ◽  
Functional Reserve ◽  
Hypertensive Patients ◽  
Renal Functional Reserve

Background: Renal functional reserve (RFR), defined as the difference between stress and resting glomerular filtration rate (GFR), may constitute a diagnostic tool to identify patients at higher risk of developing acute kidney injury or chronic kidney disease. Blunted RFR has been demonstrated in early stages of hypertension and has been attributed to impaired vascular reactivity due to an overactive sympathetic nervous system (SNS). Objective: The purpose of this study was to investigate whether RFR correlates with other phenotypes expressing overactivity of the SNS in patients with essential hypertension and preserved renal function. Methods: Thirty-six patients with untreated essential hypertension and a GFR >60 mL/min/1.73 m2 were enrolled. The following parameters were measured: RFR, 24-h ambulatory blood pressure (BP) profile, a treadmill stress test, and an echocardiographic examination. Urine and venous samples were obtained at specific time points for the determination of clinical parameters, and both resting and stress GFR were calculated by using endogenous creatinine clearance for the measurement of RFR after an acute oral protein load (1 g/kg). Results: Twenty-one patients had a RFR <30 mL/min/1.73 m2 and 15 had a RFR above this cutoff. A nondipping pattern of 24-h BP was significantly more frequent in patients with low RFR (57.1 vs. 25.0%, p < 0.05 for systolic BP and 52.3 vs. 10.0%, p < 0.02 for diastolic BP). Moreover, patients with lower RFR values showed a blunted heart rate (HR) response to exercise during treadmill test (r = 0.439, p < 0.05). None of the echocardiographic parameters differed between the two groups of patients. Conclusions: In hypertensive patients with preserved GFR, reduced RFR is related to nondipping BP phenotype as well as to attenuated exercise HR response. Overactivity of the SNS may be a common pathway. Since loss of RFR may represent a risk factor for acute or chronic kidney injury, hypertensive patients with blunted RFR might need a more careful renal follow-up.

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