POS-077 DIFFERENTIAL URINE PROTEOMIC PROFILE OF SUBJECTS WITH COMMUNITY ACQUIRED – ACUTE KIDNEY INJURY AND RENAL OUTCOME AT 4 MONTHS AFTER HOSPITAL DISCHARGE

Crescentic glomerulonephritis (GN) without immune reactants or deposits (referred to as pauci-immune) is typically characterized by the presence of anti-neutrophilic cytoplasmic antibodies (ANCA). While ANCA-negative patients might be expected to have a more benign course, they often have poor renal outcomes, especially without treatment with steroids and immune-modulating therapy. Pauci-immune crescentic GN can also co-exist with other autoimmune conditions, including rheumatoid arthritis (RA). Here, we describe an ANCA-negative patient with RA who developed dialysis-requiring acute kidney injury (AKI) with findings consistent with focal pauci-immune crescentic GN (i.e., no IgG or immune complex on kidney biopsy). Coexistent conditions included Klebsiella sepsis attributed to pneumonia, rhabdomyolysis, leukocytoclastic immune-mediated skin vasculitis, and positive ANA. He had spontaneous improvement in renal function without immunosuppressive therapy. This crescentic GN was not associated with poor renal outcome as AKI resolved with supportive care and treatment of his infection. The AKI was likely multifactorial with co-existing acute tubular necrosis in the setting of Kebsiella sepsis and rhabdomyolysis, and the crescentic GN was felt more likely to be related to the infection rather than having a primary role. This case highlights the importance of viewing crescentic GN in the context of the clinical picture, as it may not always lead to the need of aggressive immune suppression and is not a universally poor prognostic kidney finding. However, these cases do warrant close follow-up as our patient had recurrent RA disease manifestations over the next 2 years that eventually led to his death from severe pulmonary hypertension.

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Prognostic indicators of adverse renal outcome and death in acute kidney injury hospital survivors

Journal of Renal Injury Prevention ◽

10.15171/jrip.2016.14 ◽

2016 ◽

Vol 5 (2) ◽

pp. 61-68 ◽

Cited By ~ 4

Author(s):

Aida Hamzić-Mehmedbašić ◽

Senija Rašić ◽

Merima Balavac ◽

Damir Rebić ◽

Marina Delić-Šarac ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Prognostic Indicators ◽

Renal Outcome

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The missing link: hospital discharge letters following acute kidney injury

Journal of Renal Nursing ◽

10.12968/jorn.2015.7.1.20 ◽

2015 ◽

Vol 7 (1) ◽

pp. 20-26

Author(s):

Jennifer Allen ◽

Laura Harrison ◽

Linda Bisset

Keyword(s):

Acute Kidney Injury ◽

Hospital Discharge ◽

Kidney Injury ◽

Missing Link

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Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2019-030438 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030438

Author(s):

Eung Hyun Lee ◽

Su-Hyun Kim ◽

Jung-ho Shin ◽

Sung Bin Park ◽

Byung Hoon Chi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Acute Pyelonephritis ◽

Retrospective Cohort ◽

Obstructive Uropathy ◽

Kidney Injury ◽

Renal Outcome ◽

Factors Affecting

ObjectiveObstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function.DesignRetrospective cohort study.Setting and participants1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015.Outcome measuresEstimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy.ResultsWhen the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome.ConclusionsIn patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.

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High plasma C-terminal FGF-23 levels predict poor outcomes in patients with chronic kidney disease superimposed with acute kidney injury

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320964161 ◽

2020 ◽

Vol 11 ◽

pp. 204062232096416

Author(s):

Yu-Hsing Chang ◽

Che-Hsiung Wu ◽

Nai-Kuan Chou ◽

Li-Jung Tseng ◽

i-Ping Huang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Hospital Discharge ◽

Risk Prediction ◽

Hierarchical Clustering ◽

Risk Score ◽

Clustering Analysis ◽

Kidney Injury ◽

Hierarchical Clustering Analysis

Background: Elevated plasma C-terminal fibroblast growth factor-23 (cFGF-23) levels are associated with higher mortality in patients with chronic kidney disease (CKD) and acute kidney injury (AKI). Our study explored the outcome forecasting accuracy of cFGF-23 in critically ill patients with CKD superimposed with AKI (ACKD). Methods: Urine and plasma biomarkers from 149 CKD patients superimposed with AKI before dialysis were checked in this multicenter prospective observational cohort study. Endpoints were 90-day mortality and 90 days free from dialysis after hospital discharge. Associations with study endpoints were assessed using hierarchical clustering analysis, the generalized additive model, the Cox proportional hazard model, competing risk analysis, and discrimination evaluation. Results: Over a median follow up of 40 days, 67 (45.0%) patients died before the 90th day after hospital discharge and 39 (26.2%) progressed to kidney failure with replacement therapy (KFRT). Hierarchical clustering analysis demonstrated that cFGF-23 levels had better predictive ability for 90-day mortality than did other biomarkers. Higher serum cFGF-23 levels were independently associated with greater risk for 90-day mortality [hazard ratio (HR): 2.5; 95% confidence interval (CI) 1.5–4.1; p < 0.001]. Moreover, adding plasma cFGF-23 to the Demirjian AKI risk score model substantially improved risk prediction for 90-day mortality than the Demirjian model alone (integrated discrimination improvement: 0.06; p < 0.05; 95% CI 0.02–0.10). The low plasma cFGF-23 group was predicted having more weaning from dialysis in surviving patients (HR = 0.53, 95% CI, 0.29–0.95, p = 0.05). Conclusions: In patients with ACKD, plasma cFGF-23 levels are an independent risk factor to forecast 90-day mortality and 90-day progression to KFRT. In combination with the clinical risk score, plasma cFGF-23 levels could substantially improve mortality risk prediction.

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MP286THE SIGNIFICANCE OF SERUM FERRITIN LEVELS ON RENAL OUTCOME IN PATIENTS WITH ACUTE KIDNEY INJURY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx167.mp286 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii531-iii531

Author(s):

Zorica Dimitrijevic ◽

Branka Mitic ◽

Danijela Tasic ◽

Tatjana Cvetkovic

Keyword(s):

Acute Kidney Injury ◽

Serum Ferritin ◽

Kidney Injury ◽

Renal Outcome

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Renal outcome in long-term survivors from severe acute kidney injury in childhood

Pediatric Nephrology ◽

10.1007/s00467-011-2016-5 ◽

2011 ◽

Vol 27 (1) ◽

pp. 151-152 ◽

Cited By ~ 15

Author(s):

Marianne Viaud ◽

Brigitte Llanas ◽

Jérôme Harambat

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Renal Outcome ◽

Long Term Survivors

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Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

JAMA Network Open ◽

10.1001/jamanetworkopen.2021.1095 ◽

2021 ◽

Vol 4 (3) ◽

pp. e211095 ◽

Cited By ~ 1

Author(s):

James Nugent ◽

Abinet Aklilu ◽

Yu Yamamoto ◽

Michael Simonov ◽

Fan Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Discharge ◽

Kidney Function ◽

Kidney Injury

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Urine Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 to Detect Pediatric Cisplatin-Associated Acute Kidney Injury

Kidney360 ◽

10.34067/kid.0004802021 ◽

2021 ◽

pp. 10.34067/KID.0004802021

Author(s):

Kelly R. McMahon ◽

Hayton Chui ◽

Shahrad Rod Rassekh ◽

Kirk R. Schultz ◽

Tom D. Blydt-Hansen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Discharge ◽

Characteristic Curve ◽

Kidney Injury ◽

Urine Ngal ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Post Infusion ◽

Kidney Injury Molecule 1 ◽

Stage 1 ◽

Neutrophil Gelatinase

Background: Few studies have described associations between acute kidney injury (AKI) biomarkers, urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1), and AKI in cisplatin-treated children. We aimed to describe excretion patterns of urine NGAL and KIM-1 and associations with AKI in children receiving cisplatin. Methods: Participants (n=159) were enrolled between 2013 and 2017 in a prospective cohort study conducted in 12 Canadian pediatric hospitals. Participants were evaluated at early cisplatin infusions (at first or second cisplatin cycle) and late cisplatin infusions (last or second-to-last cycle). Urine NGAL and KIM-1 were measured (1) pre-cisplatin infusion, (2) post-infusion (morning after), and (3) at hospital discharge at early and late cisplatin infusions. Primary outcome: AKI defined by serum creatinine rise within 10 days post-cisplatin based on Kidney Disease: Improving Global Outcomes guidelines criteria (≥stage 1). Results: Of 159 children, 156 (median [interquartile (IQR)] age: 5.8 [2.4-12.0] years; 78 [50%] female) had biomarker data available at early cisplatin infusions and 127 had data at late infusions. Forty-six of 156 (29%) and 22/127 (17%) developed AKI within 10 days of cisplatin administration following early and late infusions, respectively. Urine NGAL and KIM-1 concentrations were significantly higher in patients with vs. without AKI (near hospital discharge of late cisplatin infusion, median [IQR]: NGAL: 76.1 [10.0-232.7] vs. 14.9 [5.4-29.7] ng/mg creatinine; KIM-1: 4415 [2083-9077] vs. 1049 [358-3326] pg/mg creatinine; P<.01). These markers modestly discriminated for AKI (area under receiver-operating characteristic curve (AUC-ROC) range: NGAL: 0.56-0.72; KIM-1: 0.48-0.75). Biomarker concentrations were higher and better discriminated for AKI at late cisplatin infusions (AUC-ROCs range: 0.54-0.75) vs. early infusions (AUC-ROCs range: 0.48-0.65). Conclusions: Urine NGAL and KIM-1 were modest at discriminating for cisplatin-associated AKI. Further research is needed to determine clinical utility and applicability of these markers and late kidney outcomes associations.

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