Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes classifications

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

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Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

Journal of Clinical Medicine ◽

10.3390/jcm10061175 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1175

Author(s):

Emaad M. Abdel-Rahman ◽

Faruk Turgut ◽

Jitendra K. Gautam ◽

Samir C. Gautam

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Complete Recovery ◽

Severe Form ◽

Clinical Syndrome ◽

Current Evidence ◽

Clinical Predictors ◽

End Stage

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

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NGAL Usefulness in the Intensive Care Unit Three Hours after Cardiac Surgery

ISRN Nephrology ◽

10.5402/2013/865164 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Geoffray Delcroix ◽

Nicole Gillain ◽

Martial Moonen ◽

Luc Radermacher ◽

François Damas ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Low Sensitivity ◽

Neutrophil Gelatinase

Objective. Neutrophil gelatinase-associated lipocalin (NGAL) measured by a research ELISA is described as an early marker of acute kidney injury (AKI). The aim of this study is to define the usefulness of plasma NGAL (pNGAL) and urine NGAL (uNGAL) measured with platform analysers to detect AKI 3 hours after cardiac surgery in fifty adult patients. Methods and Main Results. pNGAL and uNGAL were measured before and 3 hours after cardiac surgery. AKI, defined following the acute kidney injury network definition, was observed in 17 patients. pNGAL was >149 ng/mL in 8 patients with AKI, two of them died in the follow-up. We also observed elevated pNGAL in 8 patients without AKI. Only one uNGAL was >132 ng/mL among the 15 AKI patients. Sensitivity of pNGAL for prediction of AKI is 47% and specificity is 75.7%. The positive likelihood ratio (LR+) is 1.9 and negative likelihood ratio (LR−) is 0.7. uNGAL performance is slightly improved when reported to urinary creatinine. Following this study, a ratio >62 ng/mg assure a sensitivity of 66.6% and a specificity of 78.5%. LR+ is 3 and a LR− is, 0.42. Conclusions. Three hours after cardiac surgery, pNGAL predicts AKI with a low sensitivity and specificity.

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Acute Kidney Injury in Poisoned Patients Admitted to ICU

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.30471 ◽

2020 ◽

Vol 10 (4) ◽

pp. 30471.1-30471.9

Author(s):

Roghayeh Rashidi ◽

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Aluminum Phosphide ◽

Waste Products ◽

Abrupt Decrease ◽

Significant Difference ◽

Multiple Drugs ◽

End Stage

Background: Acute Kidney Injury (AKI) is an abrupt decrease in kidney function, leading to the retention of urea and other nitrogenous waste products. Poisoned patients admitted to the Intensive Care Unit (ICU) may develop AKI due to some reasons. This study was done to evaluate the AKI in poisoned patients admitted to ICU. Methods: 146 patients, admitted to the ICU of Imam Reza Hospital from March 2017 to March 2018 were studied. AKI status was assessed using Acute Kidney Injury Network (AKIN) and Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) classification. Data analysis was done through SPSS V. 22 software. Results: Opioids, organophosphates, aluminum phosphide, multiple drugs, and other types of poisoning were the main five poisoning classes. Opioid toxicity was had the highest frequency with 51 patients; cases in this group experienced longer length of hospitalization stay and higher serum creatinine level than others did. Among 146 patients, 19 patients (12.8%) died, and 97 patients (66%) were transferred to the ICU. Of all cases, 18 patients (12.3%) had renal dysfunction (six patients were at risk, five patient at injury, and seven patients were at failure phase based on the RIFLE criteria). Renal replacement therapy was required in 24 cases (16.4%). Conclusion: It is unlikely to detect a significant difference in the occurrence of AKI between the main poisoning classes. Being the largest group of intoxicated patients admitted to the ICU, the opioid poisoning had the highest rate of AKI

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Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽

10.1097/md.0000000000002025 ◽

2015 ◽

Vol 94 (45) ◽

pp. e2025 ◽

Cited By ~ 46

Author(s):

Jia-Rui Xu ◽

Jia-Ming Zhu ◽

Jun Jiang ◽

Xiao-Qiang Ding ◽

Yi Fang ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Disease ◽

Kidney Injury ◽

Long Term Mortality

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Acute Kidney Injury

10.2310/surg.2154 ◽

2020 ◽

Author(s):

Aileen Ebadat ◽

Eric Bui ◽

Carlos V. R. Brown

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Loss Of Function ◽

Management Algorithm ◽

Consensus Statements ◽

Definition Of ◽

Stage Renal Disease ◽

End Stage

Acute renal failure definitions have changed dramatically over the last 5 to 10 years as a result of criteria established through the following consensus statements/organizations: RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes). In 2002, the Acute Dialysis Quality Initiative was tasked with the goal of establishing a consensus statement for acute kidney injury (AKI). The first order of business was to provide a standard definition of AKI. Up to this point, literature comparison was challenging as studies lacked uniformity in renal injury definitions. Implementing results into evidence-based clinical practice was difficult. The panel coined the term “acute kidney injury,” encompassing previous terms, such as renal failure and acute tubular necrosis. This new terminology represented a broad range of renal insults, from dehydration to those requiring renal replacement therapy (RRT). This review provides an algorithmic approach to the epidemiology, pathophysiology, diagnosis, prevention, and management of AKI. Also discussed are special circumstances, including rhabdomyolysis, contrast-induced nephropathy, and hepatorenal syndrome. Tables outline the AKIN criteria, most current KDIGO consensus guidelines for definition of AKI, differential diagnosis of AKI, agents capable of causing AKI, treatment for specific complications associated with AKI, and options for continuous RRT. Figures show the RIFLE classification scheme and KDIGO staging with prevention strategies. This review contains 1 management algorithm, 2 figures, 6 tables, and 85 references. Keywords: Kidney, renal, KDIGO, azotemia, critical, urine, oliguria, creatinine, dialysis

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Management of acute kidney injury and chronic kidney disease

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0141 ◽

2017 ◽

pp. 1087-1096

Author(s):

Natalie Ebert ◽

Elke Schaeffner

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Staging System ◽

Kidney Damage ◽

The Right ◽

Stage Renal Disease ◽

End Stage

Both acute and chronic states of kidney disease have considerable healthcare impact as they can produce enormous disease burden and costs. To classify chronic kidney disease into the CKD staging system, glomerular filtration rate as an index of kidney function, as well as albuminuria as a marker of kidney damage have to be assessed as correctly as possible. Misclassification is a serious concern due to the difficulties in precise GFR assessment and correct interpretation of results. Differentiating between pure senescence and true disease among older adults can be a delicate issue. To find the right renal replacement option for individuals that progress to end-stage renal disease can be challenging, and some older patients may even benefit from conservative care without dialysis. To prevent acute kidney injury as a frequent and potentially life-threatening complication, clinicians need to develop an understanding of the common vulnerability to kidney damage among older adults.

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