PD29-10 ACUTE KIDNEY INJURY AFTER PARTIAL NEPHRECTOMY: ROLE OF PARENCHYMAL MASS REDUCTION AND ISCHEMIA AND IMPACT ON SUBSEQUENT FUNCTIONAL RECOVERY

We sought to evaluate the association of postoperative acute kidney injury (AKI) adjusted for parenchymal mass reduction with long-term renal function in patients undergoing partial nephrectomy. A total of 629 patients undergoing partial nephrectomy were reviewed. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, by using either the unadjusted or adjusted baseline serum creatinine level, accounting for renal parenchymal mass reduction. Estimated glomerular filtration rates (eGFRs) were followed up to 61 months (median 28 months) after surgery. The primary outcome was the functional change ratio (FCR) of eGFR calculated by the ratio of the most recent follow-up value, at least 24 months after surgery, to eGFR at 3–12 months after surgery. Multivariable linear regression analysis was performed to evaluate whether unadjusted or adjusted AKI was an independent predictor of FCR. As a sensitivity analysis, functional recovery at 3–12 months after surgery compared to the preoperative baseline was analyzed. Median parenchymal mass reduction was 11%. Unadjusted AKI occurred in 16.5% (104/625) and adjusted AKI occurred in 8.6% (54/629). AKI using adjusted baseline creatinine was significantly associated with a long-term FCR (β = −0.129 ± 0.026, p < 0.001), while unadjusted AKI was not. Adjusted AKI was also a significant predictor of functional recovery (β = −0.243 ± 0.106, p = 0.023), while unadjusted AKI was not. AKI adjusted for the parenchymal mass reduction was significantly associated with a long-term functional decline after partial nephrectomy. A creatinine increase due to remaining parenchymal ischemic injury may be important in order to predict long-term renal functional outcomes after partial nephrectomy.

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Acute kidney injury in term infants with asphyxia and the role of ACE, AGT2R1, eNOS genes polymorphisms in its development

SOVREMENNAYA PEDIATRIYA ◽

10.15574/sp.2016.76.109 ◽

2016 ◽

Vol 76 (4) ◽

pp. 109-112

Author(s):

O. Korobka ◽

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Term Infants

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Impact of goal-directed hemodynamic management on the incidence of acute kidney injury in patients undergoing partial nephrectomy: a pilot randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01288-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiong-Fang Wu ◽

Hao Kong ◽

Zhen-Zhen Xu ◽

Huai-Jin Li ◽

Dong-Liang Mu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Partial Nephrectomy ◽

Controlled Trial ◽

Intervention Group ◽

Kidney Injury ◽

Control Group ◽

Hemodynamic Management ◽

Randomized Controlled ◽

Renal Hilum ◽

Pilot Randomized Controlled Trial

Abstract Background The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemia-reperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management may reduce AKI in patients following partial nephrectomy. Methods This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke volume variation < 6%, cardiac index 3.0–4.0 L/min/m2 and mean arterial pressure > 95 mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was performed according to routine practice. The primary outcome was the incidence of AKI within the first 3 postoperative days. Results From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72; control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28–1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups. Conclusion For patients undergoing partial nephrectomy, goal-directed circulatory management during surgery reduced postoperative AKI by about 40%, although not significantly so. The trial was underpowered. Large sample size randomized trials are needed to confirm our results. Trial registration Clinicaltrials.gov identifier: NCT02803372. Date of registration: June 6, 2016.

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The Role of Renal Functional Reserve in Predicting Acute Kidney Injury

Critical Care Clinics ◽

10.1016/j.ccc.2020.11.008 ◽

2021 ◽

Author(s):

Dana Y. Fuhrman

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Functional Reserve ◽

Renal Functional Reserve

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Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis

PLoS ONE ◽

10.1371/journal.pone.0231447 ◽

2020 ◽

Vol 15 (4) ◽

pp. e0231447 ◽

Cited By ~ 1

Author(s):

Jung-Woo Shim ◽

Kyoung Rim Kim ◽

Yoonju Jung ◽

Jaesik Park ◽

Hyung Mook Lee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Colorectal Surgery ◽

Propensity Score ◽

Risk Stratification ◽

Propensity Score Matching ◽

Enhanced Recovery ◽

Kidney Injury ◽

Propensity Score Matching Analysis ◽

Enhanced Recovery Protocol

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A zebrafish model of infection-associated acute kidney injury

AJP Renal Physiology ◽

10.1152/ajprenal.00328.2017 ◽

2018 ◽

Vol 315 (2) ◽

pp. F291-F299 ◽

Cited By ~ 7

Author(s):

Xiaoyan Wen ◽

Liyan Cui ◽

Seth Morrisroe ◽

Donald Maberry ◽

David Emlet ◽

...

Keyword(s):

Acute Kidney Injury ◽

Unmet Need ◽

Kidney Injury ◽

Edwardsiella Tarda ◽

Adult Zebrafish ◽

Zebrafish Model ◽

Pericardial Edema ◽

Kidney Injury Molecule 1 ◽

Dose Dependent

Sepsis-associated acute kidney injury (S-AKI) independently predicts mortality among critically ill patients. The role of innate immunity in this process is unclear, and there is an unmet need for S-AKI models to delineate the pathophysiological response. Mammals and zebrafish ( Danio rerio) share a conserved nephron structure and homologous innate immune systems, making the latter suitable for S-AKI research. We introduced Edwardsiella tarda to the zebrafish. Systemic E. tarda bacteremia resulted in sustained bacterial infection and dose-dependent mortality. A systemic immune reaction was characterized by increased mRNA expressions of il1b, tnfa, tgfb1a, and cxcl8-l1 ( P < 0.0001, P < 0.001, P < 0.001, and P < 0.01, respectively). Increase of host stress response genes ccnd1 and tp53 was observed at 24 h postinjection ( P < 0.0001 and P < 0.05, respectively). Moderate E. tarda infection induced zebrafish mortality of over 50% in larvae and 20% in adults, accompanied by pericardial edema in larvae and renal dysfunction in both larval and adult zebrafish. Expression of AKI markers insulin-like growth factor-binding protein-7 (IGFBP7), tissue inhibitor of metalloproteinases 2 (TIMP-2), and kidney injury molecule-1 (KIM-1) was found to be significantly increased in the septic animals at the transcription level ( P < 0.01, P < 0.05, and P < 0.05) and in nephric tubules compared with noninfected animals. In conclusion, we established a zebrafish model of S-AKI induced by E. tarda injection, with both larval and adult zebrafish showing nephron injury in the setting of infection.

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