Contrast and the Kidney

2019 ◽  
pp. 241-252
Author(s):  
Ayub Akbari ◽  
Swapnil Hiremath
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Isotonic Saline ◽  
Kidney Injury ◽  
Disease Status ◽  
Acute Injury ◽  
Risk Scores ◽  
Iodinated Contrast ◽  
Risk Patients ◽  
High Risk Populations

Iodinated contrast has revolutionized diagnosis and therapy but carries the risk of adverse effects, specifically acute kidney injury, in select high risk populations. This risk is substantially lower with the current generation of low- and iso-osmolar contrast media. Acute kidney injury in most cases is mild with favorable prognostic implications, and severe acute injury requiring dialysis is rare. Risk scores, typically including level of kidney function, diabetes, and cardiovascular disease status, can identify patients at high risk of developing acute kidney injury after contrast-enhanced procedures. Volume expansion with isotonic saline remains the most robust method of preventing acute kidney injury in select high risk patients.

Predicting Cardiac Surgery-Associated Acute Kidney Injury Using a Combination of Clinical Risk Scores and Urinary Biomarkers

2019 ◽  
Vol 68 (05) ◽  
pp. 389-400
Author(s):  
Philippe Grieshaber ◽  
Sina Möller ◽  
Borros Arneth ◽  
Peter Roth ◽  
Bernd Niemann ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
High Risk ◽  
Cleveland Clinic ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Risk Scores ◽  
High Risk Patients ◽  
Clinical Risk ◽  
Risk Patients

Background Prediction, early diagnosis, and therapy of cardiac surgery-associated acute kidney injury (CSA-AKI) are challenging. We prospectively tested a staged approach to identify patients at high risk for CSA-AKI combining clinical risk stratification and early postoperative quantification of urinary biomarkers for AKI. Methods All patients, excluding those on chronic hemodialysis, undergoing scheduled surgery with cardiopulmonary bypass between August 2015 and July 2016 were included. First, patients were stratified by calculating the Cleveland clinic score (CCS) and the Leicester score (LS). In high-risk patients (defined as LS > 25 or CCS > 6), urinary concentrations of biomarkers for AKI ([TIMP-2]*[IGFBP-7]) were evaluated 4 hours postoperatively. CSA-AKI was observed until postoperative day 6 and classified using the Kidney Disease: Improving Global Outcomes criteria. Results AKI occurred in 352 of613 patients (54%). In high-risk patients, AKI occurred more frequently than in low-risk patients (66 vs. 49%; p = 0.001). In-hospital mortality after AKI stage 2 (15%) or AKI stage 3 (49%) compared with patients without AKI (1.8%; p = 0.001) was increased. LS was predictive for all stages of AKI (area under the curve [AUC] 0.601; p < 0.001) with a poor or fair accuracy, while CCS was only predictive for stage 2 or 3 AKI (AUC 0.669; p < 0.001) with fair accuracy. In 133 high-risk patients, urinary [TIMP-2]*[IGFBP-7] was significantly predictive for all-stage AKI within 24 hours postoperatively (AUC 0.63; p = 0.017). However, for the majority of AKI (55%), which occurred beyond 24 hours postoperatively, urinary [TIMP-2]*[IGFBP-7] was not significantly predictive. Sensitivity for all-stage AKI within 24 hours was 0.38 and specificity was 0.81 using a cutoff value of 0.3. Conclusion CSA-AKI is a relevant and frequent complication after cardiac surgery. Patients at high risk for CSA-AKI can be identified using clinical prediction scores, however, with only poor to fair accuracy. Due to its weak test performance, urinary [TIMP-2]*[IGFBP-7] quantification 4 hours postoperatively does not add to the predictive value of clinical scores.

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

scholarly journals What nephrologist should know about COVID-19 outbreak?

2020 ◽  
Author(s):  
Omar maoujoud
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Renal Impairment ◽  
High Mortality ◽  
Medical Management ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Prognostic Indicator ◽  
High Risk Patients ◽  
Risk Patients

Acute Kidney injury is relatively uncommon in COVID-19 patients yet carries a high mortality. It occurs in patients complicated with ARDS or multiorgan failure, but further investigation about inflammatory and apopotic mechanisms during renal impairment are needed. Since the development of AKI is an important negative prognostic indicator for survival with CoV as reported in previous SAR-CoV and MERS-CoV outbreaks, adequate medical management of high risk patients with AKI may improve the results of previous outbreaks related to CoV.

scholarly journals A prospective study of acute kidney injury in the intensive care unit: development and validation of a risk prediction model

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Qi Wang ◽  
Yi Tang ◽  
Jiaojiao Zhou ◽  
Wei Qin
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
High Risk ◽  
Prediction Model ◽  
Risk Prediction ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Risk Prediction Model ◽  
Risk Patients

Abstract Background Acute kidney injury (AKI) has high morbidity and mortality in intensive care units (ICU). It can also lead to chronic kidney disease (CKD), more costs and longer hospital stay. Early identification of AKI is important. Methods We conducted this monocenter prospective observational study at West China Hospital, Sichuan University, China. We recorded information of each patient in the ICU within 24 h after admission and updated every two days. Patients who reached the primary outcome were accepted into the AKI group. Of all patients, we randomly drew 70% as the development cohort and the remaining 30% as the validation cohort. Using binary logistic regression we got a risk prediction model of the development cohort. In the validation cohort, we validated its discrimination by the area under the receiver operator curve (AUROC) and calibration by a calibration curve. Results There were 656 patients in the development cohorts and 280 in the validation cohort. Independent predictors of AKI in the risk prediction model including hypertension, chronic kidney disease, acute pancreatitis, cardiac failure, shock, pH ≤ 7.30, CK > 1000 U/L, hypoproteinemia, nephrotoxin exposure, and male. In the validation cohort, the AUROC is 0.783 (95% CI 0.730–0.836) and the calibration curve shows good calibration of this prediction model. The optimal cut-off value to distinguish high-risk and low-risk patients is 4.5 points (sensitivity is 78.4%, specificity is 73.2% and Youden’s index is 0.516). Conclusions This risk prediction model can help to identify high-risk patients of AKI in ICU to prevent the development of AKI and treat it at the early stages. Trial registration TCTR, TCTR20170531001. Registered 30 May 2017, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=2573

scholarly journals RenalGuard system in high-risk patients for contrast-induced acute kidney injury

2016 ◽  
Vol 173 ◽  
pp. 67-76 ◽  
Author(s):  
Carlo Briguori ◽  
Gabriella Visconti ◽  
Michael Donahue ◽  
Francesca De Micco ◽  
Amelia Focaccio ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Use of Ultrasound to Assess Hemodynamics in Acutely Ill Patients

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002322021
Author(s):  
Sami Safadi ◽  
Sarah Murthi ◽  
Kianoush B. Kashani
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Preventive Measures ◽  
Kidney Injury ◽  
Ultrasound Elastography ◽  
Hepatic Veins ◽  
Improved Outcomes ◽  
Risk Patients ◽  
Laboratory Variables ◽  
Oxygenation Status

Early diagnosis of acute kidney injury (AKI) and preventive measures can likely decrease the severity of the injury and improve patient outcomes. Current hemodynamic monitoring variables, including blood pressure, heart and respiratory rates, temperature, and oxygenation status, have been used to identify patients at high risk for AKI. Despite the widespread use of such variables, their ability to accurately and timely detect high-risk patients has been questioned. Therefore, there is a critical need to develop and validate tools that can measure new and more kidney-specific hemodynamic and laboratory variables, potentially assisting with AKI risk stratification, implementing appropriate and timely preventive measures, and hopefully improved outcomes. The new ultrasonography techniques provide novel insights into kidney hemodynamics and potential management and/or therapeutic targets. Contrast-enhanced ultrasonography, Doppler flow patterns of hepatic veins (HV), portal vein (PV), and intra- kidney veins (iKV), and ultrasound elastography are among approaches that may provide such information, particularly related to vascular changes in acute kidney injury, venous volume excess or congestion, and fluid tolerance. This review summarizes the current state of these techniques and their relevance to kidney hemodynamic management.

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