Contrast-induced acute kidney injury

2010 ◽  
pp. 478-486
Author(s):  
Peter A. McCullough
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Clinical Trials ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Glomerular Function ◽  
Catheterization Laboratory ◽  
Sustained Reduction ◽  
Ckd Stage ◽  
Definition Of

Contrast-induced acute kidney injury (AKI), previously known as contrast-induced nephropathy (CIN) is an important complication in the catheterization laboratory. The most commonly used definition in clinical trials was a rise in serum creatinine (Cr) of 44.2mmol/L (0.5mg/dL) or a 25% increase from the baseline value, assessed at 48h after the procedure. In 2007, the Acute Kidney Injury Network proposed the definition to a rise in serum Cr ≥26.5mmol/L (0.3mg/dL) or a 50% rise in Cr with oliguria which is compatible with previous definitions and is a new standard to follow. If there is a sustained reduction in estimated glomerular function (eGFR) from a baseline above 60 to a new baseline below 60mL/min/1.73m2 at 90 days after the procedure, then a definition of chronic kidney disease (CKD) (Stage 3) would be met as a late outcome of this complication.

Contrast-induced acute kidney injury

2018 ◽  
pp. 447-452
Author(s):  
Peter A. McCullough
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Kidney Injury ◽  
Disease Stage ◽  
Glomerular Function ◽  
Catheterization Laboratory ◽  
Sustained Reduction ◽  
Contrast Exposure ◽  
Definition Of

Contrast-induced acute kidney injury, previously known as contrast-induced nephropathy, is an important complication in the catheterization laboratory. The definition of contrast-induced acute kidney injury should be harmonized with the Kidney Disease International Global Outcomes criteria which calls for >=0.3 mg/dl (26.5 micromol/L) rise in serum creatinine within 48 hours of contrast exposure. If there is a sustained reduction in estimated glomerular function from a baseline above 60 to a new baseline below 60 ml/min/1.73 m2 at 90 days after the procedure, then a definition of chronic kidney disease (Stage 3) would be met as a late outcome of this complication.

Acute Kidney Injury

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

scholarly journals Dickkopf-3 in the prediction of contrast media induced acute kidney injury

2020 ◽  
Author(s):  
Felix S. Seibert ◽  
Anja Heringhaus ◽  
Nikolaos Pagonas ◽  
Benjamin Rohn ◽  
Frederic Bauer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Creatinine Ratio ◽  
Creatinine Concentration

Abstract Background Dickkopf-3 (DKK3) has recently been discovered as a urinary biomarker for the prediction of acute kidney injury (AKI) after cardiac surgery. This finding needs to be confirmed for AKI in other clinical settings. The present study investigates whether DKK3 can predict contrast-induced AKI (CI-AKI). Methods We performed a prospective study in 490 patients undergoing coronary angiography. Primary endpoint was an increase in serum creatinine concentration ≥ 0.3 mg/dl within 72 h after the procedure. DKK3 was assessed < 24 h before coronary angiography. Predictive accuracy was assessed by receiver operating characteristic (ROC) curves. Results CI-AKI was observed in 30 (6.1%) patients, of whom 27 corresponded to stage I and 3 to stage II according to the Acute Kidney Injury Network (AKIN) criteria. Subjects who developed CI-AKI had a 3.8-fold higher urinary DKK3/creatinine ratio than those without CI-AKI (7.5 pg/mg [interquartile range [IQR] 1.2–1392.0] vs. 2.0 pg/mg [IQR 0.9–174.0]; p = 0.047). ROC analysis revealed an area under the curve (AUC) of 0.61. Among subjects without clinically overt chronic kidney disease (estimated glomerular filtration rate [eGFR] > 60 ml/min, urinary albumin creatinine ratio < 30 mg/g), the DKK3/creatinine ratio was 5.4-fold higher in those with subsequent CI-AKI (7.5 pg/mg [IQR 0.9–590.1] vs. 1.38 pg/mg [IQR 0.8–51.0]; p = 0.007; AUC 0.62). Coronary angiography was associated with a 43 times increase in the urinary DKK3/creatinine ratio. Conclusions Urinary DKK3 is an independent predictor of CI-AKI even in the absence of overt chronic kidney disease (CKD). The study thereby expands the findings on DKK3 in the prediction of postoperative loss of kidney function to other entities of AKI. Graphic abstract

Definitions, classification, epidemiology, and risk factors of acute kidney injury

2018 ◽  
Author(s):  
Eric A. J. Hoste ◽  
John A. Kellum ◽  
Norbert Lameire
Keyword(s):  
Acute Kidney Injury ◽  
Medical Literature ◽  
Kidney Injury ◽  
Staging System ◽  
Acute Kidney Injury Network ◽  
Classification Systems ◽  
Clinical Settings ◽  
Binary Descriptor ◽  
Staging Systems ◽  
Definition Of

The lack of a precise biochemical definition of acute kidney injury (AKI) resulted in at least 35 definitions in the medical literature, which gave rise to a wide variation in reported incidence and clinical significance of AKI, impeded a meaningful comparison of studies.The first part of this chapter describes and discusses different definitions and classification systems of AKI. Patient outcome and the need for renal replacement therapy are directly related to the severity of AKI, an observation that supports the use of a categorical staging system rather than a simple binary descriptor. The severity of AKI is commonly characterized using the relative changes in serum creatinine and urine output. Recently introduced staging systems including the RIFLE classification and the Acute Kidney Injury Network (AKIN) use these relatively simple and readily available parameters allowing the assignment of individual patients to different AKI stages. More recently, a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup developed a consensus-based AKI staging system drawing elements of both RIFLE and AKIN. The potential pitfalls and limitations of the proposed definitions and classifications are briefly described.The second part of the chapter describes the epidemiology of AKI in different clinical settings; the intensive care unit (ICU), the hospitalized population, and the community. The different spectrum of AKI in the emerging countries is discussed and the most important causes and aetiologies of the major clinical types of AKI, prerenal, renal, and post-renal are summarized in table form. Finally the patient survival and renal functional outcome of AKI are briefly discussed

scholarly journals The cardiorenal prognosis in patients underwent cardiac surgery therapy complicated by an acute kidney injury

2015 ◽  
Vol 6 (2) ◽  
pp. 35-39
Author(s):  
B. G Iskenderov ◽  
O. N Sisina
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Initial Function ◽  
Filtration Rate ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Disease Epidemiology

Frequency of development of the acute kidney injury (AKI) in patients underwent different cardiac interventions, and its influence on the cardiorenal prognosis depending on initial function of kidneys is analyzed. 1126 patients (595 men and 531 women) aged from 32 till 68 years (62.3±5.2 years) at which at which prosthetics of valves of heart, coronary artery bypass grafting (CABG) and their combination are examined. In 656 patients (the 1st group) before operation the glomerular filtration rate (GFR) was upper than 60 ml/min/1.73 m2 and in 470 patients (the 2nd group) ranged from 59 to 45 ml/min/1.73 m2, determined by a formula CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was diagnosed by level of serum creatinine (sCr) using criteria of AKIN (Acute Kidney Injury Network). In early postoperative period AKI was diagnosed in 23.9% of patients in the 1st group and in 38.7% of patients in the 2nd group ( p

P0624INCREASED URINARY BIOMARKERS OF KIDNEY INJURY IN PATIENTS AFTER ALLOGENETICHEMATOPOETIC STEM CELL TRANSPLANTATION REFLECT KIDNEY DAMAGE EVEN IN NORMALN KIDNEY FUNCTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Malgorzata Kepska ◽  
Inga Chomicka ◽  
Ewa Karakulska-Prystypiuk ◽  
Agnieszka Tomaszewska ◽  
Grzegorz Basak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Stem Cell ◽  
Kidney Disease ◽  
Healthy Volunteers ◽  
Kidney Function ◽  
Kidney Injury ◽  
Allogeneic Hsct ◽  
Ckd Stage ◽  
Nephrotoxic Drugs

Abstract Background and Aims Chronic kidney disease (CKD) and acute kidney injury (AKI) are common complications of hematopoietic stem cell transplantation (HSCT) associated with increased morbidity and mortality. On the other hand, presence of CKD is often used as an exclusion criterion when selecting patients who undergo HSCT, especially when fludarabine in conditioning or GVHD prophylaxis with a calcineurin inhibitor is contemplated. There is also no threshold (CKD stage, level of serum creatinine etc) below which patients should not undergo allogeneic HSCT. Kidney function in patients undergoing HSCT is frequently worsened by previous chemotherapy and exposure to a variety of nephrotoxic drugs. Several biomarkers were widely investigated for early diagnosis of acute kidney injury, including neutrophil gelatinase associated lipocalin (NGAL), urinary liver-type fatty acid-binding protein (uL-FABP) and others, however, in patients undergoing HSCT, the published literature is exceptionally scarce. A few studies with inconclusive results stress the knowledge gap and need for further research. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after HSCT (to avoid the effect of calcineurin inhibitors) under ambulatory care of Hematology, Oncology and Internal Medicine Department, University Teaching Hospital. Method We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtained normal ranges for biomarkers. In this cross-sectional study following biomarkers of kidney injury in urine were evaluated: IGFBP-7/TIMP2 (insulin growth factor binding protein-7/, tissue inhibitor of metalloproteinases-2), netrin-1, semaphorin A2 using commercially available assays. Results All the biomarkers studied were significantly higher in patients after HSCT when compared to healthy volunteers (all p&lt;0.001). When we divided patients according to kidney function (below and over 60 ml./min/1.72m2), we found that only concentration of IGFBP-7 was significantly higher in 23 patients with CKD stage 3 (i.e. eGFR below 60ml.min/1.72m2) relative to patients with eGFR over 60 ml.min.1.72m2. All biomarkers in both subgroups of patients with eGFR below and over 60 ml./min/1.72m2 were significantly higher relative to healthy volunteers. In univariate correlations sempahorinA2 was related to netrin 1 (r=0.47, p&lt;0.001), IGFBP7 (r=0.35, p&lt;0.01), TIMP2 (r=0.32, p&lt;0.01), whereas IGFBP7 was positively related to serum creatinine (r=0.38, p&lt;0.001) and inversely to eGFR (r=-0.36, p&lt;0.001). Conclusion Concluding, patients after allogeneic HSCT despite normal or near normal kidney function show evidence of kidney injury, which might be due to comorbidities, previous chemotherapy, conditioning regimen,complement activation, calcineurin therapy after HSCT, other possible nephrotoxic drugs etc. Nephroprotective strategies are to be considered as chronic kidney disease is a risk factor for increased morbidity and mortality in this vulnerable population.

Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: Incidence and outcome

2011 ◽  
Vol 26 (6) ◽  
pp. 593-599 ◽  
Author(s):  
Karim Lakhal ◽  
Stephan Ehrmann ◽  
Anis Chaari ◽  
Jean-Pierre Laissy ◽  
Bernard Régnier ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Contrast Induced Nephropathy ◽  
Definition Of

Chronic Kidney Disease

2016 ◽  
pp. 565-570
Author(s):  
Carrie A. Schinstock
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Relative Increase ◽  
Absolute Increase ◽  
Definition Of ◽  
Stage 1

The term acute kidney injury (AKI) has replaced acute renal failure in contemporary medical literature. AKI denotes a rapid deterioration of kidney function within hours to weeks, resulting in the accumulation of nitrogenous metabolites in addition to fluid, electrolyte, and acid-base imbalances. The definition of AKI was refined to a 3-stage definition, with criteria for stage 1 as follows: 1) an absolute increase in serum creatinine (SCr) by at least 0.3 mg/dL from baseline within 48 hours; or 2) a relative increase in SCr to at least 1.5 times baseline within the past 7 days; or 3) urine output decreased to less than 0.5 mL/kg/h for 6 hours.

scholarly journals Severity and Duration of Acute Kidney Injury and Chronic Kidney Disease after Cardiac Surgery

2021 ◽  
Vol 10 (8) ◽  
pp. 1556
Author(s):  
Suk Hyung Choe ◽  
Hyeyeon Cho ◽  
Jinyoung Bae ◽  
Sang-Hwan Ji ◽  
Hyun-Kyu Yoon ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Transient Stage ◽  
Ckd Stage ◽  
Stage 1 ◽  
New Onset

We aimed to evaluate whether the duration and stage of acute kidney injury (AKI) are associated with the occurrence of chronic kidney disease (CKD) in patients undergoing cardiac or thoracic aortic surgery. A total of 2009 cases were reviewed. The patients with postoperative AKI stage 1 and higher stage were divided into transient (serum creatinine elevation ≤48 h) or persistent (>48 h) AKI, respectively. Estimated glomerular filtration rate (eGFR) values during three years after surgery were collected. Occurrence of new-onset CKD stage 3 or higher or all-cause mortality was determined as the primary outcome. Multivariable Cox regression and Kaplan–Meier survival analysis were performed. The Median follow-up of renal function after surgery was 32 months. The cumulative incidences of our primary outcome at one, two, and three years after surgery were 19.8, 23.7, and 26.1%. There was a graded significant association of AKI with new-onset CKD during three years after surgery, except for transient stage 1 AKI (persistent stage 1: HR 3.11, 95% CI 2.62–4.91; transient higher stage: HR 4.07, 95% CI 2.98–6.11; persistent higher stage: HR 13.36, 95% CI 8.22–18.72). There was a significant difference in survival between transient and persistent AKI at the same stage. During three years after cardiac surgery, there was a significant and graded association between AKI stages and the development of new-onset CKD, except for transient stage 1 AKI. This association was stronger when AKI lasted more than 48 h at the same stage. Both duration and severity of AKI provide prognostic value to predict the development of CKD.

Acute Kidney Injury

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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