P0614URINARY EXOSOMAL MICRORNA-21 AS A MARKER OF SCRUB TYPHUS-ASSOCIATED ACUTE KIDNEY INJURY

Abstract Background and Aims Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus. Method In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI. Results Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P<0.01) and chronic kidney disease (8% vs. 0%, P<0.01). Total leukocyte count were higher in patients with AKI than in those without AKI (10.40 × 103/ mL vs. 6.40 × 103/mL, P<0.01). The levels of urinary miRNA-21 were higher in the AKI group than in the non-AKI group. Urinary exosomal miRNA-21 levels correlated directly with serum neutrophil gelatinase-associated lipocalin values and total leukocyte counts and inversely with estimated glomerular filtration rate. The receiver operator characteristics curve analysis for urinary exosomal miRNA-21 showed good discriminative power for the diagnosis of scrub typhus-associated AKI, with area under the curve value of 0.907. Conclusion Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.

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MATERNAL OUTCOMES OF PREGNANCY-RELATED ACUTE KIDNEY INJURY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.5813 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2057-60

Author(s):

Irfan Khattak ◽

Samina Naseem Khattak ◽

Ayesha Imran ◽

Khawar Kamal ◽

Umairah Yaqoob

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Previous History ◽

Kidney Injury ◽

Cross Sectional Study ◽

Military Hospital ◽

Maternal Outcomes ◽

Recent Past ◽

Cross Sectional ◽

History Of

Objective: To determine the frequency of Pregnancy-related acute kidney injury in the Pakistani population and its effect on maternal health. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Nephrology and Obstetrics and Gynecology, Combined Military Hospital Kharian, from Jan 2018 to Dec 2020. Methodology: All pregnant women with normal renal functions at the time of enrolment in the study and no previous history of any kidney disease or renal procedure in the recent past (at least 3 months) before conception were included in our study at Combined Military Hospital Kharian. All participants had serum creatinine tested at enrolment and were inquired specifically about any history of renal disease or any renal procedure in the recent past (at least 3 months old). Results: Mean maternal age in the study was 29 ± 7.67 years however it ranged from 16-41 years. Around a quarter of acute kidney injury cases occurred in the first and second trimesters combined, with 26 (12%) and 24 (11%) cases in the first and second trimesters, respectively. Thirty percent of acute kidney injury cases were diagnosed in the third trimester. A substantial number 58 (27%) of cases developed azotemia which persisted beyond three months and developed chronic kidney disease of various stages. Regarding maternal outcomes, 166 (77%) mothers recovered completely. However, 43 (20%) patients had some degree pf azotemia, a few cases required permanent renal replacement therapy. Conclusion: Acute kidney injury is a common problem in our community leading to suboptimal maternal outcomes..............

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Accuracy of urine calprotectin for diagnosis of acute kidney injury in neonates

10.21203/rs.2.12174/v1 ◽

2019 ◽

Author(s):

Nasrin Khalesi ◽

Shima Mohamadian ◽

Nakysa Hooman ◽

Mahmoud Khodadost

Keyword(s):

Acute Kidney Injury ◽

Predictive Value ◽

Area Under The Curve ◽

Kidney Injury ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Calprotectin Level ◽

Sensitivity Specificity ◽

Kappa Agreement

Abstract Background: Urine calprotectin significantly rises in acute kidney injury (AKI) in adult and pediatrics. The aim of the present study was to investigate the accuracy of urine calprotectin as a diagnostic marker for (AKI) in neonates. Methods In this cross sectional study, we assessed urine calprotectin in 100 neonates, in which 80 of them had AKI and 20 were healthy. Random urine calprotectin measured by ELISA and then compared between two groups. We included neonates who had received at least 48 hour intra venous fluid and met our inclusion and exclusion criteria. . Receiver-operating characteristic (ROC) curve used to set a cut of point for urine calprotectin to predict AKI. The overall accuracy and Kappa coefficient was used for assess the agreement between two methods.. P value below 0.05 considered significant. Results: Urine calprotectin levels were not significantly higher in neonates with AKI than healthy ones (146.2 vs 142.4, p=0.1). The results showed an optimal cutoff value of 123.5 mg/dl for urine calprotectin with area under the curve of 0•515 with sensitivity, specificity, positive predictive value and negative predictive value of 77.5%,40%,83.7% and 30.7%, respectively. The overall accuracy was 70% and the Kappa agreement coefficient was 0.15 (P=0.11.). Conclusion: Although urine calprotectin level can predict the AKI, it is not accurate measure comparing the gold standard.

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Faculty Opinions recommendation of Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726291856.793519297 ◽

2016 ◽

Author(s):

Carmine Zoccali ◽

Davide Bolignano

Keyword(s):

Acute Kidney Injury ◽

International Society ◽

Kidney Injury ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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MO376CLINICAL OUTCOMES OF ACUTE KIDNEY INJURY FOLLOWING SNAKE BITE INJURIES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0030 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Weerakit Naweera ◽

Thapat Wannarong

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Kidney Injury ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

Renal Recovery ◽

Binary Logistic Regression Analysis ◽

Cross Sectional ◽

Hospital Arrival ◽

Russell’S Viper

Abstract Background and Aims Snakebite is a common animal bite injury in tropical countries. Acute kidney injury (AKI) is an important complication in snakebite patients. This study aimed to comprehensively investigate the clinical profiles and outcomes of patients following hematotoxin-related snakebite associated with kidney impairment. Method We conducted a hospital-based, cross-sectional study of 238 patients with hematotoxin-related snakebite injuries. Data were retrieved from the King Narai Hospital Registry from October 2014 to August 2020. The prevalence of complications associated with snakebite injuries, including acute kidney injury (AKI) and its severity, was determined. Univariate and Multivariate predictors of AKI diagnosis were evaluated using binary logistic regression analysis Results A total of 238 patients, with 63.4% men, median (IQR) age 49.8 (39-61) years and median duration from injury to a hospital arrival of 1 hour (0.5-2) hours, were injured by Green pit viper (85.7%), Russell’s viper (12.6%) and Malayan pit viper (1.7%). AKI mostly occurred in Russell’s viper group 66.7%. An AKI was reported in thirty (12.6%, 95% CI: 8.7 % - 17.5%) patients, with the severity of 66.7% stage one, 6.7% stage two, 26.6% stage three by KDIGO classifications, and 13.3% requiring hemodialysis. Complete renal recovery was seen in twenty-two patients (73.3%), while partial renal recovery was 23.3%. Other complications included 84.4 % limb cellulitis, 4.6% significantly bleeding, 2.5% hypotension, 25.6% prolonged venous clotting time (VCT), 46.7% prolonged prothrombin time (PT), and 14.3% prolonged partial thromboplastin time (PTT). Of total patients, 60.1% were treated with anti-venom. Mortality was relatively low (0.4%). In multivariable logistic regression analyses, AKI was significantly associated with time to hospital arrival more than 3 hours (p = 0.04), Russell’s viper bitten (p = 0.01), clinical bleeding (p = 0.01), and prolonged PT (p < 0.01). Conclusion The prevalence of AKI in patients bitten by hematotoxin snakes was 12.6%, mostly from Russell’s viper. Factors associated with AKI outcomes were time to hospital arrival more than 3 hours, Russell’s viper bitten, clinical bleeding, and prolonged PT. Besides, one-fourth of AKI patients turned to chronic kidney disease.

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Prevalence of Acute Kidney Injury in Patients with Liver Cirrhosis

Journal of Nepal Medical Association ◽

10.31729/jnma.5147 ◽

2020 ◽

Vol 58 (228) ◽

Author(s):

Pukar Thapa ◽

Sudhamshu KC ◽

Achyut Bikram Hamal ◽

Dilip Sharma ◽

Sandip Khadka ◽

...

Keyword(s):

Acute Kidney Injury ◽

Liver Cirrhosis ◽

Hospital Stay ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Cross Sectional Study ◽

Cross Sectional ◽

Tubular Necrosis ◽

Advanced Liver Cirrhosis ◽

Life Threatening

Introduction: Acute kidney injury is a common and life-threatening event in patients with liver cirrhosis occurring in approximately 20-50% of hospitalized patients of liver cirrhosis. Pre-renal acute kidney injury, the hepatorenal syndrome type of acute kidney injury and acute tubular necrosis represent the common causes. The aim of this study was to study the profile of acute kidney injury in patients with liver cirrhosis. Methods: Consecutive patients of liver cirrhosis admitted in Liver unit of Bir Hospital were studied to see the presence of acute kidney injury in this hospital based descriptive cross-sectional study. Clinical and laboratory parameters along with various clinical outcome were compared between different groups categorized by the severity of liver disease and renal dysfunction. Results: Out of 302 liver cirrhosis patients, 56 (18.5%) had acute kidney injury among which 23 (46%) were found to have pre-renal acute kidney injury, 15 (30%) with hepatorenal syndrome– acute kidney injury and 12 (24%) with intrinsic renal disease. Patients with higher stages of acute kidney injury had longer duration of hospital stay and hepatorenal syndrome-acute kidney injury was seen in patients with higher grade of ascites and with hyponatremia. Conclusions: Acute kidney injury is a common occurrence in patients with advanced liver cirrhosis with pre-renal acute kidney injury being the commonest cause. Median hospital stay is directly affected by the severity of acute kidney injury and hepatorenal syndrome–acute kidney injury was seen in patients with higher grade of ascites and hyponatremia. Early identification of patients at high risk for acute kidney injury may help to reduce mortality and contain costs.

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

10.21203/rs.2.10114/v3 ◽

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.

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FREQUENCY OF ACUTE KIDNEY INJURY AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70isuppl-4.6033 ◽

2021 ◽

Vol 70 (Suppl-4) ◽

pp. S828-32

Author(s):

Sajid Khan ◽

Abdul Hameed Siddiqui ◽

Ariz Samin ◽

Syed Hassan Mustafa ◽

Akhtar Gul ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Serum Creatinine ◽

Study Design ◽

Kidney Injury ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Baseline Serum ◽

Control And Prevention

Objective: To determine the frequency of acute kidney injury among patients undergoing coronary angiography. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Cardiology, Hayatabad Medical Complex, Peshawar, from Jan 2018 to Jul 2018. Methodology: This study was conducted in the in the Department of Cardiology, Hayatabad Medical Complex, Peshawar from 22nd Jan 2018 to 22nd Jul 2018. Through a descriptive cross-sectional study design, a total of 116 patients scheduled for coronary angiography were included in the study in a consecutive manner and baseline / follow up serum creatinine was recorded to detect acute kidney injury. Results: In this study 116 patients were included, 61.2% males and 38.8% females. Mean age of the patients was 55.6 years with a standard deviation of 6.6 years. Mean baseline serum creatinine level was 0.9 ± 0.11mg/dl which was 1.5 ± 0.11 48 hours after coronary angiography (p 0.000). AKI was recorded in 19.8% of patients. Conclusion: Acute kidney injury after coronary angiography is not uncommon in our population. More studies are recommended on its risk factors and complications to draw future directions for its control and prevention.

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

Journal of Nephrology ◽

10.1007/s40620-020-00910-1 ◽

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

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