scholarly journals FP320RENIN ANGIOTENSIN SYSTEM (RAS) BLOCKADE AND THE RISK OF ACUTE KIDNEY INJURY (AKI) IN MEDICAL PATIENTS ADMITTED VIA THE EMERGENCY ROOM (ER)

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Maria Rosa Panagiotou ◽  
Marios Tsoukakis ◽  
Thanos Fidakis ◽  
Ourania Tsotsorou ◽  
Dimitra Bacharaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury ◽  
Medical Patients ◽  
Angiotensin System

scholarly journals Preventing contrast-induced acute kidney injury in the emergency room

2015 ◽  
Vol 3 (1) ◽  
pp. 59-60 ◽  
Author(s):  
Koichiro Homma ◽  
Tadashi Yoshida ◽  
Joe Yoshizawa ◽  
Masaru Suzuki ◽  
Junichi Sasaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury

P0646PREDICTABLE CAPACITY OF ACUTE KIDNEY INJURY OF NEPHROCHECK TEST IN EMERGENCY ROOM PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elena Gomá ◽  
Guillermo Gonzalez-Martin ◽  
Juan Alfredo López-López ◽  
Maria Vanessa Perez Gomez ◽  
Alberto Ortiz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Emergency Room ◽  
Past History ◽  
Kidney Injury ◽  
Urine Osmolality ◽  
Mortality Prediction ◽  
Emergency Room Patients ◽  
History Of ◽  
Heat Failure

Abstract Background and Aims Acute kidney injury (AKI) is increasingly prevalent and it is associated to increased hospital stay and costs, higher risk of developing a chronic kidney disease, and also major morbidity and mortality. Prediction tools may identify patients at high risk of AKI, allowing early intervention. Nephrocheck quantifies biomarkers of AKI (TIMP-2 and IGFBP-7), providing results within 20 minutes. This may allow stratification of the risk of developing an AKI in the next 12 hours in critically cardiovascular or respiratory ill patients and therefore implement preventive measures. We aimed to assess Nephrocheck performance to predict AKI development within 12 hours to 5 days in incident Emergency Room (ER) patients. Method Prospective observational study of 52 incident ER patients. Data were collected from April 2017 to November 2018. Inclusion criteria: sepsis of any origin, or cardiopulmonary insufficiency without AKI at baseline. Nephrochek was performed at baseline, patients were stratified into low (Nephrocheck test < 0.3), moderate (Nephrocheck between 0.3-2) and high risk (Nephrocheck >2) of AKI and occurrence of AKI was assessed (diagnosed as an increase of 0.3 mg/dl of serum creatinine) at 12, 24, 48 h and 5 days. Results Mean age as 70±13 years, 22/52 (43%) were women, risk factors included hypertension (54%), DM (29%), Cirrhosis: 2/52 (4%), heat failure (27%), prior CKD (12%), nephrotoxic use (38%). 18/52 (35%) of patients were Nephrocheck low risk, 21/52 (40%) were intermediate risk and 13/52 (25%) were high risk. AKI developed in 7/18 (39%), 3/21 (14%) and 3/13 (23%) of low, intermediate and high risk, respectively. When comparing patients who developed AKI with those who did not, those who developed AKI had been exposed more frequently to nephrotoxins and had lower urinary osmolarity and higher MAP (Table 1). However, a high risk Nephrocheck score identified patients with significantly higher urine osmolality (672±139 vs 387±172 mOsm/L, P=0.005) and lower MAP (76.7 ± 18.4 vs 101.62±22.7 mmHg; P=0.002). Conclusion LIMITATIONS: knowledge of Nephrocheck results may have changed patient care. CONCLUSIONS: A high risk Nephrocheck score was not associated with a higher risk of AKI in a ER setting. More nephrotoxins were used in the AKI group. Presumabily, these were discontinued in the ER, thus lowering AKI risk. By contrast, a past history of nephrotoxin use and lower urine osmolarity were associated with a higher incidence of AKI.

scholarly journals Reduced urinary levels of angiotensin-converting enzyme 2 activity predict acute kidney injury in critically ill patients

2020 ◽  
Vol 22 (4) ◽  
pp. 344-354
Author(s):  
Laurent Bitker ◽  
◽  
Sheila K Patel ◽  
Intissar Bittar ◽  
Glenn M Eastwood ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Angiotensin Converting Enzyme ◽  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Urine Collection ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Urine Creatinine

Objective: Angiotensin-converting enzyme 2 activity reflects non-classical renin–angiotensin system upregulation. We assessed the association of urinary angiotensin-converting enzyme 2 (uACE2) activity with acute kidney injury (AKI). Design, setting and participants: A prospective observational study in which we measured uACE2 activity in 105 critically ill patients at risk of AKI. We report AKI stage 2 or 3 at 12 hours of urine collection (AKI12h) and AKI stage 2 or 3 at any time during intensive care unit stay in patients free from any stage of AKI at inclusion (AKIICU). AKI prediction was assessed using area under the receiver-operating characteristics curve (AUROC) and net reclassification indices (NRIs). Main outcome measure: AKI stage 2 or 3 at 12 hours of urine collection. Results: Within 12 hours of inclusion, 32 of 105 patients (30%) had developed AKI12h. Corrected uACE2 activity was significantly higher in patients without AKI12h compared with those with AKI12h (median [interquartile range], 13 [6–24] v 7 [4–10] pmol/min/mL per mmol/L of urine creatinine; P < 0.01). A 10-unit increase in uACE2 was associated with a 28% decrease in AKI12h risk (odds ratio [95% CI], 0.72 [0.46–0.97]). During intensive care unit admission, 39 of 76 patients (51%) developed AKIICU. uACE2 had an AUROC for the prediction of AKI12h of 0.68 (95% CI, 0.57–0.79), and correctly reclassified 28% of patients (positive NRI) to AKI12h. Patients with uACE2 > 8.7 pmol/min/mL per mmol/L of urine creatinine had a significantly lower risk of AKIICU on log-rank analysis (52% v 84%; P < 0.01). Conclusions: Higher uACE2 activity was associated with a decreased risk of AKI stage 2 or 3. Our findings support future evaluations of the role of the non-classical renin–angiotensin system during AKI.

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