scholarly journals Admission plasma uromodulin and the risk of acute kidney injury in hospitalized patients with cirrhosis: a pilot study

2019 ◽  
Vol 317 (4) ◽  
pp. G447-G452
Author(s):  
Kavish R. Patidar ◽  
Pranav S. Garimella ◽  
Etienne Macedo ◽  
James E. Slaven ◽  
Marwan S. Ghabril ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Predictive Biomarker ◽  
Hospitalized Patients ◽  
Susceptible Population ◽  
Baseline Creatinine ◽  
Low Levels ◽  
Time Of Admission ◽  
Hospital Acquired

Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as hospitalized patients with cirrhosis. Thus, we investigated whether plasma uromodulin measured at the time of admission is associated with subsequent hospital-acquired AKI (defined by a rise in serum creatinine >0.3mg/dL within 48 h or ≥ 1.5 times baseline) in patients with cirrhosis. A total of 98 patients [mean age 54 yr, Model for Endstage Liver Disease Sodium (MELD-Na) score 19, and baseline creatinine of 0.95 mg/dL] were included, of which 13% ( n = 13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared with patients who did not (9.30 vs. 13.35 ng/mL, P = 0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score as covariates on multivariable logistic regression, uromodulin was independently associated with AKI [odd ratios of 1.19 (95% confidence interval 1.02, 1.37; P = 0.02)]. Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis. Further studies are needed to better understand the role of uromodulin in the pathogenesis and as a predictive biomarker of AKI in this population. NEW & NOTEWORTHY In this study, we found that admission plasma uromodulin levels are significantly lower in patients who developed subsequent acute kidney injury (AKI) during their hospital stay compared with patients who did not. Additionally, uromodulin is independently associated with AKI development after adjusting for clinically relevant parameters such as age, sex, diabetes, hypertension, severity of cirrhosis, and kidney function. To our knowledge, this is the first study linking plasma uromodulin with AKI development in patients with cirrhosis.

scholarly journals Comparison of Hospital-Acquired and Community-Acquired Acute Kidney Injury in Hospitalized Patients

2015 ◽  
Vol 1 (2) ◽  
pp. 30-36
Author(s):  
Ghita El Bardai ◽  
◽  
Nadia Kabbali ◽  
Adil Najdi ◽  
Mohamed Arrayhani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Acquired

scholarly journals Incidence and Cost of Acute Kidney Injury in Hospitalized Patients with Infective Endocarditis

2019 ◽  
Vol 8 (7) ◽  
pp. 927 ◽  
Author(s):  
Ortiz-Soriano ◽  
Donaldson ◽  
Du ◽  
Li ◽  
Lambert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Total Direct Cost ◽  
High Morbidity ◽  
Susceptible Population ◽  
Stage 1

Acute kidney injury (AKI) is a frequent complication of hospitalized patients with infective endocarditis (IE). Further, AKI in the setting of IE is associated with high morbidity and mortality. We aimed to examine the incidence, clinical parameters, and hospital costs associated with AKI in hospitalized patients with IE in an endemic area with an increasing prevalence of opioid use. This retrospective cohort study included 269 patients admitted to a major referral center in Kentucky with a primary diagnosis of IE from January 2013 to December 2015. Of these, 178 (66.2%) patients had AKI by Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria: 74 (41.6%) had AKI stage 1 and 104 (58.4%) had AKI stage ≥2. In multivariable analysis, higher comorbidity scores and the need for diuretics were independently associated with AKI, while the involvement of the tricuspid valve and the need for vasopressor/inotrope support were independently associated with severe AKI (stage ≥2). The median total direct cost of hospitalization was progressively higher according to each stage of AKI ($17,069 for no AKI; $37,111 for AKI stage 1; and $61,357 for AKI stage ≥2; p < 0.001). In conclusion, two-thirds of patients admitted to the hospital due to IE had incident AKI. The occurrence of AKI significantly increased healthcare costs. The higher level of comorbidity, the affection of the tricuspid valve, and the need for diuretics and/or vasoactive drugs were associated with severe AKI in this susceptible population.

scholarly journals Role of microRNA in the detection, progression, and intervention of acute kidney injury

2017 ◽  
Vol 243 (2) ◽  
pp. 129-136 ◽  
Author(s):  
Yan-Fang Zou ◽  
Wen Zhang
Keyword(s):  
Acute Kidney Injury ◽  
Injury Severity ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
High Morbidity ◽  
Microrna Target ◽  
Diagnostic Biomarkers ◽  
Pathological Mechanism ◽  
Multiple Signaling

Acute kidney injury, characterized by sharply decreased renal function, is a common and important complication in hospitalized patients. The pathological mechanism of acute kidney injury is mainly related to immune activation and inflammation. Given the high morbidity and mortality rates of hospitalized patients with acute kidney injury, the identification of biomarkers useful for assessing risk, making an early diagnosis, evaluating the prognosis, and classifying the injury severity is urgently needed. Furthermore, investigation into the development of acute kidney injury and potential therapeutic targets is required. While microRNA was first discovered in Caenorhabditis elegans, Gary Ruvkun’s laboratory identified the first microRNA target gene. Together, these two important findings confirmed the existence of a novel post-transcriptional gene regulatory mechanism. Considering that serum creatinine tests often fail in the early detection of AKI, testing for microRNAs as early diagnostic biomarkers has shown great potential. Numerous studies have identified microRNAs that can serve as biomarkers for the detection of acute kidney injury. In addition, as microRNAs can control the expression of multiple proteins through hundreds or thousands of targets influencing multiple signaling pathways, the number of studies on the functions of microRNAs in AKI progression is increasing. Here, we mainly focus on research into microRNAs as biomarkers and explorations of their functions in acute kidney injury. Impact statement Firstly, we have discussed the potential advantages and limitations of miRNA as biomarkers. Secondly, we have summarized the role of miRNA in the progress of AKI. Finally, we have made a vision of miRNA’s potential and advantages as therapeutic target intervention AKI.

scholarly journals The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project

2019 ◽  
Vol 39 (4) ◽  
pp. 379-387
Author(s):  
Pedro Jesús Labrador Gómez ◽  
Silvia González Sanchidrián ◽  
Jorge Labrador Gómez ◽  
Juan Ramón Gómez-Martino Arroyo ◽  
María Carmen Jiménez Herrero ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Alert System

scholarly journals The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project

Nefrología ◽  
2019 ◽  
Vol 39 (4) ◽  
pp. 379-387 ◽  
Author(s):  
Pedro Jesús Labrador Gómez ◽  
Silvia González Sanchidrián ◽  
Jorge Labrador Gómez ◽  
Juan Ramón Gómez-Martino Arroyo ◽  
María Carmen Jiménez Herrero ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Alert System

scholarly journals Iron Homeostasis and Ferritin in Sepsis-Associated Kidney Injury

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 616-620
Author(s):  
Kayla McCullough ◽  
Subhashini Bolisetty
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Clinical Data ◽  
Iron Homeostasis ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Hospitalized Patients ◽  
Circulating Levels

Sepsis associated acute kidney injury (SA-AKI) is a common clinical syndrome that occurs among hospitalized patients and significantly impacts mortality. Furthermore, survival after sepsis is intricately dependent on recovery of kidney function. In this review, we discuss the role of iron imbalance in mediating the pathogenic events during sepsis. Intracellular ferritin serves as a repository for iron and prevents iron-mediated injury and may limit the availability of iron to pathogens. Circulating levels of ferritin also increase during sepsis and often correlate with severity of sepsis. Herein, we examine preclinical and clinical data and discuss recent findings that suggest immunomodulatory roles for ferritin. We also discuss the possible mechanistic roles for ferritin in mitigating the pathogenic sequelae of sepsis and highlight current gaps in knowledge.

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