scholarly journals Identification of Maltase Glucoamylase as a Biomarker of Acute Kidney Injury in Patients with Cirrhosis

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Linda Awdishu ◽  
Shirley Tsunoda ◽  
Michelle Pearlman ◽  
Chanthel Kokoy-Mondragon ◽  
Majid Ghassemian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Kidney Injury ◽  
Meld Score ◽  
Functional Change ◽  
Decompensated Cirrhosis ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
Urinary Exosomes ◽  
History Of

Background. Acute kidney injury (AKI) is a frequent complication of decompensated cirrhosis with increased mortality. Traditional biomarkers such as serum creatinine are not sensitive for detecting injury without functional change. We hypothesize that urinary exosomes potentially carry markers that differentiate the type of kidney injury in cirrhotic patients. Methods. This is a prospective, single-center, and observational study of adult patients with cirrhosis. The patient groups included healthy normal controls, compensated cirrhosis with normal kidney function, decompensated cirrhosis with normal kidney function, and decompensated cirrhosis with AKI. Data were extracted from the electronic health record including etiology of liver disease, MELD score, history of decompensation, Child-Turcotte-Pugh score, history of AKI, and medication exposures. Urine samples were collected at the time of consent. Urine exosome protein content was analyzed, and proteomic data were validated by immunoblotting. Statistical analysis included partial least squares-discriminant analysis coupled with variable importance in projection identification. Results. Eighteen cirrhotic subjects were enrolled, and six healthy control subjects were extracted from our biorepository. Urine exosomes were isolated, and 1572 proteins were identified. Maltase-glucoamylase was the top discriminating protein confirmed by western blotting. Conclusions. Patients with cirrhosis and AKI have upregulation of renal brush border disaccharidase, MGAM, in urinary exosomes which may differentiate the type of kidney injury in cirrhosis; however, the clinical significance of this requires further validation.

Profile of Acute Kidney Injury in Patients with Decompensated Cirrhosis at a Tertiary-Care Center in Uttarakhand, India

2019 ◽  
Vol 38 (4) ◽  
pp. 335-343
Author(s):  
Manjot S. Arora ◽  
Reshma Kaushik ◽  
Shahbaj Ahmad ◽  
Rajeev Mohan Kaushik
Keyword(s):  
Acute Kidney Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Kidney Injury ◽  
International Normalized Ratio ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Total Leucocyte Count ◽  
Bacterial Peritonitis ◽  
Ctp Score

Objectives: To study the clinical profile and predictors of acute kidney injury (AKI) in patients with decompensated cirrhosis. Materials and Methods: This observational study was conducted at Himalayan Institute of Medical Sciences, Dehradun, India, on 175 consecutive patients with decompensated cirrhosis. Patients were studied for AKI as per International Club of Ascites-AKI criteria. Results: The prevalence of AKI was 40.6%, with prerenal AKI 67.6%, hepatorenal syndrome (HRS) 23.8%, intrinsic renal AKI 7%, and postrenal AKI 1.4%. Mean arterial pressure (MAP), platelet count, and serum albumin were significantly lower and total leucocyte count (TLC), blood urea nitrogen, serum creatinine (SCr), total bilirubin, aspartate aminotransferase, international normalized ratio, Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score higher in cirrhosis patients with AKI than without AKI (p < 0.05 each). MAP, hemoglobin, TLC, and SCr were significantly different in various types of AKI (p < 0.05 each). AKI had a significant association with CTP score, alcohol, spontaneous bacterial peritonitis (SBP), sepsis, and shock (p < 0.05 each). Type of AKI had significant association with SBP, sepsis, and shock (p < 0.05 each). Mortality occurred in 33.8% patients with AKI with 64.7% mortality in patients with HRS. Outcome had significant association with AKI, stage and type of AKI (p < 0.05 each). Multivariate analysis showed SBP, sepsis, and shock as independent predictors of AKI (p < 0.05 each). Conclusions: AKI occurred commonly in patients with decompensated cirrhosis. Prerenal AKI and HRS were the most common types of AKI. SBP, sepsis, and shock were important predictors of AKI.

scholarly journals Differential Performance of Neutrophil Gelatinase-Associated Lipocalin and Cystatin C to Predict Ischemic Stroke

2021 ◽  
Author(s):  
Ling Peng ◽  
Xiaohong Chen ◽  
Yanhong Fu ◽  
Yuwei Yang ◽  
Jiafu Feng
Keyword(s):  
Kidney Function ◽  
Partial Correlation ◽  
Kidney Injury ◽  
Predictive Performance ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase ◽  
The Relationship ◽  
Partial Correlation Coefficient

Abstract Objective Both cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) are markers of kidney injury and may also be marker candidates for neuroinflammation. The aim of this article is to explore the relationship between kidney injury and ischemic stroke (IS).Methods 498 IS patients were enrolled, and 173 IS-related disease control (DC) patients and 293 healthy control (HC) subjects were randomly selected. We analyzed the relationship between the levels of serum kidney function markers (including NGAL, Cre, Ure, CysC and eGFR) and the occurrence of IS.Results When they were admitted to the hospital, the NGAL level of patients with first-onset IS was higher than that of both HC group (z=5.964, P<0.001) and DC (z=12.191, P<0.001); The level of CysC of them was higher than that of HC group (z=5.762, P<0.001), and was the similar with that of DC group (z=1.663, P=0.289). The partial correlation coefficient between NGAL and the occurrence of IS was the highest (rp=0.341, P<0.001) in IS patients with normal kidney function. However, the partial correlation coefficient between CysC and IS was the highest (rp=0.460) , P<0.001) in IS patients with chronic kidney disease (CKD). For patients with normal kidney function, only NGAL was a risk factor for IS [OR(95%CI)=6.54(3.75,11.41)], and had the certain predictive performance AUC=0.734(z=12.928, P<0.001). However, for CKD patients, CysC has better predictive performance for IS occurrence AUC=0.835 (z=11.343, P<0.001) and risk assessment ability [OR(95%CI)=5.97(2.45, 14.56)] than NGAL.Conclusion IS is related to kidney injury and neuroinflammation. NGAL and CysC are suitable for IS prediction in patients with normal kidney function and CKD, respectively. Researchers should pay attention to the changes of NGAL and CysC for the prevention and treatment of stroke in these two types of patients, respectively.

scholarly journals Acute Kidney Injury in Children: Etiologies and Results

2020 ◽  
Vol 1 (2) ◽  
pp. 01-05
Author(s):  
Seba Atmane
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Hemolytic Uremic Syndrome ◽  
Kidney Function ◽  
Emergency Treatment ◽  
Kidney Injury ◽  
Obstructive Nephropathy ◽  
Normal Kidney ◽  
Uremic Syndrome

The aim of the study is to show the etiologies and the follow-up of our AKI cases. This was conducted in our hospital, between 2015 and 2018. During this period we included 26 children with AKI (64% femals) with a median age of 7 years (range 40 days to 15 years). In the majority of the cases revealed by digestive signs and that related to the etiology of AKI (Hemolytic Uremic Syndrome post diarrhea). In our study, 44% of the patients have thrombocytopenia associated with AKI. The etiology of AKI is : Nephropathy glomerular in 37% hemolytic and uremic syndrom in 54% and obstructive nephropathy in 9%. Patients survived in 92 % of the cases and 58% of them have recovered normal kidney function, 7% of death. Peritoneal dialysis is the most commonly used emergency treatment for AKI in children at a frequency of 37%., hemodialysis was used less.

ST-ELEVATION MYOCARDIAL INFARCTION AND ACUTE ISCHEMIC KIDNEY INJURY

2020 ◽  
Vol 4 (2) ◽  
pp. 979-985
Author(s):  
E.Yu. Brankovskaya ◽  
◽  
L.V. Kartun ◽  
E.V. Hodosovskaya ◽  
N.P. Mitkovskaya ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Myocardial Necrosis ◽  
St Elevation Myocardial Infarction ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
St Elevation

The aim of the study was to investigate specific clinical manifestations, homeostasis indices and parameters of the cardiovascular system in patients with acute ST-elevation myocardial infarction (STEMI) and acute ischemic kidney injury. Methods. 173 patients with STEMI participated in the study. The study group consisted of 111 patients with acute ischemic kidney injury associated with myocardial infarction (MI); 62 patients with MI and normal kidney function were enrolled in the comparison group. Clinical, anthropometric, laboratory, and instrumental diagnostic methods were used. Results. Compared with patients of the MI and normal kidney function group, those with MI and acute ischemic kidney injury had a higher average heart rate, required more prolonged vasopressor and/or inotropic therapy, and more frequently developed tachyarrhythmias with adverse prognostic impact and postinfarction aneurysms. The study revealed that patients of the MI and acute ischemic kidney injury group demonstrated more severe dilatation of the left ventricle (LV), more pronounced reduction in myocardial LV contractility according to echocardiography results; they developed multivessel coronary artery disease more frequently. Furthermore, patients of this group had a higher incidence of infarction-associated artery damage located in the proximal segments of major coronary arteries and more frequently developed thrombotic occlusion in the infarction-affected artery. Patients with MI and acute ischemic kidney injury had higher levels of inflammatory, myocardial necrosis, hemostasis and neurohormonal activation markers. Higher concentration of neutrophil gelatinase-associated lipocalin (uNGAL) was observed in patients with MI and acute ischemic kidney injury; moreover, in 14,1% of patients belonging to this group, elevated levels of this marker preceded the diagnostically significant increase in creatinine concentration and decrease in glomerular filtration rate. Conclusion. In patients with MI, the development of acute ischemic kidney injury was accompanied by more severe clinical manifestations, prognostically adverse indicators of early LV remodeling and coronary arteries disease, enhanced inflammatory processes and neuroendocrine system activity, as well as by elevated levels of myocardial necrosis and blood coagulation activity markers. The present study suggests applying uNGAL as an early marker of acute ischemic kidney injury in patients with MI.

scholarly journals Acute Kidney Injury Caused by Obstructive Nephropathy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jonathan S Chávez-Iñiguez ◽  
Goretty J Navarro-Gallardo ◽  
Ramón Medina-González ◽  
Luz Alcantar-Vallin ◽  
Guillermo García-García
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract ◽  
Kidney Function ◽  
Kidney Injury ◽  
Inflammatory Factors ◽  
Obstructive Nephropathy ◽  
Urine Retention ◽  
Frequent Event ◽  
History Of ◽  
Tract Infections

Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.

SAT-140-The natural history of stages 2 and 3 acute kidney injury in hospitalized patients with decompensated cirrhosis and ascites

2019 ◽  
Vol 70 (1) ◽  
pp. e692
Author(s):  
Florence Wong ◽  
Rajender Reddy ◽  
Puneeta Tandon ◽  
Jacqueline O’leary ◽  
Guadalupe Garcia-Tsao ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Natural History ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Decompensated Cirrhosis ◽  
History Of

P0618PREOPERATIVE LOW URINE SPECIFIC GRAVITY PREDICTS ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wonji Jo ◽  
Chan-Young Jung ◽  
Jaeyoung Kim ◽  
Jihye Kim ◽  
Sangmi Lee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Specific Gravity ◽  
Kidney Function ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Urine Specific Gravity ◽  
Normal Kidney ◽  
The Mean ◽  
Post Cardiac Surgery

Abstract Background and Aims Acute kidney injury (AKI) is a common and serious complication following cardiac surgery. However, strategies that effectively predict AKI risk before cardiac surgery are scarce. Recent investigations identified urinary osmolality to be associated with non-glomerular kidney damage in normal kidney function individuals, suggesting urine concentration ability to be a surrogate of early kidney damage. Therefore, hypothesizing that urine specific gravity (SG) could reflect asymptomatic kidney damage, the clinical implication of preoperative urine specific gravity on AKI occurrence after cardiac surgery was investigated in subjects with normal kidney function. Method A total of 4135 patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from were enrolled. Patients whose eGFR was lower than 60mL/min/1.73m2 were excluded. Fasting urinary SG was measured from the morning first void a day before the surgery. The patients were divided into tertiles based on urine SG. The primary outcome was occurrence of AKI within 48hours of cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Results The mean age of the patients was 60 years and 60% were male. Diabetes consisted of 25.6% of the patients and 54.5% were hypertensive. The mean eGFR and urine SG was 98.8mL/min/1.73m2 and 1.020, respectively. AKI developed in 1,089 (26.3%) patients. The incidence of AKI was highest in the lowest urine SG tertile group (410, 29.0%) and lowest in the highest tertile group (304, 23.5%) (P &lt; 0.001). Multivariable logistic regression analysis revealed that being included in the lowest preoperative urine SG tertile group was significantly related with higher post cardiac surgery AKI incidence risk (odd ratio (OR), 1.33; CI, 1.12-1.57; P =0.001). This association was significant even after adjustments were made for confounding factors. Conclusion Low urine SG was associated with increased risk of cardiac surgery associated AKI in patient with normal renal function. Evaluating preoperative urine SG may be useful in stratifying post cardiac surgery AKI risk.

scholarly journals Gadolinium Induced Acute Kidney Injury and Nephrogenic Systemic Fibrosis

JMS SKIMS ◽  
2012 ◽  
Vol 15 (2) ◽  
pp. 166-169
Author(s):  
Khurshid A Banday ◽  
Irfan Robbani ◽  
Nasir A Choh ◽  
Farhana Siraj ◽  
Fayaz Ul Haque ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mr Imaging ◽  
Contrast Agents ◽  
Renal Dysfunction ◽  
Kidney Function ◽  
Nephrogenic Systemic Fibrosis ◽  
Kidney Injury ◽  
Normal Kidney ◽  
Imaging Studies ◽  
Clinical Problems

Use of contrast agents like gadolinium in MR imaging studies has considerably increased. Although safe in patients with normal kidney function, administration of these agents in people with renal dysfunction can result in many clinical problems that the nephrologists should be familiar with. This brief review discusses these iatrogenic problems that can be induced by contrast agents like gadolinium. JMS 2012;15(2):166-69

scholarly journals MO160COVID-19 INFECTION AND ACUTE TUBULOINTERSTITIAL NEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Carlos León ◽  
Irene Agraz ◽  
Ander Vergara Arana ◽  
Natalia Ramos Terrada ◽  
Clara García Carro ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Function ◽  
Nosocomial Pneumonia ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Acute Tubulointerstitial Nephritis ◽  
History Of

Abstract Background COVID-19 infection manifests as pneumonia associated with multiple organ failure, and death. Acute kidney injury is a risk factor for mortality. There is limited scientific literature on COVID-19 infection and allergic tubulointerstitial nephritis, its clinical course and short- and long-term prognosis. Method We performed a retrospective study where medical records of 60 patients with histological diagnosis of allergic tubulointerstitial nephritis from January 2009 to November 2020. In these patients, we studied the incidence of COVID-19 infection, clinical characteristics and prognosis from March to the actual date. Results Of 60 patients with allergic tubulointerstitial nephritis, 6 (10%) patients were diagnosed with COVID-19. The first case, an 85-year-old woman with a history of metastatic melanoma treated with nivolumab and allergic tubulointerstitial nephritis by immunobiological agents in 2018, diagnosed with mild COVID-19 infection in April 2020 without deterioration of renal function in controls at 3 and 6 months of follow-up. The second case, a 51-year-old woman with a history of large B-cell lymphoma with plasmacytic differentiation and progression to multiple myeloma of lambda light chains and allergic tubulointerstitial nephritis due to chemotherapy since 2019, admitted for acute pyelonephritis and PRES syndrome secondary to first dose of bortezomib complicated with COVID-19 nosocomial pneumonia and acute pancreatitis treated with corticosteroids and broad spectrum antibiotic therapy; she died of abdominal refractory septic shock. The third patient, a 64-year-old man without prior renal impairment, was admitted for severe COVID-19 pneumonia and acute kidney injury secondary to acute tubulointerstitial nephritis of uncertain etiology that required orotracheal intubation and continuous veno-venous hemodiafiltration for a week who received methylprednisolone in bolus for 3 days and continued treatment with corticosteroid therapy with complete recovery of renal function and improvement in proteinuria at 3 months of follow-up. The fourth patient, an 82-year-old woman with acute kidney injury AKIN 3 secondary to acute allergic tubulointerstitial nephritis related to ciprofloxacin complicated with severe COVID-19 nosocomial pneumonia, who died despite ventilatory support and high-dose steroids therapy and tocilizumab. The fifth patient, a 75-year-old with a history of metastatic lung adenocarcinoma treated with immunobiological agents and allergic tubulointerstitial nephritis in  2018, admitted in march 2020 for mild COVID-19 pneumonia treated with steroids and hydroxychloroquine without deterioration of respiratory and kidney function.  The sixth patient, an 86-years-old man with acute kidney injury AKIN 3 due to acute allergic tubulointerstitial nephritis secondary to proton-binding inhibitors and nosocomial COVID-19 infección with improvement of kidney function with steroids therapy only.  Conclusion Our 6 patients with allergic tubulointerstitial nephritis and COVID-19 infection presented different spectrum of the disease. It seems that nosocomial COVID-19 infection in patients admitted with recent diagnosis of acute allergic tubulointerstitial nephritis presented a worse clinical prognosis compared with long-term diagnosed acute tubulointerstitial nephritis. Further studies with a larger sample size are needed.

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