scholarly journals The Predictive Value of Serum Uric Acid on Acute Kidney Injury following Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Ruo Ran Wang ◽  
Min He ◽  
Xiao Feng Ou ◽  
Xiao Qi Xie ◽  
Yan Kang
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Creatinine ◽  
Serum Uric Acid ◽  
Operating Characteristic ◽  
Kidney Injury ◽  
Multivariate Logistic Regression ◽  
Training Set ◽  
Validation Set

Backgrounds. Acute kidney injury (AKI) is a prevalent nonneurological complication in patients with traumatic brain injury (TBI). We designed this study to explore the association between serum uric acid (SUA) level and the occurrence of AKI following TBI. Methods. This is a retrospective single-center study. A total of 479 patients admitted with TBI were included in this study. We utilized SUA and other risk factors for AKI to construct a predictive model by performing multivariate logistic regression. 374 patients and 105 patients were, respectively, divided into a training set and validation set. The predictive value of the single SUA and constructed model was evaluated by drawing a receiver operating characteristic (ROC) curve. AKI was diagnosed according to the KIDGO criteria. Results. 79 (21.12%) patients were diagnosed with AKI in the training cohort. The patients in the AKI group are older than those in the non-AKI group (p=0.01). And the Glasgow Coma Scale (GCS) of the AKI group was lower than that of the non-AKI group (p<0.001). In a multivariate logistic regression analysis, we found that heart rate (p=0.041), shock (p=0.018), serum creatinine (p<0.001), and serum uric acid (SUA) (p<0.001) were significant risk factors for AKI. Bivariate correlation analyses showed that serum creatinine was moderately positively correlated with SUA (r=0.523, p<0.001). Finally, the area under the receiver operating characteristic curve (AUC) of SUA for predicting AKI in the training set and validation set was 0.850 (0.805-0.895) and 0.869 (0.801-0.938), respectively. Conclusions. SUA is an effective risk factor for AKI following TBI. Combining SUA with serum creatinine could more accurately identify TBI patients with high risk of developing AKI.

scholarly journals Association of Hyperuricemia With Acute Kidney Injury: Case Series Report Among Patients Hospitalized With General Tonic-Clonic Seizures

2020 ◽  
Vol 7 ◽  
pp. 205435812097738
Author(s):  
Jean Maxime Côté ◽  
Arline-Aude Bérubé ◽  
Guillaume Bollée
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Creatinine ◽  
Serum Uric Acid ◽  
Case Series ◽  
Kidney Injury ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Median Serum ◽  
Urate Nephropathy

Background: Urate nephropathy is a rare cause of acute kidney injury. Although most risk factors are associated with chemotherapy, tumor lysis syndrome or rhabdomyolysis, occurrence following severe seizure has also been reported. Uric acid measurement following convulsion is rarely performed and, therefore, the incidence of hyperuricemia in this context is unknown. Objective: The objective is to present a case of urate nephropathy following generalized tonic-clonic seizure (GTCS) and to investigate the kinetics of serum uric acid and creatinine levels in a series of patients admitted for severe seizures. Design: Retrospective case report and prospective case series. Setting: Emergency room department and neurology unit of a tertiary care hospital. Patients: The study included 13 hospitalized patients for severe GTCS. Measurements: Type, timing, and duration of seizure episodes were documented. Demographic data, weight, hypouricemic therapy, and baseline serum creatinine were recorded. Blood samples (uric acid, creatinine, blood gas, lactate, and creatinine kinase) and urine samples (uric acid, creatinine, and dipstick) were prospectively collected at Day 0, 1, 2, and 3 following the GTCS episode. Methods: We identified and described one rare case of urate nephropathy following GTCS. Then, we presented the kinetic of uric acid and creatinine levels and the acute kidney injury incidence over the follow-up period. All analyses were using descriptive statistics. Results: During the study period, 13 patients with a median tonic-clonic seizure duration of 5.0 minutes (interquartile range [IQR], 2.0–12.5) were included. From day 0 to day 3, the median serum uric acid level decreased from 346.0 µmol/L (IQR, 155.0–377.5) to 178.0 µmol/L (IQR, 140.0–297.5) and median serum creatinine from 73.0 µmol/L (IQR, 51.0–80.0) to 57.0 µmol/L (IQR, 44.0–70.0). Acute kidney injury occurred in four patients. Limitations: This is a single-center observational study with small sample size, which does not allow us to demonstrate causality between the increase of uric acid levels observed and the occurrence of acute kidney injury. A delay between the first sampling and seizure episodes was observed and could explain the limited increase of uric acid levels captured. Conclusions: There is a signal for an acute increase of uric acid levels following a severe seizure before returning to baseline within 3 days. During that period, there might be an increased risk of acute kidney injury, although these changes seem to be usually mild and reversible. Our findings suggest that routine serum uric acid measurement in patients presenting with GTCS could help to identify those patients at risk of developing acute kidney injury as a result of acute hyperuricemia. Further larger studies are required to confirm the effectiveness of such screening in acute kidney injury prevention. Trial Registration: As an observational noninterventional study, no registration was required.

scholarly journals Development and Validation of a Model to Predict Acute Kidney Injury Following Wasp Stings: A Multicenter Cohort Study

2020 ◽  
Author(s):  
Xin Tang ◽  
Li Lin ◽  
ying Ying Yang ◽  
shuang Rong Huang ◽  
bei Bei Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Health Hazard ◽  
External Validation ◽  
Kidney Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Training Set ◽  
Wasp Stings ◽  
Validation Set

Abstract BackgroundAcute kidney injury (AKI) following wasp stings is a serious and common health hazard, however the early prediction remains challenging. The study aimed to establish a model to predict AKI following wasp stings and validate it.MethodsIn the multicenter prospective cohort study, 508 patients with wasp stings from Jul 2015 to Dec 2019 were randomly divided into the training set (n = 381) and validation set (n = 127) for internal and external validation. A model that based on the multivariable logistic regression analysis was utilized to predict the probability of AKI following wasp stings by a predictive formula and a nomogram. The performances of the model were assessed by using the area under the curve (AUC) and accuracy (ACC) of the receiver operating characteristic curve. The calibration curves were utilized for estimating the consistency between the actual observed outcome and the nomogram predicted AKI probability. Decision curve analysis (DCA) demonstrated the net benefit associated with the use of the nomogram-derived probability for the prediction of AKI following wasp stings.Results Number of stings, hemoglobin (HB) < 110 g/dl, total bilirubin (TBI) > 34 mg/dl, alanine transaminase (ALT) > 40 U/L and activated partial thromboplastin time (APTT) > 47 s were demonstrated as the independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.912, ACC = 0.869 and AUC = 0.936, ACC = 0.898 in the training set and validation set respectively). The predictive formula and nomogram of the model could be utilized to predict the AKI following wasp stings, which having sufficient accuracies, good predictive capabilities and good net benefits.ConclusionIn conclusion, we proved that number of stings, HB < 110 g/dl, TBI > 34 mg/dl, ALT > 40 U/L and APTT > 47 s were independence risk factors for AKI following wasp stings. The predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of the AKI following wasp stings.

scholarly journals Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

2020 ◽  
Vol 73 (1-2) ◽  
pp. 5-12
Author(s):  
Miodrag Golubovic ◽  
Andrej Preveden ◽  
Ranko Zdravkovic ◽  
Jelena Vidovic ◽  
Bojan Mihajlovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Preoperative Hemoglobin ◽  
Significant Difference ◽  
Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

scholarly journals 1244. Evaluation of Intraoperative Topical Vancomycin and the Incidence of Acute Kidney Injury

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S448-S448
Author(s):  
Alison L Blackman ◽  
Sabeen Ali ◽  
Xin Gao ◽  
Rosina Mesumbe ◽  
Carly Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Serum Creatinine ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Kidney Injury ◽  
Topical Formulation ◽  
Multivariable Logistic Regression Model ◽  
Multivariable Logistic Regression

Abstract Background The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN. Methods This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model. Results A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%. Conclusion AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN. Disclosures All authors: No reported disclosures.

scholarly journals Acute kidney injury calculated using admission serum creatinine underestimates 30-day and 1-year mortality after acute stroke

2019 ◽  
Vol 13 (1) ◽  
pp. 46-54
Author(s):  
Julia Arnold ◽  
Don Sims ◽  
Paramjit Gill ◽  
Paul Cockwell ◽  
Charles Ferro
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Confidence Interval ◽  
Serum Creatinine ◽  
Acute Stroke ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Regression Analyses ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio

AbstractBackgroundAcute kidney injury (AKI) diagnosis requires ascertainment of change from a known baseline. Although pre-admission serum creatinine (SCr) is recommended, to date, all studies of AKI in acute stroke have used the first SCr on admission.MethodsAll patients admitted with an acute stroke to an emergency hospital were recruited. We compared use of pre-admission SCr with admission SCr to diagnose AKI. Regression analyses were used to identify risk factors for 30-day and 1-year mortality, respectively.ResultsA total of 1354 patients were recruited from December 2012 to September 2015. Incidence of AKI was 18.7 and 19.9% using pre-admission SCr and admission SCr, respectively. Diagnosis of AKI was associated with significantly increased 30-day and 1-year mortality. Diagnosis of AKI using pre-admission SCr had a stronger relationship with both 30-day and 1-year mortality. In 443 patients with a pre-admission SCr and at least two SCr during admission, AKI diagnosed using pre-admission SCr had a stronger relationship than AKI diagnosed using admission SCr with 30-day mortality [odds ratio (OR) = 2.64; 95% confidence interval (CI) 1.36–5.12; P = 0.004 versus OR = 2.10; 95% CI 1.09–4.03; P = 0.026] and 1-year mortality [hazard ratio (HR) = 1.90, 95% CI 1.32–2.76; P = 0.001 versus HR = 1.47; 95% CI 1.01–2.15; P = 0.046] in fully adjusted models.ConclusionsAKI after stroke is common and is associated with increased 30-day and 1-year mortality. Using first SCr on admission gives a comparable AKI incidence to pre-admission SCr, but underestimates 30-day and 1-year mortality risk.

Lowering serum uric acid to prevent acute kidney injury

2012 ◽  
Vol 78 (6) ◽  
pp. 796-799 ◽  
Author(s):  
A. Ahsan Ejaz ◽  
Bhagwan Dass ◽  
Ganesh Kambhampati ◽  
Noel I. Ejaz ◽  
Natallia Maroz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Kidney Injury

scholarly journals Acute kidney injury in patients with severe COVID-19 in Mexico

2020 ◽  
Author(s):  
GUSTAVO CASAS ◽  
MARIA-ISABEL LEON ◽  
MAURICIO GONZALEZ-NAVARRO ◽  
CLAUDIA ALVARADO DE LA BARRERA ◽  
Santiago Avila-Rios ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Vasoactive Drugs ◽  
D Dimer

Introduction: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results: Of 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02-2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). In-hospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). Conclusions: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission. Key words: Acute kidney injury; AKI; acute renal failure; COVID-19; SARS-CoV-2.

scholarly journals Serum uric acid and acute kidney injury: A mini review

2017 ◽  
Vol 8 (5) ◽  
pp. 529-536 ◽  
Author(s):  
Kai Hahn ◽  
Mehmet Kanbay ◽  
Miguel A. Lanaspa ◽  
Richard J. Johnson ◽  
A. Ahsan Ejaz
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Kidney Injury
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