Continuous infusion of low-dose iohexol confirms 1-hour creatinine clearance is more accurate in acute kidney injury than 4-hour creatinine clearance: preliminary data

AbstractThe use of kidneys from donation after brain death (DBD) donors with acute kidney injury (AKI) is a strategy to expand the donor pool. The aim of this study was to evaluate how kidney transplantation (KT) from a donor with AKI affects long-term graft survival in various situations. All patients who underwent KT from DBD donors between June 2003 and April 2016 were retrospectively reviewed. The KDIGO (Kidney Disease: Improving Global Outcomes) criteria were used to classify donor AKI. The cohort included 376 donors (no AKI group, n = 117 [31.1%]; AKI group n = 259 [68.9%]). Death-censored graft survival was similar according to the presence of AKI, AKI severity, and the AKI trend (p = 0.929, p = 0.077, and p = 0.658, respectively). Patients whose donors had AKI who received using low dose (1.5 mg/kg for three days) rabbit anti-thymocyte globulin (r-ATG) as the induction agent had significantly superior death-censored graft survival compared with patients in that group who received basiliximab (p = 0.039). AKI in DBD donors did not affect long-term death-censored graft survival. Low-dose r-ATG may be considered as an induction immunosuppression in recipients receiving kidneys with AKI because it showed better graft survival than basiliximab.

Download Full-text

THE RATIO OF CONTRAST VOLUME TO CREATININE CLEARANCE PREDICTS CONTRAST-INDUCED ACUTE KIDNEY INJURY AND LONG-TERM OUTCOMES IN PATIENTS WITH CHRONIC TOTAL OCCLUSIONS UNDERGOING CARDIAC CATHETERIZATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)61816-2 ◽

2015 ◽

Vol 65 (10) ◽

pp. A1816

Author(s):

Jiyan Chen ◽

Ning Tan ◽

Yong Liu ◽

Yuan-Hui Liu

Keyword(s):

Acute Kidney Injury ◽

Creatinine Clearance ◽

Cardiac Catheterization ◽

Kidney Injury ◽

Long Term Outcomes ◽

Chronic Total Occlusions ◽

Contrast Volume

Download Full-text

Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery

Paediatrica Indonesiana ◽

10.14238/pi56.4.2016.230-7 ◽

2016 ◽

Vol 56 (4) ◽

pp. 230

Author(s):

Meta Herdiana Hanindita ◽

Riskky Vitria Prasetyo ◽

Ninik Asmaningsih Soemyarso ◽

I Ketut Alit Utamayasa ◽

Paul Tahalele

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Creatinine Clearance ◽

Sensitivity And Specificity ◽

Area Under The Curve ◽

Kidney Injury ◽

Schwartz Formula ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Neutrophil Gelatinase

Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.

Download Full-text

The description of a method for accurately estimating creatinine clearance in acute kidney injury

Mathematical Biosciences ◽

10.1016/j.mbs.2016.02.010 ◽

2016 ◽

Vol 275 ◽

pp. 107-114 ◽

Cited By ~ 5

Author(s):

John Mellas

Keyword(s):

Acute Kidney Injury ◽

Creatinine Clearance ◽

Kidney Injury

Download Full-text

Abstract 655: Ischemia-induced Epoxyeicosatrienoic Acid Release Protects Female Rats From Acute Kidney Injury

Hypertension ◽

10.1161/hyp.60.suppl_1.a655 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Duska Dragun ◽

Uwe Hoff ◽

Maximilian Blum ◽

Gordana Bubalo ◽

Mandy Fechner ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatinine Clearance ◽

Ischemia Reperfusion ◽

Kidney Injury ◽

Female Rats ◽

Epoxyeicosatrienoic Acid ◽

Renal Protection ◽

Sham Control ◽

Male And Female ◽

Enhanced Production

Females are naturally protected against ischemia/reperfusion (I/R)-induced acute kidney injury (AKI) in various clinical and experimental settings. However, the underlying mechanisms are unknown. We hypothesized that female protection may be conferred by enhanced production of cytochrome P450 (CYP)-dependent epoxyeicosatrienoic acids (EETs) that promote vasodilation as well as antiinflammatory and antiapoptotic pathways in the kidney. To test this hypothesis, we first analyzed the renal CYP-eicosanoid profile by liquid chromatography tandem mass spectrometry in male and female Lewis rats. Ischemia was induced through 45 min of left renal vessel clamping after right nephrectomy (n=6-8 per group). In non-ischemic controls, male and female kidneys stored almost identical amounts of EETs as well as 20-hydroxyeicosatetraenoic acid (20-HETE), both predominantly esterified into phospholipids, under basal non-ischemic conditions. 45 min of ischemia induced a massive release of EETs from membrane stores in females but not males. The free renal EET-levels reached 70.2±20.1 in females compared to only 4.6±1.3 ng/g in males. After ischemia, the ratio of free EETs to free 20-HETE was about 1:1 in females and 1:3 in males. Next, we proved the functional importance of EETs in renal protection by pretreating males with a synthetic EET-agonist (12-HUDE) and females with a selective EET-antagonist (14,15-EEZE-mSI). As analyzed two days after reperfusion, the EET-agonist protected males against loss of creatinine clearance (1.03±0.18 vs. 0.26±0.02 ml/min, p<0.01 vs. vehicle, compared to 1.28±0.06 ml/min in sham control). Females were rendered susceptible to I/R-injury by the EET-antagonist (creatinine clearance: 0.25±0.05 vs. 0.67±0.04; p<0.01 vs. vehicle, compared to 0.81±0.04 ml/min in sham control). Changes in inflammatory cell infiltration and tubular apoptosis paralleled these effects on renal function. Our results indicate that female rats are protected against renal I/R-injury by enhanced ischemia-induced EET-release and demonstrate that renal protection can be transferred to males using synthetic EET-agonists.

Download Full-text

Evaluation of estimated glomerular function (eGFR) versus creatinine clearance (CrCl) to predict acute kidney injury when using zoledronate for the treatment of osteoporosis

Osteoporosis International ◽

10.1007/s00198-021-06160-6 ◽

2021 ◽

Author(s):

M. Schini ◽

N. Peel ◽

L. Toronjo-Urquiza ◽

E. Thomas ◽

S. Salam ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatinine Clearance ◽

Kidney Injury ◽

Treatment Of Osteoporosis ◽

Glomerular Function

Download Full-text

The patient with sarcoidosis

10.1093/med/9780199592548.003.0156 ◽

2015 ◽

Author(s):

Ravindra Rajakariar ◽

Muhammad M. Yaqoob

Keyword(s):

Acute Kidney Injury ◽

Renal Impairment ◽

Renal Disease ◽

Low Dose ◽

Clinical Presentation ◽

Tubulointerstitial Nephritis ◽

Renal Involvement ◽

Kidney Injury ◽

Chronic Renal Impairment

Renal involvement in sarcoidosis is common and often under-recognized. The most frequent manifestation is acute kidney injury secondary to hypercalcaemia and granulomatous tubulointerstitial nephritis. The latter can lead to both acute kidney injury and to slowly progressive chronic renal impairment with concomitant chronic damage seen on histology. This chapter describes the types of renal disease that may occur in sarcoidosis and the pathogenesis, clinical presentation, diagnosis, and treatment of the patient with sarcoidosis. Corticosteroid therapy is the cornerstone of therapy. In patients with granulomatous tubulointerstitial nephritis, the authors recommend long-term, low-dose maintenance steroids.

Download Full-text