scholarly journals Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Josefine Thomsen ◽  
Ulrik Sprogøe ◽  
Palle Toft
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

2019 ◽  
Vol 48 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Xiaohan Chen ◽  
Zhiwen Chen ◽  
Tiantian Wei ◽  
Peiyun Li ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background: To determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) by evaluating serum neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI). Methods: A prospective observational study was conducted from September 2015 to March 2018. AKI patients treated with CRRT for at least 24 h were divided into “success” and “failure” groups according to their RRT requirement within 7 days after the initial discontinuation of CRRT. The prefilter and effluent NGAL concentrations were measured to calculate the sieving coefficient (SC) of NGAL in all included subjects from 0 to 72 h. Results: In total, 110 patients were divided into success (n = 78) and failure groups (n = 32). The mean SC of NGAL during CRRT was less than 0.05. The patients in the failure group were associated with higher mortality compared with patients in the success group (37.5 vs. 12.8%, respectively, p = 0.013). There were significant differences in serum NGAL, creatinine, and urine output at discontinuation. In patients without sepsis (n = 70), serum NGAL and urine output were significant predictors of successful cessation. The area under the receiver operating characteristic to predict the successful discontinuation of CRRT was 0.88 for NGAL and 0.86 for urine output. An NGAL level of 403 ng/mL had the highest sensitivity (81%) and specificity (89%) and a urine output of 695 mL/day had the highest sensitivity (83%) and specificity (88%). However, in septic patients (n = 40), urine output but not serum NGAL (OR 0.999, p = 0.69) was a significant variable (OR 1.002, p = 0.005), with a cutoff of 796 mL/day (sensitivity 83%, specificity 88%). Conclusions: Serum NGAL was a significant factor for predicting successful CRRT discontinuation in nonseptic AKI patients. However, urine output, rather than serum NGAL, was a significant predictor in septic AKI patients.

scholarly journals Acute Kidney Injury in Critically Ill Patients

2021 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Yuswanto Setyawan
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Kidney Injury Molecule 1 ◽  
Neutrophil Gelatinase ◽  
Urinary Cystatin C

Abstrak: Gagal ginjal akut (GGA) sering ditemukan dalam praktek klinik namun diagnosisnya dapat tertunda oleh karena keterbatasan alat diagnostik. Dewasa ini, kriteria diagnostik RIFLE, AKIN, dan KDIGO untuk menilai adanya GGA dan keparahannya dianggap tidak cukup untuk menggambarkan kompleksitas sindrom GGA. Proteinuria dan mikroalbuminuria yang merupa-kan marker klasik progresi cedera ginjal kronik, telah dipergunakan dan divalidasi untuk progresi GGA ke CKD. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), dan urinary cystatin C dapat berperan dalam memrediksi pemulihan ginjal. Indikasi biopsi ginjal pada pasien kritis ialah gangguan ginjal yang tidak jelas atau progresi CKD dengan hematuria glomerulus dan proteinuria lebih dari 1 gram per hari, manifestasi ginjal dari penyakit sistemik yang mengancam nyawa, kecurigaan penolakan akut atau kronik dari ginjal transplan. Mempertahankan hemodinamik yang adekuat seharusnya bermanfaat dalam pence-gahan onset atau perburukan GGA, namun kelebihan cairan harus dihindari. Sampau saat ini penentuan saat inisiasi acute renal replacement therapy (ARRT) masih kontroversial, demikian pula nilai ambang spesifik untuk memulainya belum sepenuhnya disepakati. Kata kunci: gagal ginjal akut; penyakit kritis' laju filtrasi glomerulus (LFG)  Abstract: Acute kidney injury (AKI) is a common problem in clinical practice, but its diagnosis could be delayed due to the inherent limitation of current diagnostic tools. Current practice suggests that RIFLE, AKIN, and KDIGO diagnostic criteria used to assess the presence of AKI and its severity are insufficient to illustrate the complexity of the AKI syndrome. Proteinuria and micro-albuminuria, classical markers of chronic kidney disease (CKD) progression, have been used and validated for the progression of AKI to CKD. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and urinary cystatin C could play a role in prediction of renal recovery. Indication of renal biopsy in critically ill patients are unexplained renal impairment or progression of CKD with both glomerular hematuria and proteinuria more than 1 gr per day, renal manifestations of life threathening systemic disease, suspected acute or chronic rejection of a transplanted kidney. The maintenance of adequate hemodynamics should be beneficial in preventing the onset or the worsening of AKI, but fluid overload should be avoided. Timing of acute renal replacement therapy (ARRT) initiation is still controversial, moreover, specific thresholds for starting are still unclear.Keywords: acute kidney injury (AKI); critically ill; glomerular filtration rate (GFR)

Continuous renal replacement therapy for critically ill patients in the intensive care units of two tertiary hospitals. v1

2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Scores

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.

Sign in / Sign up

Export Citation Format

Share Document