scholarly journals Skin autofluorescence as a novel predictor of acute kidney injury after liver resection

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maciej Krasnodębski ◽  
Karolina Grąt ◽  
Marcin Morawski ◽  
Jan Borkowski ◽  
Piotr Krawczyk ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Resection ◽  
Operative Time ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Extent Of Resection ◽  
Primary Outcome Measure ◽  
Skin Autofluorescence ◽  
Predictive Values ◽  
Risk Patients

Abstract Background Skin autofluorescence (SAF) reflects accumulation of advanced glycation end-products (AGEs). The aim of this study was to evaluate predictive usefulness of SAF measurement in prediction of acute kidney injury (AKI) after liver resection. Methods This prospective observational study included 130 patients undergoing liver resection. The primary outcome measure was AKI. SAF was measured preoperatively and expressed in arbitrary units (AU). Results AKI was observed in 32 of 130 patients (24.6%). SAF independently predicted AKI (p = 0.047), along with extent of resection (p = 0.019) and operative time (p = 0.046). Optimal cut-off for SAF in prediction of AKI was 2.7 AU (area under the curve [AUC] 0.611), with AKI rates of 38.7% and 20.2% in patients with high and low SAF, respectively (p = 0.037). Score based on 3 independent predictors (SAF, extent of resection, and operative time) well stratified the risk of AKI (AUC 0.756), with positive and negative predictive values of 59.3% and 84.0%, respectively. In particular, SAF predicted AKI in patients undergoing major and prolonged resections (p = 0.010, AUC 0.733) with positive and negative predictive values of 81.8%, and 62.5%, respectively. Conclusions AGEs accumulation negatively affects renal function in patients undergoing liver resection. SAF measurement may be used to predict AKI after liver resection, particularly in high-risk patients.

scholarly journals Skin Autofluorescence in Prediction of Acute Kidney Injury after Liver Resection

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S156
Author(s):  
M. Grąt ◽  
M. Morawski ◽  
J. Borkowski ◽  
M. Krasnodębski ◽  
K. Grąt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Resection ◽  
Kidney Injury ◽  
Skin Autofluorescence

scholarly journals P0614URINARY EXOSOMAL MICRORNA-21 AS A MARKER OF SCRUB TYPHUS-ASSOCIATED ACUTE KIDNEY INJURY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
In O Sun ◽  
Kwang Young Lee ◽  
A Young Cho
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Scrub Typhus ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Total Leukocyte Count ◽  
Cross Sectional ◽  
Exosomal Mirna

Abstract Background and Aims Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus. Method In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI. Results Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P<0.01) and chronic kidney disease (8% vs. 0%, P<0.01). Total leukocyte count were higher in patients with AKI than in those without AKI (10.40 × 103/ mL vs. 6.40 × 103/mL, P<0.01). The levels of urinary miRNA-21 were higher in the AKI group than in the non-AKI group. Urinary exosomal miRNA-21 levels correlated directly with serum neutrophil gelatinase-associated lipocalin values and total leukocyte counts and inversely with estimated glomerular filtration rate. The receiver operator characteristics curve analysis for urinary exosomal miRNA-21 showed good discriminative power for the diagnosis of scrub typhus-associated AKI, with area under the curve value of 0.907. Conclusion Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.

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

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.

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

scholarly journals What nephrologist should know about COVID-19 outbreak?

2020 ◽  
Author(s):  
Omar maoujoud
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Renal Impairment ◽  
High Mortality ◽  
Medical Management ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Prognostic Indicator ◽  
High Risk Patients ◽  
Risk Patients

Acute Kidney injury is relatively uncommon in COVID-19 patients yet carries a high mortality. It occurs in patients complicated with ARDS or multiorgan failure, but further investigation about inflammatory and apopotic mechanisms during renal impairment are needed. Since the development of AKI is an important negative prognostic indicator for survival with CoV as reported in previous SAR-CoV and MERS-CoV outbreaks, adequate medical management of high risk patients with AKI may improve the results of previous outbreaks related to CoV.

scholarly journals Diagnostic relevance of neutrophil gelatinase-associated lipocalin in early detection of acute kidney injury

2020 ◽  
Vol 7 (2) ◽  
pp. 88-92
Author(s):  
Madhusudhan Mahadevaiah ◽  
Murali Mohan Nidasale Thimmaiah ◽  
Venu Sashank Yerramsetty ◽  
Jeevan Kumar ◽  
Ranjith Kumar
Keyword(s):  
Acute Kidney Injury ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Point Of Care Test ◽  
Reliable Marker ◽  
Neutrophil Gelatinase

Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker. Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC). Results: In this study, 100 patients with the mean age of 49.56±19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n=55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65±734.72 vs. 255.62±440.09 μg/L; P<0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%. Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.

EP.TH.1043Outcomes of liver resections by trainee surgeons versus consultant surgeon – a single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Umasankar Mathuram Thiyagarajan ◽  
Alaa Al-Mohammad ◽  
Stephanie Goh ◽  
Siong-Seng Liau ◽  
Emmanuel Huguet ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hospital Readmission ◽  
Operative Time ◽  
Bile Leak ◽  
Kidney Injury ◽  
Consultant Surgeon ◽  
Liver Resections ◽  
Trainee Group ◽  
Significant Difference ◽  
Long Term Follow Up

Abstract Introduction Liver resection is a most effective treatment for patients with operable primary or secondary cancer deposits. The role of trainee as a lead surgeon versus consultant surgeon performing liver resections and its impact on surgical outcomes had never been reported. Methods and Materials This study was aimed to assess the liver resection outcomes including operative time, acute kidney injury (AKI), bile leak, sepsis, mortality and hospital readmission within 3 months. A total of 320 liver resections from Addenbookes Hospital at Cambridge between 2015 to 2017 were included in this study. All liver resections were performed under supervision of the consultant surgeon who is either scrubbed or unscrubbed in theatre. Trainee surgeons have performed 116 of 320 as lead surgeon and the consultant surgeons performed the remaining 204. Results The mean operative time was 413±129 versus 383±118 (P = 0.41) minutes in trainee surgeons and consultant surgeons respectively. The incidence of postoperative AKI were similar in between the groups (5/116 versus 11/204;P=0.79). Although the bile leak was numerically high in the trainee group, did not reach statistical difference (13/116 versus 12/204;P=0.12); similar results noted in the incidence of sepsis too (3/116 versus 4/204;P=070). Mortality, hospital readmission at 3 months were (1/204 versus 1/116;P=1) and (2/116 versus 4/204;P=1) respectively. No significant difference was observed. Conclusion Liver resections performed by the trainee surgeons under supervision appeared to be safe without increasing the operative time, morbidity, mortality and hospital readmission at 90 days. Further multicentre prospective study with long-term follow up is recommended.

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