scholarly journals Ultrasound examination as a method of early “bedside” diagnosis of acute kidney injury in geriatric patients after urgent abdominal surgery

Pathologia ◽  
2021 ◽  
Vol 18 (2) ◽  
pp. 142-151
Author(s):  
N. V. Momot ◽  
N. V. Tumanska ◽  
S. I. Vorotyntsev
Keyword(s):  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Predictive Value ◽  
Geriatric Patients ◽  
Ultrasound Examination ◽  
Resistance Index ◽  
Kidney Injury ◽  
Renal Perfusion ◽  
Renal Resistance Index ◽  
Bedside Diagnosis

Geriatric patients are particularly vulnerable to the development of postoperative complications, one of which is acute kidney injury (AKI). Early diagnosis of AKI is an important component of the effectiveness of its prevention and treatment. It is believed that ultrasound examination of renal blood flow may be a promising method for bedside diagnosis of AKI. The aim is to evaluate the predictive value of renal resistance index (RRI) and semiquantitative renal perfusion (SQP) as methods for early diagnosis of AKI in geriatric patients after urgent abdominal surgery. Materials and methods. A prospective single-center study included 40 patients (72.5 (65; 81.5) y. o.) who were assessed for the risk of development, the presence and stage of AKI, and additionally measured hemodynamic parameters, intra-abdominal pressure (IAP), and abdominal perfusion pressure (APP). Renal resistance index (RRI) and semi-quantitative renal perfusion score (SQP) were determined using Doppler ultrasound (ultrasound probe CH-6, SIEMENS, Acuson Antares). Statistical analysis was performed using the STATISTICA for Windows 13 program (StatSoftInc., No. JPZ804I382130ARCN10-J). Results. In the postoperative period, AKI developed in 26 patients (65%). Compared with patients without AKI, they had a 14% lower level of mean arterial pressure (MAP) (p=0.008), as well as an average of 4 mmHg higher IAP (p=0.005) and significantly lower APP (p=0.0348). Correlation analysis revealed a weak relationship between the values of MAP, IAP, APP and the development of AKI (r=0.34, r=0.41, r=0.392, respectively, p˂0.05). Patients with AKI had a 13.9% higher RRI than patients without AKI (0.75 (0.72; 0.81) r.u. vs 0.66 (0.61; 0.69) r.u., respectively, p=0.000001), however, the degree of SQP of the kidneys did not differ significantly between the groups (p=0.636). The correlation between the RRI and the development of AKI was of moderate strength (r=0.57, p˂0.05). MAP, IAP, and APP were significantly very weakly correlated with RRI (r=0.34; r=0.41, r=0.392, respectively, p˂0.05). ROC analysis showed that RRI>0.71 r.u. is the threshold level for AKI with 87.2% sensitivity and 73.5% specificity, and it has a high predictive value (area under the curve AUC 0.868 (p<0.0001)). Conclusions. High RRI values are associated with AKI in geriatric patients after urgent abdominal surgery. RRI may be a bedside diagnostic tool for AKI, in contrast to renal SQP, which has shown no predictive value.

scholarly journals Early diagnosis and prevention of acute kidney injury in elderly patients after urgent abdominal surgery

2021 ◽  
Vol 17 (5) ◽  
pp. 46-55
Author(s):  
N.V. Momot ◽  
N.V. Tumanska ◽  
Yu.M. Petrenko ◽  
S.I. Vorotyntsev
Keyword(s):  
Acute Kidney Injury ◽  
Early Diagnosis ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Cystatin C ◽  
Resistance Index ◽  
Kidney Injury ◽  
Positive Effects ◽  
Age Related

Due to the rapidly aging of the population, the number of elderly patients is boosting. Elderly patients are a special cohort of patients due to their typical physiological and anatomical age-related changes, fragility, and comorbidity. One of the threatening perioperative complications is acute kidney injury (AKI), which is associated with a longer hospital stay, increased short-term and long-term mortality. Despite constant efforts to standardize the determination of AKI using serum creatinine, this method has several disadvantages, which makes the search for other diagnostic criteria for kidney damage urgent. Recently, the determination of biomarkers (lipocalin-2, interleukin-18, cystatin C), which can be useful in the early diagnosis of AKI, has become increasingly popular. Even though the filtration capacity of the kidneys is the only factor determining the serum cystatin C concentration, this marker is the most valuable. The use of ultrasound for the early diagnosis of AKI is also considered promising. Several studies show that the renal resistance index and semi-quantitative assessment of renal blood flow work are well for diagnosing persistent AKI. The high mortality rate and the lack of special treatment increase the need for AKI prevention in the elderly, the main one of which is careful clinical monitoring with timely correction of hypovolemia and hypotension. With invasive procedures, the risk of AKI can be reduced by maintaining mean arterial pressure > 80 mmHg and hematocrit > 30 %, as well as providing adequate oxygenation and volume restoration. Prescription of drugs should be individualized by adjusting doses based on the glomerular filtration rate and the patient’s age. However, the question of specific drug prevention of AKI remains open. Several studies have confirmed the renoprotective properties of dexmedetomidine in cardiac surgery, and some positive effects of pentoxifylline for the treatment of renal pathology are also described in the literature. This review explores the topic of AKI in elderly patients undergoing abdominal surgery and focuses on the early diagnosis and prevention of this syndrome.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

scholarly journals Predictive value of stress hyperglycemia ratio for the occurrence of acute kidney injury in acute myocardial infarction patients with diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Side Gao ◽  
Qingbo Liu ◽  
Hui Chen ◽  
Mengyue Yu ◽  
Hongwei Li
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Cardiogenic Shock ◽  
Predictive Value ◽  
Kidney Injury ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Patients With Diabetes

Abstract Background Acute hyperglycemia has been recognized as a robust predictor for occurrence of acute kidney injury (AKI) in nondiabetic patients with acute myocardial infarction (AMI), however, its discriminatory ability for AKI is unclear in diabetic patients after an AMI. Here, we investigated whether stress hyperglycemia ratio (SHR), a novel index with the combined evaluation of acute and chronic glycemic levels, may have a better predictive value of AKI as compared with admission glycemia alone in diabetic patients following AMI. Methods SHR was calculated with admission blood glucose (ABG) divided by the glycated hemoglobin-derived estimated average glucose. A total of 1215 diabetic patients with AMI were enrolled and divided according to SHR tertiles. Baseline characteristics and outcomes were compared. The primary endpoint was AKI and secondary endpoints included all-cause death and cardiogenic shock during hospitalization. The logistic regression analysis was performed to identify potential risk factors. Accuracy was defined with area under the curve (AUC) by a receiver-operating characteristic (ROC) curve analysis. Results In AMI patients with diabetes, the incidence of AKI (4.4%, 7.8%, 13.0%; p < 0.001), all-cause death (2.7%, 3.6%, 6.4%; p = 0.027) and cardiogenic shock (4.9%, 7.6%, 11.6%; p = 0.002) all increased with the rising tertile levels of SHR. After multivariate adjustment, elevated SHR was significantly associated with an increased risk of AKI (odds ratio 3.18, 95% confidence interval: 1.99–5.09, p < 0.001) while ABG was no longer a risk factor of AKI. The SHR was also strongly related to the AKI risk in subgroups of patients. At ROC analysis, SHR accurately predicted AKI in overall (AUC 0.64) and a risk model consisted of SHR, left ventricular ejection fraction, N-terminal B-type natriuretic peptide, and estimated glomerular filtration rate (eGFR) yielded a superior predictive value (AUC 0.83) for AKI. Conclusion The novel index SHR is a better predictor of AKI and in-hospital mortality and morbidity than admission glycemia in AMI patients with diabetes.

scholarly journals Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

2018 ◽  
Vol 7 (11) ◽  
pp. 431 ◽  
Author(s):  
Diamantina Marouli ◽  
Kostas Stylianou ◽  
Eleftherios Papadakis ◽  
Nikolaos Kroustalakis ◽  
Stavroula Kolyvaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Care Center ◽  
Chronic Kidney Disease Stage ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Disease Stage ◽  
Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

Comparison of Predictive Value of Preoperative and Immediate Postoperative Proteinuria With Cardiac Surgery-associated Acute Kidney Injury

2018 ◽  
Vol 27 ◽  
pp. S522-S523
Author(s):  
Shahrul Hashim ◽  
Yeong Sing Lee ◽  
Kenny Cheng ◽  
Ashvin Nair ◽  
Sivakumar Krishnasamy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Predictive Value ◽  
Kidney Injury
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