Assessment of the diagnostic ability of RIFLE and SOFA scoring systems in comparison with protein biomarkers in acute kidney injury

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Siavash Abedi ◽  
Atieh Makhlough ◽  
Alireza Rafie ◽  
Ali Sharifpour ◽  
Masoud Aliyali ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Urine Output ◽  
Kidney Injury ◽  
Scoring Systems ◽  
Risk Level ◽  
Control Group ◽  
Diagnostic Ability

AbstractBackgroundWe aimed to assess the diagnostic sensitivity of Risk, Injury, Failure, Loss, and End-stage (RIFLE) and Sequential Organ Failure Assessment (SOFA) scoring systems regarding the serum creatinine level in acute kidney injury (AKI) patients hospitalized in the intensive care unit (ICU). This study also aims to compare the sensitivity of these scoring systems with that of mitochondrial pyruvate carrier 1 (MPC-1), interleukin-10 (IL-10) and neutrophil gelatinase-associated lipocalin (NGAL) as biomarkers.MethodsThis is a cross-sectional study. Thirty patients with increased creatinine level and decreased urine output were recognized as AKI patients, and 30 patients were selected as the control group. The serum levels of each of the proteins of interest were measured at the initial state (moment of entrance) and final state (14th day in the ICU). Statistical analysis was performed with respect to t-test, and a p-value < 0.05 was considered significant. The diagnostic ability of biomarkers was assessed using receiver operating characteristic (ROC) curve.ResultsThe majority of patients were recognized in the risk level of RIFLE, and level 1 of SOFA scoring system. There was no correlation between RIFLE and SOFA (p = 0.123). The expression of MPC-1, IL-10 and NGAL was more remarkable compared with the serum creatinine level. The ROC area change for MPC-1 and IL-10 was higher compared with that for NGAL. As a result, MPC-1 and IL-10 are more reliable biomarkers than NGAL to predict the incidence of AKI in the earlier stage.ConclusionsThere was no significant correlation between SOFA and RIFLE classification, and also the sensitivity of these scoring systems was identified at the risk level for AKI patients. Instead, the level of biomarkers alters earlier, and in higher concentration, than creatinine and urine output changes; therefore, they are more reliable than RIFLE and SOFA scoring systems for prognosis purposes.

Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms

2016 ◽  
Vol 8 (12) ◽  
pp. 1231-1234 ◽  
Author(s):  
Shelby L Hall ◽  
Stephan A Munich ◽  
Marshall C Cress ◽  
Leonardo Rangel-Castilla ◽  
Elad I Levy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Acute Ischemic Stroke ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Vascular Pathology ◽  
Baseline Serum ◽  
Iodinated Contrast

BackgroundCombining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.ObjectiveWe aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.MethodsWe identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.ResultsFour patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).ConclusionsThis study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.

scholarly journals Valacyclovir Neurotoxicity and Nephrotoxicity in an Elderly Patient Complicated by Hyponatremia

2018 ◽  
Vol 12 (1) ◽  
Author(s):  
Takuya Murakami ◽  
Tetsu Akimoto ◽  
Mari Okada ◽  
Erika Hishida ◽  
Taro Sugase ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Blood Purification ◽  
Standard Dosage ◽  
History Of

A 66-year-old women with no history of renal disease was admitted due to a coma and acute kidney injury with a serum creatinine level of 7.44 mg/dL which were ascribed to valacyclovir neurotoxicity and nephrotoxicity, respectively. She had received valacyclovir at a standard dosage for the treatment of herpes zoster and was finally discharged, having fully returned to her normal baseline mental status with a recovered serum creatinine level of 0.68 mg/dL. We feel that awareness of this pathology remains a challenge for physicians and therefore strongly recommend the further accumulation of experiences similar to our own. Our experience underscores the pitfalls of administering valacyclovir to elderly patients who barely appear to have a favorable renal function. Several concerns regarding the therapeutic management, including blood purification strategies, that emerged in this case are also discussed.

scholarly journals The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

2021 ◽  
Vol 10 (8) ◽  
pp. 1636
Author(s):  
Jaeyeon Chung ◽  
Min Hur ◽  
Hyeyeon Cho ◽  
Jinyoung Bae ◽  
Hyun-Kyu Yoon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Partial Nephrectomy ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Control Group ◽  
Significant Difference ◽  
Secondary Outcomes

Renal function declines after partial nephrectomy due to ischemic reperfusion injury induced by surgical insult or renal artery clamping. The effect of remote ischemic preconditioning (RIPC) on reducing renal injury after partial nephrectomy has not been studied regarding urinary biomarkers. Eighty-one patients undergoing partial nephrectomy were randomly assigned to either RIPC or the control group. RIPC protocol consisted of four cycles of five-min inflation and deflation of a blood pressure cuff to 250 mmHg. Serum creatinine levels were compared at the following time points: preoperative baseline, immediate postoperative, on the first and third days after surgery, and two weeks after surgery. The incidence of acute kidney injury, other surgical complication rates, and urinary biomarkers, including urine creatinine, β-2 microglobulin, microalbumin, and N-acetyl-beta-D-glucosaminidase were compared. Split renal functions measured by renal scan were compared up to 18 months after surgery. There was no significant difference in the serum creatinine level on the first postoperative day (median (interquartile range) 0.87 mg/dL (0.72–1.03) in the RIPC group vs. 0.92 mg/dL (0.71–1.12) in the control group, p = 0.728), nor at any other time point. There was no significant difference in the incidence of acute kidney injury. Secondary outcomes, including urinary biomarkers, were not significantly different between the groups. RIPC showed no significant effect on the postoperative serum creatinine level of the first postoperative day. We could not reveal any significant difference in the urinary biomarkers and clinical outcomes. However, further larger randomized trials are required, because our study was not sufficiently powered for the secondary outcomes.

Results of Autologous Stem Cell Transplantation in Multiple Myeloma Patients with Renal Failure

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 1-1
Author(s):  
Maiia Firsova ◽  
Larisa Mendeleeva ◽  
Maxim Solovev ◽  
Daria Mironova ◽  
Valery Savchenko
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Induction Therapy ◽  
Kidney Injury ◽  
Platelet Recovery ◽  
Renal Response

Introduction According to the Russian register renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). Timely induction therapy followed by autologous stem cell transplantation (ASCT) in some cases contributes to the reversibility of renal failure. Although ASCT appears safe in patients with mild and moderate renal impairment, there are limited data in those with severe acute kidney injury. These patients are often considered to be unfit for ASCT. The aim of the study To study the efficacy and safety of high dose therapy followed by ASCT in patients with MM and renal failure and to evaluate the results of the treatment depending on the severity of acute kidney injury. Materials and methods A retrospective single-center study was performed, including 59 (28 males, 31females) MM patients with renal failure at the time of diagnosis aged 19 to 65 years (median 53) underwent ASCT during a period from 2014 to 2019. Hematologic response and renal response was defined according to International Myeloma Working Group criteria. At the time of diagnosis median of serum creatinine level was 450 μmol/L, and median of glomerular filtration rate (GFR) was 10 ml/min/1.73 m2 (CKD-EPI). 18 patients (30,5%) were dialysis-dependent. Induction therapy included bortezomib-containing regimens in all patients, immunomodulatory drugs were used in 9 patients (15%). Before ASCT overall response rate (CR, VGPR, PR) was documented in 55 patients (93%), median of serum creatinine level was 143 μmol/L, median of GFR increased to 40 ml/min/1.73 m2. Renal response was achieved in 48 patients (81%), in 10 cases dialysis was stopped. 8 patients (13,5%) were dialysis-dependent at the time of ASCT. 43 patients (73%) underwent a single and 16 patients (27%) underwent a tandem ASCT (Mel 140-200 mg/m2). The analysis of such parameters as neutrophil and platelet recovery, a requirement for transfusion therapy was carried out in 2 subgroups: subgroup A - patients without dialysis at the time of ASCT (n = 51), subgroup B - dialysis-dependent patients at the time of ASCT (n = 8). Statistical analysis was done using Statistica 10. Survival curves were constructed using the Kaplan-Meier method. Frequency analysis (Fisher's test) was used. Results Median delay for neutrophil recovery was 14 days and 15 days for platelet recovery in subgroups A and B. Platelet concentrate transfusion was required for all patients of both subgroups in a comparable amount. In patients from subgroup B (dialysis-dependent) compared to those from subgroup A (dialysis independent) significant differences was observed in a requirement of red blood cell transfusions (100% vs 37%, p = 0.001). There was no transplant-related mortality. At 100 days after ASCT overall response rate (CR, VGPR, PR) was achieved in 57 patients (96,6%), median of serum creatinine level was 130 μmol/L, and median of GFR was 50 ml/min/1.73 m2. Renal response was achieved in 49 patients (83%); in one case dialysis was stopped after ASCT (Fig. 1). At one year after ASCT median of serum creatinine level was 127 μmol /L, and median of GFR was 46 ml/min/1.73 m2 (Table 1). Seven patients (12%) remained dialysis-dependent. After a median follow-up of 36 months 5-year overall survival was 60%, and 5-year progression-free survival (PFS) was 40%. The analysis of PFS dependent on the severity of acute kidney injury demonstrated that the 5-year PFS of patients who were dialysis-dependent at the time of diagnosis did not differ from that in patients with mild and moderate renal impairment (42% vs 39%, respectively). Conclusion ASCT is feasible and safe method of treatment in MM patients with severe kidney injury. Dialysis-dependent patients during the early post-transplant period significantly more often require red blood cell transfusions (p = 0.001). Induction therapy followed by ASCT allowed reducing a requirement for dialysis from 30.5% at the time of diagnosis to 12% after ASCT (Fig. 2). In our study 11 of 18 MM patients (61%) became dialysis independent. Overall, this work confirmed no difference in PFS dependent on the severity of acute kidney injury; dialysis-dependent myeloma patients should not be excluded from high dose therapy followed by ASCT. Disclosures No relevant conflicts of interest to declare.

scholarly journals Classifying AKI by Urine Output versus Serum Creatinine Level

2015 ◽  
Vol 26 (9) ◽  
pp. 2231-2238 ◽  
Author(s):  
John A. Kellum ◽  
Florentina E. Sileanu ◽  
Raghavan Murugan ◽  
Nicole Lucko ◽  
Andrew D. Shaw ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Urine Output

scholarly journals Effect of Fasting on Temporal Variation in the Nephrotoxicity of Amphotericin B in Rats

1999 ◽  
Vol 43 (3) ◽  
pp. 520-524 ◽  
Author(s):  
Michel LeBrun ◽  
Louis Grenier ◽  
Michel G. Bergeron ◽  
Louise Thibault ◽  
Gaston Labrecque ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Temporal Variation ◽  
Amphotericin B ◽  
Creatinine Level ◽  
Renal Toxicity ◽  
Intraperitoneal Administration ◽  
Control Group ◽  
Similar Data ◽  
Ad Libitum

ABSTRACT Evidence for temporal variation in the nephrotoxicity of amphotericin B was recently reported in experimental animals. The role of food in these variations was determined by studying the effect of a short fasting period on the temporal variation in the renal toxicity of amphotericin B. Twenty-eight normally fed and 28 fasted female Sprague-Dawley rats were used. Food was available ad libitum to the fed rats, while the fasted animals were fasted 12 h before and 24 h after amphotericin B injection to minimize stress for the animals. Water was available ad libitum to both groups of rats, which were maintained on a 14-h light, 10-h dark regimen (light on at 0600 h). Renal toxicity was determined by comparing the levels of excretion of renal enzyme and the serum creatinine and blood urea nitrogen (BUN) levels at the time of the maximal (0700 h) or the minimal (1900 h) nephrotoxicity after the intraperitoneal administration of a single dose of dextrose (5%; control group) or amphotericin B (50 mg/kg of body weight; treated group) to the rats. The nephrotoxicities obtained after amphotericin B administration at both times of day were compared to the nephrotoxicities observed for time-matched controls. In fed animals, the 24-h urinary excretion ofN-acetyl-β-d-glucosaminidase and β-galactosidase was significantly higher when amphotericin B was injected at 0700 and 1900 h. The excretion of these two enzymes was reduced significantly (P < 0.05) in fasting rats, and this effect was larger at 0700 h (P < 0.05) than at 1900 h. The serum creatinine level was also significantly higher (P < 0.05) in fed animals treated at 0700 h than in fed animals treated at 1900 h. Fasting reduced significantly (P < 0.05) the increase in the serum creatinine level, and this effect was larger in the animals treated at 0700 h. Similar data were obtained for BUN levels. Amphotericin B accumulation was significantly higher (P < 0.05) in the renal cortexes of fed rats than in those of fasted animals, but there was no difference according to the time of injection. These results demonstrated that fasting reduces the nephrotoxicity of amphotericin B and that food availability is of crucial importance in the temporal variation in the renal toxicity of amphotericin B in rats.

Definition and Diagnosis of Acute Kidney Injury in Cirrhosis

2015 ◽  
Vol 33 (4) ◽  
pp. 539-547 ◽  
Author(s):  
Florence Wong
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Urine Output ◽  
Negative Impact ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Severe Form ◽  
Loss Of Function ◽  
Baseline Serum ◽  
Advanced Cirrhosis

Background: Acute kidney injury (AKI) is a common complication of advanced cirrhosis. Type 1 hepatorenal syndrome is the best-known and most severe form of AKI, and it has a precise definition and a set of specific diagnostic criteria. More recently, it has become recognized that milder degrees of renal dysfunction also have a negative impact on patient outcome in various patient populations. Key Messages: Several definitions and criteria for staging the severity of AKI have been proposed, including the RIFLE (Risk, Injury, Failure, Loss of Function and End-Stage Renal Disease) group, the Acute Kidney Injury Network (AKIN), and the Kidney Disease: Improving Global Outcome (KDIGO) group. All of them incorporate some changes of serum creatinine and urine output in the definition and staging of AKI. The hepatology community has mostly embraced the AKIN diagnostic and staging criteria and has applied them in the prognostication of patients with advanced cirrhosis. However, the AKIN criteria have not been strictly applied in all studies on cirrhosis. This is partly related to the fact that changes in urine output are difficult to assess in advanced cirrhosis, and partly related to the difficulty in defining the baseline serum creatinine from which the change in serum creatinine is calculated. This has led to some confusion in the interpretation of results of the various studies on AKI in cirrhosis. More recently, some investigators have suggested incorporating the AKIN criteria with setting a lower limit of serum creatinine of 1.5 mg/dl in determining the diagnosis and prognosis of AKI in cirrhosis. Conclusions: This is an ongoing debate as to how best to define AKI in cirrhosis. In the near future there should be prospective clinical trials that will clarify which diagnostic and staging criteria of AKI will best serve the cirrhotic population.

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