scholarly journals Clinical significance of frusemide stress test in predicting the severity of acute kidney injury

2021 ◽  
Author(s):  
Arun Gokul Pon ◽  
Raveendran Vairakkani ◽  
Edwin Fernando Mervin ◽  
Nagalakshmi Dhanapal Srinivasaprasad ◽  
Thirumalvalavan Kaliaperumal
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Clinical Significance ◽  
Urine Output ◽  
Primary Outcome ◽  
Stress Test ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Operating Characteristics ◽  
Roc Curve Analysis

Abstract Introduction: The outcomes of Acute Kidney Injury (AKI) remain dismal even today, owing in part due to the lack of an ideal biomarker for detecting renal damage early enough. We conducted this pilot study to determine the clinical significance of Frusemide Stress Test (FST) to predict the severity of AKI. Methods: A total of 80 patients with AKI-KDIGO (Kidney Disease: Improving Global Outcomes) stage 1 or stage 2 underwent FST by administering a bolus dose of frusemide (1mg/kg for frusemide naïve and 1.5mg/kg for prior frusemide exposure in the past week), and urine output was then measured for the next two hours with volume replacement as desirable. The progression to AKI-KDIGO stage 3 within 14 days of FST was studied as the primary outcome. The composite end point of achieving AKI-KDIGO stage 3 or death within 14 days of FST was studied as the secondary outcome. Results: Out of 80 patients, 28(35%) patients met the primary outcome, and 34(42.5%) patients met the secondary composite outcome. Except for baseline Chronic Kidney Disease (CKD) status (p=0.018), other demographic characteristics were comparable between progressors and non-progressors group. Using receiver operating characteristics (ROC) curve analysis, a cumulative 2-hour post-FST urine output of ≤300 mL predicted progression to stage 3 AKI with 82.14% sensitivity, 82.69% specificity, and AUC of 0.89±0.03 (p<0.0001). Conclusion: The FST showed promising results as a novel tubular biomarker to identify progression to severe AKI with good predictive ability.

Angiopoietins as Prognostic Markers for Future Kidney Disease and Heart Failure Events After Acute Kidney Injury

2022 ◽  
pp. ASN.2021060757
Author(s):  
Sherry Mansour ◽  
Pavan Bhatraju ◽  
Steven Coca ◽  
Wassim Obeid ◽  
Francis Wilson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Lower Risk ◽  
Kidney Injury ◽  
Early Response ◽  
Secondary Outcome ◽  
Ckd Progression ◽  
Angiopoietin 2 ◽  
Vessel Stability

Background The mechanisms underlying long-term sequelae following acute kidney injury (AKI) remain unclear. Vessel instability, an early response to endothelial injury, may reflect a shared mechanism and early trigger for chronic kidney disease (CKD) and heart failure. Methods To investigate whether plasma angiopoietins, markers of vessel homeostasis, are associated with CKD progression and heart failure admissions after hospitalization in patients with and without AKI, we conducted a prospective cohort study to analyze the balance between angiopoietin-1 (Angpt-1), which maintains vessel stability, and angiopoietin-2 (Angpt-2), which increases vessel destabilization. Three months after discharge, we evaluated the associations between angiopoietins and development of the primary outcomes of CKD progression and heart failure, as well as the secondary outcome of all-cause mortality 3 months after discharge or later. Results Median age for the 1503 participants was 65.8 years; 746 (50%) had AKI. Compared with the lowest quartile, the highest quartile of the Angpt-1:Angpt-2 ratio was associated with 72% lower risk of CKD progression (adjusted hazard ratio [aHR], 0.28; 95% confidence interval [95% CI], 0.15 to 0.51), 94% lower risk of heart failure (aHR, 0.06; 95% CI, 0.02 to 0.15), and 82% lower risk of mortality (aHR, 0.18; 95% CI, 0.09 to 0.35) for those with AKI. Among those without AKI, the highest quartile of Angpt-1:Angpt-2 ratio was associated with 71% lower risk of heart failure (aHR, 0.29; 95% CI, 0.12 to 0.69) and 68% less mortality (aHR, 0.32; 95% CI, 0.15 to 0.68). There were no associations with CKD progression. Conclusions A higher Angpt-1:Angpt-2 ratio was strongly associated with less CKD progression, heart failure, and mortality in the setting of AKI.

scholarly journals Serum Myoglobin Potentiates Acute Kidney Injury Following Exertional Heatstroke and Its Mechanisms Involved Endoplasmic Reticulum Stress-Associated Ferroptosis

2021 ◽  
Author(s):  
Ying-yi Luan ◽  
En-ping Huang ◽  
Rong-ping Zhou ◽  
Jia-jia Huang ◽  
Zhen-jia Yang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Heat Stress ◽  
Molecular Mechanisms ◽  
Primary Outcome ◽  
Experimental Studies ◽  
Kidney Injury ◽  
High Serum ◽  
Secondary Outcome ◽  
Therapeutic Drug ◽  
Serum Myoglobin

Abstract Background: Myoglobin released by rhabdomyolysis (RM) is considered to be involved in the pathogenesis of kidney disease caused by crush injury, but whether a high level of serum myoglobin predisposes patients to acute kidney injury (AKI) and increases mortality following exertional heatstroke (EHS) and its molecular mechanisms are still unclear. Methods: Serum myoglobin concentrations in patients with EHS were measured at admission, 24 h and 48 h after admission and discharge. The risk of AKI at 48 hours was the primary outcome, AKI at discharge and death at 90 days were the secondary outcome. In experimental studies, we further investigated the mechanisms of human kidney proximal tubular (HK-2) cells that were exposed to human myoglobin under heat stress conditions and the effect of baicalein.Results: The myoglobin levels were assessed in 187 patients who were undergoing EHS, 82 who were undergoing AKI. The highest myoglobin quartile (vs. the lowest) had an adjusted odds ratio (OR) of 18.95 (95% confidence interval [CI], 6.00 to 59.83) for the primary outcome and the OR (vs. quartile 2) was 7.92 (95% CI, 1.62 to 38.89) for the secondary outcome. The survival rate of HK-2 cells treated with myoglobin under heat stress was significantly decreased, and the production of Fe2+ and ROS was markedly increased, accompanied by changes in ferroptosis proteins, including increased p53, decreased SLC7A11 and GPX4, and alterations in ERS marker proteins. Treatment with baicalein attenuated HK-2 cell ferroptosis induced by myoglobin under heat stress through inhibition of ERS. Conclusions: High serum myoglobin levels were associated with AKI and mortality following EHS, which mechanisms involved ferroptosis and ERS. Baicalein-targeted ERS- ferroptosis may be a potential therapeutic drug for the treatment of AKI in patients with RM after EHS.

MO378WHAT LIES BENEATH ANTICOAGULATION-RELATED ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hernando Trujillo ◽  
Justo Sandino Pérez ◽  
Teresa Cavero Escribano ◽  
Eduardo Gutierrez ◽  
Angel Sevillano ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Iga Nephropathy ◽  
Kidney Biopsy ◽  
Vitamin K Antagonists ◽  
Immunosuppressive Treatment ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Biopsy Specimens

Abstract Background and Aims Acute kidney injury (AKI) secondary to glomerular hemorrhage in the context of overanticoagulation, commonly known as anticoagulant-related nephropathy (ARN), is a relatively novel recognized entity. Preexisting or underlying kidney disease seems to be a predisposing factor; however, few studies have described histologic findings in patients with ARN. We aimed to examine underlying kidney pathology in patients on oral anticoagulation who presented an episode of AKI with hematuria in whom a kidney biopsy was performed. Method Spanish retrospective observational multicenter case study in patients treated with oral anticoagulants who developed macroscopic or intense hematuria followed by AKI. Only patients with available kidney biopsy specimens were included. Histologic findings and clinical data throughout follow-up were analyzed. The main outcome was to describe pathologic findings in kidney biopsy specimens of patients with clinical suspicion of ARN. The secondary outcome was to assess kidney outcomes during follow-up. Results Twenty-four patients were included with a median age of 76 years (interquartile range [IQR] 64-81) and a follow-up period of 10.1 (IQR 1.3-41.1) months. 79% were male, 22 (91%) had hypertension and 9 (37%) were diabetic. Most cases (91%) were on anticoagulation with vitamin K antagonists. At admission, 87% of cases presented gross hematuria with a median serum creatinine (SCr) of 4.2 mg/dl and a median INR of 2.3. During follow-up, median highest (peak) SCr was 6.3 mg/dl and 11 (45%) patients required acute dialysis. Kidney biopsy showed that all patients except one had an underlying nephropathy (confirmed IgA nephropathy in 16 [66.7%], probable IgA nephropathy in 2, diabetic nephropathy in 3, nephrosclerosis in 1, and idiopathic nodular glomerulosclerosis in 1). Tubules filled with red cells and red cell casts were observed in 66.7% of the cases and acute tubular necrosis in 70.8%. Management included anticoagulation withdrawal in 14 cases (58.3%) and immunosuppressive treatment with corticosteroids (n = 17 [70.8%]) and mycophenolic acid (n = 5 [20.8%]). At 12 weeks after discharge, 11 patients had &gt;50% decrease in SCr (with respect to peak SCr), 6 had &lt;50% decrease and 5 were on chronic dialysis. Conclusion IgA nephropathy was the most common underlying kidney disease in our biopsy-proven series of ARN, in which a significant percentage of patients did not achieve kidney function recovery.

scholarly journals Severity and Duration of Acute Kidney Injury and Chronic Kidney Disease after Cardiac Surgery

2021 ◽  
Vol 10 (8) ◽  
pp. 1556
Author(s):  
Suk Hyung Choe ◽  
Hyeyeon Cho ◽  
Jinyoung Bae ◽  
Sang-Hwan Ji ◽  
Hyun-Kyu Yoon ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Transient Stage ◽  
Ckd Stage ◽  
Stage 1 ◽  
New Onset

We aimed to evaluate whether the duration and stage of acute kidney injury (AKI) are associated with the occurrence of chronic kidney disease (CKD) in patients undergoing cardiac or thoracic aortic surgery. A total of 2009 cases were reviewed. The patients with postoperative AKI stage 1 and higher stage were divided into transient (serum creatinine elevation ≤48 h) or persistent (>48 h) AKI, respectively. Estimated glomerular filtration rate (eGFR) values during three years after surgery were collected. Occurrence of new-onset CKD stage 3 or higher or all-cause mortality was determined as the primary outcome. Multivariable Cox regression and Kaplan–Meier survival analysis were performed. The Median follow-up of renal function after surgery was 32 months. The cumulative incidences of our primary outcome at one, two, and three years after surgery were 19.8, 23.7, and 26.1%. There was a graded significant association of AKI with new-onset CKD during three years after surgery, except for transient stage 1 AKI (persistent stage 1: HR 3.11, 95% CI 2.62–4.91; transient higher stage: HR 4.07, 95% CI 2.98–6.11; persistent higher stage: HR 13.36, 95% CI 8.22–18.72). There was a significant difference in survival between transient and persistent AKI at the same stage. During three years after cardiac surgery, there was a significant and graded association between AKI stages and the development of new-onset CKD, except for transient stage 1 AKI. This association was stronger when AKI lasted more than 48 h at the same stage. Both duration and severity of AKI provide prognostic value to predict the development of CKD.

Non-steroidal anti-inflammatory drugs and risk of acute adverse renal outcomes in diabetes and diabetic kidney disease

2021 ◽  
pp. 1-10
Author(s):  
Cynthia Ciwei Lim ◽  
Hanis Bte Abdul Kadir ◽  
Ngiap Chuan Tan ◽  
Andrew Teck Wee Ang ◽  
Yong Mong Bee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Singapore General Hospital ◽  
Nsaid Prescription ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

BACKGROUND: Individuals with diabetes mellitus (DM) may be susceptible to non-steroidal anti-inflammatory drug (NSAID) – induced acute kidney injury (AKI) but data on NSAID-related adverse renal events is sparse. We aimed to evaluate the risk of acute kidney injury and/or hyperkalemia after systemic NSAID among individuals with DM and diabetic chronic kidney disease (CKD). METHODS: Retrospective cohort study of 3896 adults with DM with incident prescriptions between July 2015 and December 2017 from Singapore General Hospital and SingHealth Polyclinics. Laboratory, hospitalization and medication data were retrieved from electronic medical records. The primary outcome was the incidence of AKI and/ or hyperkalemia within 30 days after prescription. RESULTS: AKI and/or hyperkalemia occurred in 13.5% of all DM and 15.8% of diabetic CKD. The association between systemic NSAID >14 days and 30-day risk of AKI and/or hyperkalemia failed to reach statistical significance in unselected DM (adjusted OR 1.62, 95% CI 0.99–2.65, p = 0.05) and diabetic CKD (adjusted OR 0.64, 95% CI 0.15–2.82, p = 0.64), but the odds of AKI and/or hyperkalemia were markedly and significantly increased when NSAID was prescribed with renin-angiotensin-aldosterone system (RAAS) blocker (adjusted OR 4.17, 95% CI 1.74–9.98, p = 0.001) or diuretic (adjusted OR 3.31, 95% CI 1.09–10.08, p = 0.04) and in the absence of diabetic CKD (adjusted OR 1.98, 95% CI 1.16–3.36, p = 0.01). CONCLUSION: NSAID prescription >14 days in individuals with DM with concurrent RAAS blockers or diuretics was associated with higher 30-day risk of AKI and/or hyperkalemia.

Kidney and Mortality Outcomes Associated with Ondansetron in Critically Ill Patients

2022 ◽  
pp. 088506662110735
Author(s):  
Matthew Gray ◽  
Priyanka Priyanka ◽  
Sandra Kane-Gill ◽  
Lirong Wang ◽  
John A. Kellum
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Multivariate Logistic Regression ◽  
Increased Risk ◽  
Secondary Outcomes

Background: Ondansetron is a preferred anti-emetic in critical care to treat nausea and vomiting, and has historically been considered a largely safe option. A recent pharmacoepidemiology study reported that ondansetron may be associated with an increased risk for acute kidney injury (AKI). Methods: We interrogated the High-Density Intensive Care (HiDenIC-15) database containing intensive care data for 13 hospitals across Western Pennsylvania between Oct 2008-Dec 2014. AKI was defined using the Kidney Disease, Improving Global Outcomes 2012 guidelines. Ondansetron use was considered as receiving any form of ondansetron within 24 h of admission. The subsequent 48 h (hours 25-72 after admission) were analyzed for outcomes. Primary outcome was development of AKI; secondary outcomes included 90-day mortality and time to AKI. Propensity-matched, multivariate logistic regression was applied for both outcomes. Comparator groups were metoclopramide and prochlorperazine using the same exposure criteria. Results:AKI occurred in 965 (5.6%), 12 (3.0%), and 61 (6.5%) patients receiving ondansetron, prochlorperazine, and metoclopramide, respectively. In the adjusted analysis, no anti-emetic was associated with a significant change in the odds of developing AKI. Ondansetron was associated with a 5.48% decrease (CI −6.17–−4.79) in death within 90 days of ICU-admission, which was independent of AKI status; an effect not seen with other anti-emetics. Anti-emetic usage was not associated with a change in the time to first AKI. Conclusion:Anti-emetic usage did not alter AKI risk. Ondansetron was associated with a significant decrease in 90-day mortality that was not seen by other anti-emetics, which requires further exploration.

scholarly journals Association of Acute Kidney Injury with Cardiovascular Events and Death in Systolic Blood Pressure Intervention Trial

2019 ◽  
Vol 49 (5) ◽  
pp. 359-367
Author(s):  
Brad P. Dieter ◽  
Kenn B. Daratha ◽  
Sterling M. McPherson ◽  
Robert Short ◽  
Radica Z. Alicic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Intervention Trial ◽  
Major Cardiovascular Events

Rationale and Objective: In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. Study Design: Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. Setting and Participants: Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). Predictor: AKI episodes. Outcomes: The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. Results: Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05–2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56–3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. Limitations: The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. Conclusions: Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.

Fluids and renal

2018 ◽  
pp. 385-404
Author(s):  
Tim Raine ◽  
George Collins ◽  
Catriona Hall ◽  
Nina Hjelde ◽  
James Dawson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Urine Output ◽  
Kidney Injury ◽  
Glomerular Disease ◽  
Electrolyte Imbalance ◽  
Urological Disorders

This chapter discusses fluids and renal, including acute kidney injury, chronic kidney disease, haematuria, proteinuria, glomerular disease, urological disorders, low urine output, IV fluids, potassium emergencies, and electrolyte imbalance.

scholarly journals The Clinical Utility of Kinetic Glomerular Filtration Rate in the Assessment of Renal Function and Prediction of Outcomes Among Critically Ill Patients With Acute Kidney Injury: A Single-Center Retrospective Cohort Study

2021 ◽  
Vol 5 (1) ◽  
pp. 611-620
Author(s):  
Shari Ann Atanacio ◽  
Maria Rachel Uy
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Urine Output ◽  
Filtration Rate ◽  
Kidney Injury

Objective: To determine the discriminatory ability of kinetic glomerular filtration rate (kGFR) to detect acute kidney injury (AKI) when compared with established GFR equations and criteria and relating it to mortality, renal replacement therapy initiation and renal recovery. Methods: This was a retrospective analysis using data from chart review of 109 intensive care unit (ICU) patients at the University of Santo Tomas Hospital (USTH). The renal function estimates using Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi), modification of diet in renal disease (MDRD), Kidney Disease Improving Global Outcomes Acute Kidney Injury (KDIGO AKI), as well as kinetic GFR equations were compared and correlated with renal and cardiovascular outcomes. Results: The renal function assessed by kGFR, CKD-Epi, MDRD and KDIGO staging based on serum creatinine (SCr) showed no significant association with mortality outcomes. However, AKI diagnosed based on urine output (UO), and combined SCr and urine output (KDIGO) showed association with all-cause mortality. The UO detected severe stages of AKI while SCr (based on KDIGO) better identified the earlier stages of AKI. The criteria for KDIGO AKI when combined also shows mortality prediction since it joins together the effects of SCr and UO. There was a remarkable 3.5 times increase  in hemodialysis initiation (p=0.0001) and 12.89 times increase in peritoneal dialysis initiation (p=0.01) for every stage increase in the KDIGO classification. kGFR, CKD-Epi and MDRD have 5%, 6%, and 6% decrease, respectively in the odds of initiating hemodialysis. There was however, no association for peritoneal dialysis. Conclusion: kGFR was the least able in detecting AKI and KDIGO AKI criteria remains to be the standard in identifying AKI in the critical care setting. Increase in SCr was a sensitive tool in diagnosing AKI due to its ability to detect AKI based on a small increase in SCr regardless of the baseline renal function. Decreasing UO, however, is the prognosticating variable in KDIGO AKI criteria, in that it portends higher probability of initiation of renal replacement therapy (RRT) and ultimately higher mortality when present.

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