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

Abstract Background: Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney failure (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT.Methods: This was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72 hours from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24 hours after CRRT discontinuation. The cumulated urine output was measured for 24 hours prior to discontinuation and at 6, 12, and 24 hours after discontinuation. Logistic regression was used to calculate the missing 6-hour uNGAL values by interpolation. The Youden index was used to calculate cut-off values. A P-value <0.05 was considered statistically significant.Results: Baseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, REC patients had significantly higher urine output (p<0.0001) and lower uNGAL (p<0.001) at all time points, except for uNGAL at 24 hours (p<0.24). The best single predictor for renal recovery was the cumulated urine output 24 hours after discontinuation (predictive value 83%). Combining uNGAL at 6 hours (cut-off 1650 µg/L) with the cumulated urine output during the 24 hours prior to discontinuation (cut-off 210 ml) proved superior, with predictive values of 92% (CRRT dependency) and 93% (renal function recovery).Conclusions: With predictive values up to 93%, the combination of uNGAL at 6 hours and the cumulatated urine output during the 24 hours prior to CRRT cessation proved to be the best diagnostic test for renal function recovery in ICU patients.Clinical trial registration: N/A

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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

10.21203/rs.3.rs-23814/v2 ◽

2020 ◽

Author(s):

Josefine Thomsen ◽

Ulrik Sprogøe ◽

Palle Toft

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Predictive Value ◽

Urine Output ◽

Kidney Injury ◽

Icu Patients ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

Abstract Background: Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT.Methods: This was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72 hours from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24 hours after CRRT discontinuation. The cumulated urine output was measured for 24 hours prior to discontinuation and at 6, 12, and 24 hours after discontinuation. Missing uNGAL values were calculated by interpolation. The Youden’s index was used to calculate cut-off values in order to define uNGAL and urine output single variable and 2-variable diagnostic tests with the optimum prediction of successful CRRT discontinuation. Results: Baseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, the REC group had significantly higher urine output (p<0.0001) and lower uNGAL (p<0.001) at all time points, except for uNGAL at 24 hours (p<0.24). The best uNGAL predictor for successful CRRT discontinuation was uNGAL at 6 hours after discontinuation (predictive value 80%). The best single predictor was cumulated urine output 24 hours before discontinuation (predictive value 85%). The combinations of uNGAL at 6 hours (cut-off 1650 µg/L) with cumulated urine output 24 hours prior to discontinuation (cut-off 210 ml) proved to be the superior tests (using either “or” or “and”), with predictive values of 93% (successful CRRT discontinuation) and 92% (dialysis dependency).Conclusions: With a predictive value of 93%, the combination of uNGAL at 6 hours after and the cumulated urine output 24 hours prior to CRRT cessation proved to be the best diagnostic test for successful CRRT discontinuation in ICU patients.Clinical trial registration: N/A

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Serum Cystatin C is Associated with Renal Function Recovery in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Nephron Clinical Practice ◽

10.1159/000350245 ◽

2012 ◽

Vol 122 (3-4) ◽

pp. 86-92 ◽

Cited By ~ 5

Author(s):

Z. Zhang ◽

X. Xu ◽

H. Ni ◽

N. Jin

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Renal Function Recovery ◽

Function Recovery

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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

BMC Nephrology ◽

10.1186/s12882-020-02035-w ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 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

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

Blood Purification ◽

10.1159/000499026 ◽

2019 ◽

Vol 48 (1) ◽

pp. 10-17 ◽

Cited By ~ 4

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.

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Secondary Oxalate Nephropathy: Causes and Clinicopathological Characteristics of a Case Series

Nephron ◽

10.1159/000517072 ◽

2021 ◽

pp. 1-8

Author(s):

Shaoshan Liang ◽

Lijuan Li ◽

Dacheng Chen ◽

Dandan Liang ◽

Feng Xu ◽

...

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Renal Biopsy ◽

Replacement Therapy ◽

Case Series ◽

Common Cause ◽

Renal Function Recovery ◽

Function Recovery ◽

Renal Biopsies ◽

Oxalate Nephropathy

Introduction: Secondary oxalate nephropathy (OxN) is associated with a variety of causes and has not been well characterized in Chinese population. To investigate the etiology, clinicopathological features, and outcomes of secondary OxN, we report a case series from a single center in China. Methods: A retrospective analysis of 68 patients diagnosed with secondary OxN by renal biopsy from January 2013 to February 2019 in Jinling Hospital was performed. Results: Secondary OxN accounted for 0.23% of the renal biopsies and 2.31% of patients who received renal biopsies due to acute kidney injury (AKI). A total of 49 men and 19 women with an average age of 51.6 ± 11.8 years were enrolled. The most common cause was iatrogenic medication, followed by oxalate-rich diet and industry exposure. Stage 1, 2, and 3 AKI and AKI on chronic kidney disease (ACKD) were found in 4.4, 8.8, 69.1, and 17.6% of the patients, respectively. The peak serum creatinine during hospitalization was 8.62 ± 4.67 mg/dL. The median urinary oxalate excretion was 51.5 (23.2–147.1) mg/24 h. Kidney biopsy showed extensive calcium oxalate crystal deposits with acute tubulointerstitial nephritis. Thirty-four patients (50.0%) required renal replacement therapy. At the end of a follow-up that lasted 8.7 (0.1–72.1) months, 81.0% of patients achieved renal function recovery in 50 (14–432) days. Patients with renal function recovery had a lower rate of ACKD, a higher level of hemoglobin, a lower level of urine lysozyme, and a lower degree of interstitial fibrosis/tubular atrophy, interstitial inflammation, and global glomerulosclerosis than those in the nonrecovery group. Conclusions: In this case series of secondary OxN, the most common cause was iatrogenic medication, and it presented with AKI or ACKD. Half of the patients required renal replacement therapy, and in most of them, the renal function was reversible. Renal biopsy played an important role in diagnosis and prognosis evaluation.

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