Prognostic Implications of a Cumulative Renal Score Based on Both Serum Creatinine and Urine Output Criteria for Staging of Acute Kidney Injury: A Cohort Study

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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Cystatin C- an early marker indicative of renal dysfunction in critically ill children: a prospective cohort study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20193709 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1981

Author(s):

Hawwa M.S. Siddiqua ◽

Mathew John ◽

V. C. Manoj ◽

Rati Santhakumar

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Serum Creatinine ◽

Renal Dysfunction ◽

Critically Ill ◽

Cystatin C ◽

Prospective Cohort ◽

Kidney Injury ◽

Critically Ill Children ◽

Serum And Urine

Background: Acute kidney injury (AKI) is a sudden onset of kidney failure or kidney damage that happens within a few hours or a few days and can also affect other organs such as brain, heart and the lungs. Hence early diagnosis and intervention is needed to improve the outcome of the children. In these studies this objective was to determine if cystatin C is an early marker indicative of renal dysfunction in critically ill children and to determine if Cystatin C can detect Acute kidney injury earlier than serum creatinine.Methods: This prospective cohort study was undertaken in PICU at Jubilee Mission Medical College from December 2016- May 2018. Blood samples were collected from 34 critically ill children for serum creatinine estimation at 0,24 and 48 hours of admission and serum and urine were collected for cystatin C estimation at admission. Children were categorized into AKI and NON-AKI based on pRIFLE criteria. Comparison of cystatin C values with serum creatinine was performed and Statistical analysis was done using IBM SPSS version 20.Results: A total of 34 critically ill children were enrolled in this study, out of which 12 children progressed to AKI during the course of illness according to modified Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease (pRIFLE) criteria. We found a strong positive correlation between cystatin C at 0 hours and serum creatinine at 48 hours among AKI groups.Conclusions: Serum and Urine cystatin C are early markers to diagnose AKI in critically ill children. Serum cystatin C is more sensitive than urine cystatin C for the diagnosis of AKI.

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Acute kidney injury after liver surgery: does postoperative urine output correlate with postoperative serum creatinine?

HPB ◽

10.1016/j.hpb.2019.06.016 ◽

2020 ◽

Vol 22 (1) ◽

pp. 144-150

Author(s):

Gaëtan-Romain Joliat ◽

Ismail Labgaa ◽

Nicolas Demartines ◽

Nermin Halkic

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Liver Surgery ◽

Urine Output ◽

Kidney Injury ◽

Postoperative Serum

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Acute Kidney Injury Classified by Serum Creatinine and Urine Output in Critically Ill Cancer Patients

BioMed Research International ◽

10.1155/2016/6805169 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Bertha M. Córdova-Sánchez ◽

Ángel Herrera-Gómez ◽

Silvio A. Ñamendys-Silva

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Cancer Patients ◽

Critically Ill ◽

Urine Output ◽

Cohort Analysis ◽

Kidney Injury ◽

Risk Of Death ◽

Increased Risk ◽

Stage 1

Acute kidney injury (AKI) is common in critically ill patients and is associated with higher mortality. Cancer patients are at an increased risk of AKI. Our objective was to determine the incidence of AKI in our critically ill cancer patients, using the criteria of serum creatinine (SCr) and urine output (UO) proposed by the Kidney Disease: Improving Global Outcomes (KDIGO).Methods.We performed a retrospective cohort analysis of a prospectively collected database at the intensive care unit (ICU) of the Instituto Nacional de Cancerología from January 2013 to March 2015.Results.We classified AKI according to the KDIGO definition. We included 389 patients; using the SCr criterion, 192 (49.4%) had AKI; using the UO criterion, 219 (56.3%) had AKI. Using both criteria, we diagnosed AKI in 69.4% of patients. All stages were independently associated with six-month mortality; stage 1 HR was 2.04 (95% CI 1.14–3.68,p=0.017), stage 2 HR was 2.73 (95% CI 1.53–4.88,p=0.001), and stage 3 HR was 4.5 (95% CI 2.25–8.02,p<0.001). Patients who fulfilled both criteria had a higher mortality compared with patients who fulfilled just one criterion (HR 3.56, 95% CI 2.03–6.24,p<0.001).Conclusion.We diagnosed AKI in 69.4% of patients. All AKI stages were associated with higher risk of death at six months, even for patients who fulfilled just one AKI criterion.

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The impact of acute kidney injury by serum creatinine or urine output criteria on major adverse kidney events in cardiac surgery patients

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.11.137 ◽

2020 ◽

Cited By ~ 2

Author(s):

Priyanka Priyanka ◽

Alexander Zarbock ◽

Junichi Izawa ◽

Thomas G. Gleason ◽

Ronny W. Renfurm ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Serum Creatinine ◽

Urine Output ◽

Kidney Injury ◽

The Impact ◽

Major Adverse Kidney Events

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Reno-protective effects of melatonin against vancomycin-related acute kidney injury in hospitalized patients: a retrospective cohort study

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00462-21 ◽

2021 ◽

Author(s):

Thomas S. Hong ◽

Kelsey Briscese ◽

Marshall Yuan ◽

Kiran Deshpande ◽

Lauren M. Aleksunes ◽

...

Keyword(s):

Oxidative Stress ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Cohort Study ◽

Serum Creatinine ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Kidney Injury ◽

Multivariable Logistic Regression

Background: Vancomycin is associated with nephrotoxicity and the mechanism may in part be related to oxidative stress. In vitro and preclinical studies suggest melatonin supplementation decreases oxidative stress. The objective of this study was to evaluate concomitant use of melatonin and vancomycin and the incidence of acute kidney injury (AKI). Methods: We performed a retrospective cohort study at a large community medical center. All consecutive patients admitted to the medical center between January 2016 and September 2020 who received vancomycin therapy alone or concomitantly with melatonin as part of ordinary care were considered for inclusion. The primary endpoint was the development of AKI defined as an absolute increase in serum creatinine of ≥ 0.3 mg/dL or a ≥ 50% increase in serum creatinine. All data were analyzed using descriptive statistics. A multivariable logistic regression was constructed to account for potential confounding variables. Results: A total of 303 adult patients meeting inclusion and exclusion criteria treated with vancomycin were identified, 101 of which received melatonin concomitantly. Overall baseline characteristics were similar between the two groups except for the incidence of bactremia/sepsis. After controlling for vancomycin area under the curve, baseline creatinine clearance, and intensive care unit admission in multivariable logistic regression, melatonin use was associated with a 63% decrease in AKI (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14 – 0.96; p =0.041). Conclusions: Melatonin use was associated with a significant reduction in vancomycin-related AKI. Although this was a retrospective study with a small sample size, given the magnitude of the difference seen, further large prospective studies are warranted.

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