scholarly journals А PROBLEM OF ACUTE KIDNEY INJURY IN CHILDREN TODAY

2017 ◽  
pp. 42-47
Author(s):  
O. Lavrenchuk
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Pathological Changes ◽  
Foreign Literature ◽  
Chronic Kidney Injury ◽  
Modern System ◽  
Different Parts

In this survey of contemporary foreign literature presents the results of recent studies on acute kidney damage in children. Present modern system of stratification by severity degrees ofacute kidney injury and their comparison (RIFLE and AKIN – criteria). For this reason recently there has been a great surge of interest in identifying biomarkers ofacute and chronic kidney injury which help to detect early pathological changes in kidneys, to differentiate the injury of different parts of the nephron, to accurately determine the stage of the process, to assess the severity of inflammation and fibrogenesis intensity. The most important new markers which are currently studied include KIM–1, VEGF–А, L–FABP, TGF–b1, NGAL and NAG. This review highlights the results of major recent studies in this area.

scholarly journals Acute Kidney Injury and Kidney Damage in COVID-19 Patients

2020 ◽  
Vol 35 (28) ◽  
Author(s):  
Ki Ryang Na ◽  
Hae Ri Kim ◽  
Youngrok Ham ◽  
Dae Eun Choi ◽  
Kang Wook Lee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Kidney Damage

Management of acute kidney injury and chronic kidney disease

2017 ◽  
pp. 1087-1096
Author(s):  
Natalie Ebert ◽  
Elke Schaeffner
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Staging System ◽  
Kidney Damage ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Both acute and chronic states of kidney disease have considerable healthcare impact as they can produce enormous disease burden and costs. To classify chronic kidney disease into the CKD staging system, glomerular filtration rate as an index of kidney function, as well as albuminuria as a marker of kidney damage have to be assessed as correctly as possible. Misclassification is a serious concern due to the difficulties in precise GFR assessment and correct interpretation of results. Differentiating between pure senescence and true disease among older adults can be a delicate issue. To find the right renal replacement option for individuals that progress to end-stage renal disease can be challenging, and some older patients may even benefit from conservative care without dialysis. To prevent acute kidney injury as a frequent and potentially life-threatening complication, clinicians need to develop an understanding of the common vulnerability to kidney damage among older adults.

scholarly journals P1828A PANEL OF URINE BIOMARKERS FOR EARLY KIDNEY INJURY DETECTION IN NEWBORNS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Irina Pevzner ◽  
Kirill Goryunov ◽  
Valentina Vtorushina ◽  
Vasily Popkov ◽  
Denis Silachev ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Excretion ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Urine Samples ◽  
Reference Level ◽  
Control Group ◽  
Tubular Damage ◽  
Urine Biomarkers ◽  
Rate Of Increase

Abstract Background and Aims Neonatal kidney damage is a wide spread pathology, especially among preterm infants. Acute kidney injury (AKI) in newborns remains one of the most important problems because the features of neonatal nephrogenesis and physiology. The current clinical criteria for the diagnosis of AKI, including pediatric scales pRIFLE and nRIFLE, rely on glomerulal filtration rate (GFR), blood urea nitrogen (BUN), and serum creatinine (SCr), which are the late biomarkers detectable only within days or weeks after kidney damage occurred, and therefore have limitations when used within the first days after birth. Therefore, sensitive and specific tests for early diagnostics of kidney injury are extremely needed in neonatology. Urine biomarkers appear to be promising for early diagnosis of AKI. Quite often renal pathologies result in markedly increased (or decreased) urinary excretion of a number of protein biomarkers, indicating subclinical tubular injury while conventional AKI signs are not manifested yet. The aim of this study was to determine clinical value of urine molecular biomarkers for the prediction of acute kidney injury in newborns. Method Urine samples from newborns with congenital malformation were collected on the 1st day after born, and then once a week until the 21th postnatal day. Urine samples were centrifuged, aliquoted and stored at –80°С until testing. The next urinary biomarkers were analyzed: calbindin 1, clusterin, IL-18, KIM-1, GST-π, MCP-1 and NGAL. Quantitative determination was performed with immunoassay kit Bio-Plex Pro™ RBM Human Kidney Toxicity Panel 1 (Bio-Rad Inc., USA) and Human NGAL ELISA kit (Invitrogen, Germany). Control group included five age-matched healthy infants. Results 8 of 20 patients showed a direct correlation of increased NGAL levels in urine (50-fold compared to control group) with high levels of C-reactive protein in the blood (3-10-fold rise above the reference level). NGAL is the most sensitive marker for assessing AKI or tubular damage. These 8 patients were further investigated for other urine biomarkers. The IL-18 level in urine was slightly increased in 4 patients. IL-18 is proposed to be a predictor for AKI severity and mortality in children with critical illness. KIM-1 has low basal expression in the normal kidney but its appearance is highly specific and sensitive sign for nephrotoxicity in proximal tubules. We observed the increase of KIM-1 urinary excretion for 7 patients. However, we discover the equal occurrence of decrease or increase of urine MCP-1 through studied patients. Elevated levels of urine MCP-1 were earlier observed in experimental maleate induced azotemia, LPS injection and in model of unilateral ureteral obstruction (UUO). An increase of KIM-1 and/or MCP-1 urinary excretion is known to be associated with some risk of AKI development. We found 3-fold growth of urine clusterin in 7 children. It is noticed, that clusterin increased in damaged tubular cells during polycystic kidney disease and renal carcinoma. Additionally, we revealed 7-fold decrease of calbindin 1 in urine of 7 patients. Сalbindin 1 exclusively localized in the kidney distal nephron segment, and its decrease was discribed for models of UUO, glomerulonephritis and cisplatin nephropathy. GST-π protein is found in cells lining the lumen of the distal tubules and is elevated in the urine of patients with sepsis, independently of accompanied AKI. We also observed 10- to 20-fold rising of urine GST-π for all 8 NGAL-positive newborns. Conclusion The specificity, rate of increase, and non-invasive detection of urine markers studied in this work, make them indispensable in clinical practice. However, their use in neonatology is still experimental. We showed potential applicability of wide biomarker panel for early detection and prediction of AKI in newborns.

scholarly journals Prediction of Acute Kidney Injury with a Machine Learning Algorithm using Electronic Health Record Data

2017 ◽  
Author(s):  
Hamid Mohamadlou ◽  
Anna Lynn-Palevsky ◽  
Christopher Barton ◽  
Uli Chettipally ◽  
Lisa Shieh ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
Sofa Score ◽  
Learning Algorithm ◽  
Medical Center ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Prediction Algorithm ◽  
Prediction Tool ◽  
Electronic Health Record Data

AbstractBackgroundA major problem in treating acute kidney injury (AKI) is that clinical criteria for recognition are markers of established kidney damage or impaired function; treatment before such damage manifests is desirable. Clinicians could intervene during what may be a crucial stage for preventing permanent kidney injury if patients with incipient AKI and those at high risk of developing AKI could be identified.MethodsWe used a machine learning technique, boosted ensembles of decision trees, to train an AKI prediction tool on retrospective data from inpatients at Stanford Medical Center and intensive care unit patients at Beth Israel Deaconess Medical Center. We tested the algorithm’s ability to detect AKI at onset, and to predict AKI 12, 24, 48, and 72 hours before onset, and compared its 3-fold cross-validation performance to the SOFA score for AKI identification in terms of Area Under the Receiver Operating Characteristic (AUROC).ResultsThe prediction algorithm achieves AUROC of 0.872 (95% CI 0.867, 0.878) for AKI onset detection, superior to the SOFA score AUROC of 0.815 (P < 0.01). At 72 hours before onset, the algorithm achieves AUROC of 0.728 (95% CI 0.719, 0.737), compared to the SOFA score AUROC of 0.720 (P < 0.01).ConclusionsThe results of these experiments suggest that a machine-learning-based AKI prediction tool may offer important prognostic capabilities for determining which patients are likely to suffer AKI, potentially allowing clinicians to intervene before kidney damage manifests.

scholarly journals Orai1: A New Therapeutic Target for the Acute Kidney Injury-to-Chronic Kidney Disease Transition

Nephron ◽  
2021 ◽  
pp. 1-4
Author(s):  
David P. Basile ◽  
Jason A. Collett
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Peripheral Blood ◽  
Th17 Cells ◽  
Ischemia Reperfusion ◽  
Kidney Injury ◽  
Acute Injury ◽  
Chronic Kidney Injury ◽  
Sustained Increase

This review focuses on the potential mediation in the acute kidney injury (AKI)-to-chronic kidney disease (CKD) transition by lymphocytes. We highlight evidence that lymphocytes, particularly Th17 cells, modulate the severity of both acute injury and chronic kidney disease. Th17 cells are strongly influenced by the activity of the store-operated Ca<sup>2+</sup>channel Orai1, which is upregulated on lymphocytes in animal models of AKI. Inhibition of this channel attenuates both acute and chronic kidney injury in rodent models. In addition, Oria1+ cells are increased in peripheral blood of patients with AKI. Similarly, peripheral blood cells manifest an early and sustained increase in Orai1 expression in a rat model of ischemia/reperfusion, suggesting that blood cell Orai1 may represent a marker informing potential Th17 activity in the setting of AKI or the AKI-to-CKD transition.

scholarly journals PERSPECTIVE URINARY BIOMARKERS ACCORDING TO PATHOGENETIC MECHANISMS OF ACUTE KIDNEY INJURY IN PRETERM-BORN CHILDREN

2021 ◽  
Vol 11 (3(41)) ◽  
pp. 27-33
Author(s):  
Y. Hodovanets ◽  
A. Frunza
Keyword(s):  
Acute Kidney Injury ◽  
Body Weight ◽  
Gestational Age ◽  
Renal Injury ◽  
Transient Receptor Potential ◽  
Kidney Injury ◽  
Transient Receptor Potential Channels ◽  
Kidney Damage ◽  
Tubular Damage ◽  
Preterm Born

Technologies for nursing preterm-born babies have evolved significantly in recent years. However, we still have several unresolved issues, among which acute kidney injury remains one of the most urgent. This pathological clinical syndrome is associated with high rates of morbidity and mortality, especially in premature infants with severe perinatal pathology. Arrester diagnosis is based on the classification proposed in 2012 by the International Expert Group - Kidney Disease: Improving Global Outcomes. The main criteria for verifying the diagnosis of acute renal injury are an increase in serum creatinine levels and a decrease in urine output. The problem of diagnosis and differential diagnosis of acute renal failure in prematurely born children occupies a leading place, because it is still no consensus on the possibilities of using specific biomarkers of kidney damage, and no nomograms are taking into account the gestational age at birth, body weight and the severity of perinatal pathology.Plasma creatinine is still the most commonly used marker of impaired filtration function, but in recent years there have been numerous scientific discussions and new, highly sensitive, and highly specific markers of renal injury. In particular, it was proposed to consider functional biomarkers and markers of tubular damage as separate categories, since impaired renal function and the injury itself can coexist independently, simultaneously, or a transition of categories is observed. Plasma cystatin C, urinary and serum fractions of alpha-1-microglobulin and beta-2-microglobulin, lipocalin associated with neutrophil gelatinase, and others are promising biomarkers. Attention is focused on the importance of the epigenetic concept in the formation of kidney damage, blocking of the renin- angiotensin-aldosterone-antidiuretic hormone system, and the role of transient receptor potential channels in the modulation of basic renal functions. Metabolic urine profiles are widely studied taking into account gestational age and body weight.

scholarly journals Kidney Tubular Damage Secondary to Deferasirox: Systematic Literature Review

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1104
Author(s):  
Martin Scoglio ◽  
Maria Domenica Cappellini ◽  
Emanuela D’Angelo ◽  
Mario G. Bianchetti ◽  
Sebastiano A. G. Lava ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Kidney Injury ◽  
The United States ◽  
Kidney Damage ◽  
Tubular Damage ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
First Line Therapy

Deferasirox is a first-line therapy for iron overload that can sometimes cause kidney damage. To better define the pattern of tubular damage, a systematic literature review was conducted on the United States National Library of Medicine, Excerpta Medica, and Web of Science databases. Twenty-three reports describing 57 individual cases could be included. The majority (n = 35) of the 57 patients were ≤18 years of age and affected by thalassemia (n = 46). Abnormal urinary findings were noted in 54, electrolyte or acid–base abnormalities in 46, and acute kidney injury in 9 patients. Latent tubular damage was diagnosed in 11 (19%), overt kidney tubular damage in 37 (65%), and an acute kidney injury in the remaining nine (16%) patients. Out of the 117 acid–base and electrolyte disorders reported in 48 patients, normal-gap metabolic acidosis and hypophosphatemia were the most frequent. Further abnormalities were, in decreasing order of frequency, hypokalemia, hypouricemia, hypocalcemia, and hyponatremia. Out of the 81 abnormal urinary findings, renal glucosuria was the most frequent, followed by tubular proteinuria, total proteinuria, and aminoaciduria. In conclusion, a proximal tubulopathy pattern may be observed on treatment with deferasirox. Since deferasirox-associated kidney damage is dose-dependent, physicians should prescribe the lowest efficacious dose.

scholarly journals PROGNOSTIC VALUE OF ACUTE KIDNEY INJURY IN STROKE PATIENTS

2021 ◽  
pp. 26-38
Author(s):  
A.M. Gerdt ◽  
A.M. Shutov ◽  
L.A. Belova ◽  
E.A. Gubareva
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Prognostic Value ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Hospital Treatment ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Relative Risk Of Death

The development of acute kidney injury (AKI) in stroke patients is associated with an increase in hospital mortality, period of hospital treatment, disability, and economic health costs. At the same time, the influence of AKI on long-term stroke outcomes remains unclear. The aim of the study was to determine the prognostic value of acute kidney damage in stroke patients. Materials and Methods. The authors examined 272 stroke patients. Acute kidney damage was established according to the KDIGO recommendations (2012). Mortality of stroke patients during hospital treatment was 20.6 %. The prospective follow-up of stroke patients discharged from the hospital was 12 months. Results. Acute kidney injury was diagnosed in 89 (32.7 %) stroke patients. After discharging from the hospital, 45 (20.8 %) patients died within 12 months. The relative risk of death within 12 months after stroke in the group of AKI patients was 3.7 (95 % CI 2.2–6.2, p<0.001) if compared with patients without AKI. Multivariate analysis did not show any independent statistically significant correlation between AKI history and patients’ death within 12 months after hemorrhagic stroke. However, such a correlation was evident in ischemic stroke. Conclusions. Acute kidney injury, developed in the acute period, increases the 12-month mortality in ischemic stroke patients. Keywords: prognosis, stroke, acute kidney injury. Развитие ОПП у больных с инсультом ассоциируется с увеличением госпитальной летальности, сроков стационарного лечения, инвалидизации и экономических затрат здравоохранения. При этом остается неясным влияние ОПП на отдаленные исходы инсульта. Целью исследования явилось определение прогностического значения острого повреждения почек у больных с инсультом. Материалы и методы. Обследовано 272 больных с инсультом. Острое повреждение почек устанавливали согласно «Рекомендациям KDIGO» (2012). Летальность у больных с инсультом в период стационарного лечения составила 20,6 %. Срок проспективного наблюдения за больными инсультом, выписанными из стационара, составил 12 мес. Результаты. Острое повреждение почек было диагностировано у 89 (32,7 %) больных инсультом. За 12 мес. наблюдения за больными, выписанными из стационара, умерло 45 (20,8 %) пациентов. Относительный риск смерти в течение 1-го года после инсульта в группе больных с ОПП составил 3,7 (95 % ДИ 2,2–6,2, p<0,001) в сравнении с больными без ОПП. Независимая статистически значимая связь между ОПП в анамнезе и летальным исходом в течение года после геморрагического инсульта в многофакторном анализе не прослеживалась, в отличие от ишемического инсульта. Выводы. Острое повреждение почек, развившееся в остром периоде, повышает годичную летальность у больных с ишемическим инсультом. Ключевые слова: прогноз, инсульт, острое повреждение почек.

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