scholarly journals Non-invasive Early Prediction of Septic Acute Kidney Injury by Doppler-Based Renal Resistive Indexes Combined With Echocardiographic Parameters: An Experimental Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Ying Zhang ◽  
Jianing Zhu ◽  
Chuyue Zhang ◽  
Jing Xiao ◽  
Chao Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Early Stage ◽  
Kidney Injury ◽  
Systemic Circulation ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Early Prediction ◽  
Non Invasive ◽  
Septic Acute Kidney Injury ◽  
Echocardiographic Parameters

Non-invasive early prediction of septic acute kidney injury (S-AKI) is still urgent and challenging. Increased Doppler-based renal resistive index (RRI) has been shown to be associated with S-AKI, but its clinical use is limited, which may be explained by the complex effects of systemic circulation. Echocardiogram allows non-invasive assessment of systemic circulation, which may provide an effective supplement to RRI. To find the value of RRI combined with echocardiographic parameters in the non-invasive early prediction of S-AKI, we designed this experiment with repeated measurements of ultrasonographic parameters in the early stage of sepsis (3, 6, 12, and 24 h) in cecum ligation and puncture (CLP) rats (divided into AKI and non-AKI groups at 24 h based on serum creatinine), with sham-operated group serving as controls. Our results found that RRI alone could not effectively predict S-AKI, but when combined with echocardiographic parameters (heart rate, left ventricular end-diastolic internal diameter, and left ventricular end-systolic internal diameter), the predictive value was significantly improved, especially in the early stage of sepsis (3 h, AUC: 0.948, 95% CI 0.839–0.992, P < 0.001), and far earlier than the conventional renal function indicators (serum creatinine and blood urea nitrogen), which only significantly elevated at 24 h. Our method showed novel advances and potential in the early detection of S-AKI.

Association between left ventricular diastolic dysfunction and septic acute kidney injury in severe sepsis and septic shock: A multicenter retrospective study

Perfusion ◽  
2021 ◽  
pp. 026765912198896
Author(s):  
Guangwei Yu ◽  
Kun Cheng ◽  
Qing Liu ◽  
Xiaohong Lin ◽  
Fenghui Lin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Kidney Injury ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Septic Acute Kidney Injury ◽  
Ventricular Diastolic Dysfunction ◽  
Sepsis And Septic Shock

Introduction: Left ventricular diastolic dysfunction (LVDD) adversely impacts renal function, and E/e′ is a significant predictor of adverse kidney events under different clinical conditions. However, no studies have evaluated the association between LVDD and septic acute kidney injury (AKI) among patients with severe sepsis and septic shock. Methods: This multicenter retrospective study evaluated adult patients with severe sepsis or septic shock between January 1, 2013, and December 31, 2019, who underwent echocardiography within 24 hours after admission to an intensive care unit. Results: A total of 495 adult patients were enrolled in the study. LVDD grades II and III were associated with severe (stage 3) AKI ( p < 0.001, p for trend < 0.001). E/e′ and e′ were risk factors for septic AKI (OR, 1.155; 95% CI, 1.088–1.226, p < 0.001; and OR, 7.218; 95% CI, 2.942–17.712, p < 0.001, respectively) in the multivariate logistic regression analysis. The area under the receiver operating characteristic curve of E/e′ and e′ was 0.728 (95% CI, 0.680–0.777, p < 0.001) and 0.715 (95% CI, 0.665–0.764, p < 0.001), respectively. Conclusions: LVDD was associated with septic AKI, and E/e′ and e′ are useful predictors of septic AKI among patients with severe sepsis or septic shock. Trial registration The study was registered at the Chinese Clinical Trial Registry (Protocol No. ChiCTR2000033083).

scholarly journals RIP3 impedes transcription factor EB to suppress autophagic degradation in septic acute kidney injury

2021 ◽  
Vol 12 (6) ◽  
Author(s):  
Ruizhao Li ◽  
Xingchen Zhao ◽  
Shu Zhang ◽  
Wei Dong ◽  
Li Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Transcription Factor ◽  
Nuclear Translocation ◽  
Kidney Injury ◽  
Septic Acute Kidney Injury ◽  
Transcription Factor Eb ◽  
Autophagic Degradation ◽  
Lps Treatment

AbstractAutophagy is an important renal-protective mechanism in septic acute kidney injury (AKI). Receptor interacting protein kinase 3 (RIP3) has been implicated in the renal tubular injury and renal dysfunction during septic AKI. Here we investigated the role and mechanism of RIP3 on autophagy in septic AKI. We showed an activation of RIP3, accompanied by an accumulation of the autophagosome marker LC3II and the autophagic substrate p62, in the kidneys of lipopolysaccharide (LPS)-induced septic AKI mice and LPS-treated cultured renal proximal tubular epithelial cells (PTECs). The lysosome inhibitor did not further increase the levels of LCII or p62 in LPS-treated PTECs. Moreover, inhibition of RIP3 attenuated the aberrant accumulation of LC3II and p62 under LPS treatment in vivo and in vitro. By utilizing mCherry-GFP-LC3 autophagy reporter mice in vivo and PTECs overexpression mRFP-GFP-LC3 in vitro, we observed that inhibition of RIP3 restored the formation of autolysosomes and eliminated the accumulated autophagosomes under LPS treatment. These results indicated that RIP3 impaired autophagic degradation, contributing to the accumulation of autophagosomes. Mechanistically, the nuclear translocation of transcription factor EB (TFEB), a master regulator of the lysosome and autophagy pathway, was inhibited in LPS-induced mice and LPS-treated PTECs. Inhibition of RIP3 restored the nuclear translocation of TFEB in vivo and in vitro. Co-immunoprecipitation further showed an interaction of RIP3 and TFEB in LPS-treated PTECs. Also, the expression of LAMP1 and cathepsin B, two potential target genes of TFEB involved in lysosome function, were decreased under LPS treatment in vivo and in vitro, and this decrease was rescued by inhibiting RIP3. Finally, overexpression of TFEB restored the autophagic degradation in LPS-treated PTECs. Together, the present study has identified a pivotal role of RIP3 in suppressing autophagic degradation through impeding the TFEB-lysosome pathway in septic AKI, providing potential therapeutic targets for the prevention and treatment of septic AKI.

scholarly journals Contrast Volume/Raw eGFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction

2015 ◽  
Vol 5 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Hoon Suk Park ◽  
Chan Joon Kim ◽  
Jeong-Eun Yi ◽  
Byung-Hee Hwang ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Roc Curve ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Contrast Volume ◽  
Percutaneous Coronary

Background: Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). Methods: This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. Results: The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Conclusions: Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.

scholarly journals Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU

2019 ◽  
Vol 41 (4) ◽  
pp. 462-471 ◽  
Author(s):  
Kellen Hyde Elias Pinheiro ◽  
Franciana Aguiar Azêdo ◽  
Kelsy Catherina Nema Areco ◽  
Sandra Maria Rodrigues Laranja
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Icu Patients ◽  
Septic Acute Kidney Injury ◽  
Observational Cohort ◽  
Worse Prognosis

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

Abstract 13306: Combined Assessment of Acute Kidney Injury and Increased Plasma Concentration of D-dimer Is Useful for Evaluating 1-year Mortality in Patients Hospitalized to Coronary Care Units

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shigeru Matsui ◽  
Junichi Ishii ◽  
Ryuunosuke Okuyama ◽  
Hiroshi Takahashi ◽  
Hideki Kawai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Relative Risk ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Absolute Increase ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Coronary Care ◽  
D Dimer

Background: Acute kidney injury (AKI) detected after admission to coronary care unit (CCU) is associated with very poor outcomes. We prospectively investigated the prognostic value of a combination of AKI and high plasma D-dimer levels for 1-year mortality in patients hospitalized to CCUs. Methods: D-dimer, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitive C-reactive protein (hsCRP) levels were measured in 1228 patients on admission to CCUs, of whom 56% had decompensated heart failure and 38% had acute coronary syndrome. AKI was defined as an increase of >25% in creatinine from baseline or an absolute increase of ≥0.5 mg/dL within 48 h after admission. Left ventricular ejection fraction (LVEF) and E/e’ ratio were estimated using echocardiography with tissue Doppler imaging. Results: AKI was detected in 163 (13%) patients. During 1-year follow-up period, there were 149 (12%) deaths. The patients who died were older (median: 77 vs. 73 years; p < 0.0001) and exhibited higher D-dimer (2.7 vs. 1.3 μg/mL; p < 0.0001), NT-proBNP (5495 vs. 1525 pg/mL; p < 0.0001), and hsCRP levels (0.92 vs, 0.26 mg/L; p < 0.0001) and E/e’ ratio (15.0 vs. 13.2; p = 0.006). They also had a higher incidence of AKI (26% vs. 12%; p < 0.0001) and lower LVEF (39% vs. 49%; p < 0.0001) and estimated glomerular filtration rate (45 vs. 62 mL/min/1.73 m 2 ; p < 0.0001) than patients who survived. Multivariate Cox regression analysis, including 12 clinical, biochemical, and echocardiographic variables, identified AKI (relative risk: 1.79; p = 0.008) and increased D-dimer level (relative risk: 1.83 per 10-fold increment; p = 0.002) as independent predictors of 1-yeart mortality. The combined assessment of AKI and D-dimer quartiles was significantly associated with 1-year mortality rates (Figure). Conclusions: The combined assessment of AKI and high D-dimer levels may be useful for evaluating the risk of 1-year mortality in patients admitted to CCUs.

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