Outpatient Assessment of Mechanical Load, Heat Strain and Dehydration as Causes of Transitional Acute Kidney Injury in Endurance Trail Runners

Background: This study aimed to globally assess heat strain, dehydration, and mechanical load as acute kidney injury (AKI) indicators in amateur endurance trail athletes during a 35.3 km run. Methods: Thirty amateur experienced trail runners completed an endurance trail run (total positive ascend 1815 m). The following assessments were performed at four measurement time points (pre-, during, immediately post [-post0h], and after 24 h of the finish of the run [-post24h]): serum test (creatinine, blood ureic nitrogen, albumin, creatine kinase, blood ureic nitrogen: creatinine ratio, creatinine clearance, and glomerular filtration rate), mechanical load (impacts and Player Load), heat strain and dehydration (hematocrit, urine solids, body weight and urine specific gravity), pain and exertion perception (rate of perceived exertion, lumbar and bipodal, and one-leg squat pain), and urinalysis (pH, protein, glucose, erythrocytes, and urine specific gravity). Results: There were pre vs. post0h changes in all serum biomarkers (F = 5.4–34.45, p < 0.01). The change in these biomarkers correlated with an increase in mechanical load indicators (r = 0.47–59, p < 0.05). A total of 40% and 23.4% of participants presented proteinuria and hematuria, respectively. Pain and perceived exertion increased significantly due to effort made during the endurance trail running (F = 4.2–176.4, p < 0.01). Conclusions: Endurance trail running may lead to an increase in blood and urine indicators of transitional AKI. The difference in blood and urine markers was significantly related to the mechanical load during running, suggesting potential kidney overload and cumulative mechanical load.

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P0618PREOPERATIVE LOW URINE SPECIFIC GRAVITY PREDICTS ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0618 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Wonji Jo ◽

Chan-Young Jung ◽

Jaeyoung Kim ◽

Jihye Kim ◽

Sangmi Lee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Specific Gravity ◽

Kidney Function ◽

Kidney Injury ◽

Kidney Damage ◽

Urine Specific Gravity ◽

Normal Kidney ◽

The Mean ◽

Post Cardiac Surgery

Abstract Background and Aims Acute kidney injury (AKI) is a common and serious complication following cardiac surgery. However, strategies that effectively predict AKI risk before cardiac surgery are scarce. Recent investigations identified urinary osmolality to be associated with non-glomerular kidney damage in normal kidney function individuals, suggesting urine concentration ability to be a surrogate of early kidney damage. Therefore, hypothesizing that urine specific gravity (SG) could reflect asymptomatic kidney damage, the clinical implication of preoperative urine specific gravity on AKI occurrence after cardiac surgery was investigated in subjects with normal kidney function. Method A total of 4135 patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from were enrolled. Patients whose eGFR was lower than 60mL/min/1.73m2 were excluded. Fasting urinary SG was measured from the morning first void a day before the surgery. The patients were divided into tertiles based on urine SG. The primary outcome was occurrence of AKI within 48hours of cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Results The mean age of the patients was 60 years and 60% were male. Diabetes consisted of 25.6% of the patients and 54.5% were hypertensive. The mean eGFR and urine SG was 98.8mL/min/1.73m2 and 1.020, respectively. AKI developed in 1,089 (26.3%) patients. The incidence of AKI was highest in the lowest urine SG tertile group (410, 29.0%) and lowest in the highest tertile group (304, 23.5%) (P < 0.001). Multivariable logistic regression analysis revealed that being included in the lowest preoperative urine SG tertile group was significantly related with higher post cardiac surgery AKI incidence risk (odd ratio (OR), 1.33; CI, 1.12-1.57; P =0.001). This association was significant even after adjustments were made for confounding factors. Conclusion Low urine SG was associated with increased risk of cardiac surgery associated AKI in patient with normal renal function. Evaluating preoperative urine SG may be useful in stratifying post cardiac surgery AKI risk.

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Determination of the reference interval for the activity of N-Acetyl-β-D-Glucosaminidase (NAG) in urine of healthy dogs

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-5025 ◽

2018 ◽

Vol 38 (8) ◽

pp. 1685-1690

Author(s):

Luiz Eduardo S. Tassini ◽

Fabiola O.P. Leme ◽

Júlio César C. Veado ◽

Márcio H.L. Arndt

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Specific Gravity ◽

Kidney Injury ◽

Reference Interval ◽

Urine Specific Gravity ◽

Automated Method ◽

Function Change ◽

Healthy Dogs

ABSTRACT: The diagnosis of acute kidney injury by evaluating the activity of urinary enzymes is an important tool especially for its precocity in relation to methods of assessment of renal function considered late as the installation of injury precedes the function change. This study was performed to determine the reference interval for urinary NAG activity (N-Acetyl-β-D-glucosaminidase) in urine of healthy dogs of different breeds, ages and sexes. It was utilized an automated method for the determination of NAG activity standardized for dog urine samples. Through statistical analysis it was observed that NAG is positively correlated with the age of the animal and urine specific gravity but is not interfered by sex or weight. Based on the determination of urinary activity and after correcting the values for a 1,025 urine specific gravity was obtained an reference interval of X ‘= 3.62U/L±0.66U/L.

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CIRP Secretion during Cardiopulmonary Bypass Is Associated with Increased Risk of Postoperative Acute Kidney Injury

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1730450 ◽

2021 ◽

Author(s):

Wenyan Liu ◽

Yang Yan ◽

Dan Han ◽

Yongxin Li ◽

Qian Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Rna Binding ◽

Multivariable Analysis ◽

Kidney Injury ◽

Proinflammatory Response ◽

Increased Risk ◽

Before And After ◽

The Difference

Abstract Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response. Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed. Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007). Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

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2669. Evaluation of Post-Operative Acute Kidney Injury with Piperacillin–Tazobactam Combined with Vancomycin for Lung Transplant Prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2347 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S936-S936

Author(s):

Natasha N Pettit ◽

Cynthia T Nguyen ◽

Lisa Potter ◽

Jennifer Pisano

Keyword(s):

Acute Kidney Injury ◽

Antibiotic Prophylaxis ◽

Lung Transplant ◽

Statistical Significance ◽

Prophylactic Antibiotic ◽

Kidney Injury ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Transplant Patients ◽

The Difference

Abstract Background Several studies have identified that the addition of vancomycin (VAN) to piperacillin–tazobactam (PT) is associated with a higher incidence of nephrotoxicity when compared with other antibiotic regimens. Beginning in June 2017, our lung transplant antibiotic prophylaxis regimen was modified from PT monotherapy to VAN and PT. Methods All adult lung transplant patients between January 1, 2015 and November 10, 2018 were included. Patients were excluded if acute kidney injury (AKI) was present prior to transplant. Rates of AKI within 7 days of transplant were compared between those who received prophylaxis with PT and VAN vs. those receiving alternative regimens (AR). Patients receiving less than 1 dose of vancomycin or less than 3 doses PT (less than 24hours) were deemed to be in the alternative regimen group. AKI was defined as either an increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours or increase in SCr to ≥1.5 times baseline (within 7 days post-transplant). Secondary outcomes included duration of initial prophylactic antibiotic regimens, hospital length of stay (LOS), and all-cause inpatient mortality. Results Eighty-six patients were included, 44 (51%) patients received PT/VAN. Baseline characteristics and results shown in Table 1. Of those receiving PT/VAN for prophylaxis, 24 (54%) developed AKI within 7 days of transplant while 15 (36%) of 42 patients receiving AR developed AKI (P = 0.08). Conclusion A larger proportion of patients that received PT/VAN for transplant antibiotic prophylaxis experienced AKI within 7 days. Although the difference did not reach statistical significance, a 19% higher incidence of AKI warrants need for further investigation. Disclosures All authors: No reported disclosures.

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Acute kidney injury in the tropics

10.1093/med/9780199592548.003.0241 ◽

2015 ◽

Author(s):

Vivekanand Jha

Keyword(s):

Public Health ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Tropical Climate ◽

Public Health Importance ◽

Productivity Improvement ◽

Tropical Zone ◽

Effective Interventions ◽

The Difference ◽

The Tropics

The spectrum of acute kidney injury (AKI) encountered in the hospitals of the tropical zone countries is different from that seen in the non-tropical climate countries, most of which are high-income countries. The difference is explained in large part by the influence of environment on the epidemiology of human disease. The key features of geographic regions falling in the tropical zones are climatic, that is, high temperatures and absence of winter frost, and economic, that is, lower levels of income. The causes and presentation of tropical AKI reflect these prevailing cultural, socioeconomic, climatic, and eco-biological characteristics.Peculiarities of tropical climate support the propagation of several infectious organisms that can cause AKI and the disease-transmitting vectors. In contrast to the developed world, where AKI usually develops in already hospitalized patients with multiorgan problems and iatrogenic factors play a major role, tropical AKI is acquired in the community due to issues of public health importance such as safe water, sanitation, infection control, and good obstetric practices. Infections such as malaria, leptospirosis, typhus, HIV, and diarrhoeal diseases; envenomation by animals or insects; ingestion of toxic herbs or chemicals; intravascular haemolysis; poisoning; and obstetric complications form the bulk of AKI in the tropics. Poor access to modern medical facilities and practices such as seeking treatment from traditional faith-healers contribute to poor outcomes.AKI extracts macro- and microeconomic costs from the affected population and reduces productivity. Improvement in the outcomes of tropical AKI requires improvement in basic public health through effective interventions, and accessibility to effective medical care.

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Fluctuations in Serum Chloride and Acute Kidney Injury among Critically Ill Patients: A Retrospective Association Study

Journal of Clinical Medicine ◽

10.3390/jcm8040447 ◽

2019 ◽

Vol 8 (4) ◽

pp. 447 ◽

Cited By ~ 3

Author(s):

Tak Kyu Oh ◽

In-Ae Song ◽

Young-Tae Jeon ◽

You Hwan Jo

Keyword(s):

Acute Kidney Injury ◽

Confidence Interval ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Kidney Injury ◽

Icu Admission ◽

Serum Chloride ◽

Increased Risk ◽

The Difference

Exposure to dyschloremia among critically ill patients is associated with an increased risk of acute kidney injury (AKI). We aimed to investigate how fluctuations in serum chloride (Cl−) are associated with the development of AKI in critically ill patients. We retrospectively analyzed medical records of adult patients admitted to the intensive care unit (ICU) between January 2012 and December 2017. Positive and negative fluctuations in Cl− were defined as the difference between the baseline Cl- and maximum Cl- levels and the difference between the baseline Cl− and minimum Cl− levels measured within 72 h after ICU admission, respectively. In total, 19,707 patients were included. The odds of developing AKI increased 1.06-fold for every 1 mmol L−1 increase in the positive fluctuations in Cl− (odds ratio: 1.06; 95% confidence interval: 1.04 to 1.08; p < 0.001) and 1.04-fold for every 1 mmol L−1 increase in the negative fluctuations in Cl− (odds ratio: 1.04; 95% confidence interval: 1.02 to 1.06; p < 0.001). Increases in both the positive and negative fluctuations in Cl- after ICU admission were associated with an increased risk of AKI. Furthermore, these associations differed based on the functional status of the kidneys at ICU admission or postoperative ICU admission.

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The Timing of Fluid Intake during an Olympic Distance Triathlon

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.16.6.611 ◽

2006 ◽

Vol 16 (6) ◽

pp. 611-619 ◽

Cited By ~ 8

Author(s):

Robert McMurray ◽

David K. Williams ◽

Claudio L. Battaglini

Keyword(s):

Heart Rate ◽

Specific Gravity ◽

Oxygen Uptake ◽

Perceived Exertion ◽

Fluid Intake ◽

Rating Of Perceived Exertion ◽

Urine Specific Gravity ◽

Cycle Phase ◽

Performance Time ◽

Overall Performance

Seven highly trained male triathletes, aged 18 to 35 years, were tested during two simulated Olympic distance triathlons to determine whether run performance was enhanced when consuming 177 ml of water at 8, 16, 24, and 32 kilometers (Early Trials) compared to consumption at 10, 20, 30, and 40 kilometers (Late Trials), during the cycling segment of the triathlon. Swim times for 1500 m were similar between trials; 40-km cycling times were ~10 s faster during the Late trials; however, 10-km run times were faster during the Early Trials (P < 0.02). No significant differences between run trials were found for the rating of perceived exertion, oxygen uptake, heart rate, and change in urine specific gravity. It was concluded that the consumption of fluids earlier in the cycle phase of the Olympic distance triathlon benefits the run and overall performance time.

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Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study

African Journal of Urology ◽

10.1186/s12301-020-00052-7 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Metin Yığman ◽

Semih Tangal ◽

Tuba Candar ◽

Mehmet İlker Gökçe

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Renal Stones ◽

Primary Treatment ◽

Study Data ◽

Complication Rates ◽

Duration Of Hospitalization ◽

Prospective Comparative Study ◽

The Mean ◽

The Difference

Abstract Background The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm. Methods In this prospective study, data of 60 consecutive patients underwent mini-PNL (n = 31) or RIRS (n = 29) was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI. Success and complication rates were also compared. Results The mean stone size was significantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p = 0.02). The mean postoperative NGAL levels were 45.6 ± 12.4 and 48.1 ± 13.6 for the mini-PNL and RIRS groups, respectively. The increase was statistically significant for both groups (p: 0.01). The difference between the two groups for mean postoperative NGAL measurements was not statistically significant (p = 0.47). The SFR was significantly higher in the mini-PNL group (96.7% vs. 79.3%, p = 0.04). The complication rates were similar for the two groups (p = 0.99). The mean duration of operation was 48.2 ± 22.5 min in the mini-PNL group and 62.6 ± 18.1 min in the RIRS group (p = 0.03). The median duration of hospitalization was 1 day for both groups. Conclusions In patients with renal stones < 3 cm in diameter, mini-PNL in supine position provides higher SFR and shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being a more invasive option.

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Acute Kidney Injury Biomarkers and Hydration Outcomes at the Boston Marathon

Frontiers in Physiology ◽

10.3389/fphys.2021.813554 ◽

2022 ◽

Vol 12 ◽

Author(s):

Whitley C. Atkins ◽

Cory L. Butts ◽

Melani R. Kelly ◽

Chris Troyanos ◽

R. Mark Laursen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Sex Differences ◽

Kidney Injury ◽

Urine Specific Gravity ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Time Points ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Boston Marathon ◽

Neutrophil Gelatinase

The purpose of our field study was to investigate the effects of running the Boston Marathon on acute kidney injury (AKI) biomarkers. We hypothesized that biomarker values would be elevated immediately post-marathon but would resolve in the 24-h post-marathon. Secondarily, we sought to identify sex differences related to renal stress. Participants were 65 runners who completed the Boston Marathon (46 ± 9 years, 65.4 ± 10.8 kg). Urine samples were collected at three different time points (pre-marathon, post-marathon, and 24-h post-marathon). Blood samples were collected post-marathon and 24-h post-marathon. Urine specific gravity (USG) and AKI biomarkers were evaluated. Pre-marathon USG (1.012 ± 0.007) was significantly less than post-marathon (1.018 ± 0.008) and 24-h post-marathon (1.020 ± 0.009; P < 0.001). Male USG (1.024 ± 0.009) was significantly greater 24-h post-marathon than females (1.017 ± 0.008; P = 0.019). Urinary neutrophil gelatinase-associated lipocalin values were significantly greater over time (P < 0.001), and there was a main effect of sex with female urinary creatinine (UCr) greater than males at all three time points (P = 0.040). Post-marathonUCr (366.24 ± 295.16 mg/dl) was significantly greater than pre-marathon (206.65 ± 145.28.56 mg/dl; p < 0.001) and 24-h post-marathon was significantly lower than other time-points (93.90 ± 125.07 mg/dl; P < 0.001). FemaleUCr values were significantly greater than males 24-h post-marathon (P < 0.001). There was no difference in serum cystatin C (SCys) values post- or 24-h post-marathon (P = 0.178). Serum creatinine (SCr) significantly decreased between post-marathon and 24-h post-marathon, (P < 0.001). We can infer that the characteristics unique to the Boston Marathon may have attributed to prolonged elevations in AKI biomarkers. Sex differences were observed during the Boston Marathon warranting further investigation.

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Influence of preanalytic and analytic variables in canine and feline urine specific gravity measurement by refractometer

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638719896785 ◽

2019 ◽

Vol 32 (1) ◽

pp. 36-43

Author(s):

Martina Mösch ◽

Sven Reese ◽

Karin Weber ◽

Katrin Hartmann ◽

Roswitha Dorsch

Keyword(s):

Specific Gravity ◽

Storage Time ◽

Urine Specific Gravity ◽

Gravity Measurement ◽

Observer Variability ◽

Important Indicator ◽

Single Scale ◽

The Difference ◽

Whole Urine ◽

The Impact

Urine specific gravity (USG), which is usually measured by refractometry, is an important indicator of renal concentrating ability. Few studies have evaluated refractometers with separate scales for canine and feline urine. Variables such as protein content or storage time may influence the USG. We compared the effects of measuring USG with a refractometer with single or separate scales for canine and feline urine, investigated inter- and intra-observer variability, and measured agreement between whole urine and supernatant. We evaluated the correlation between USG and osmolality, the influence of urinary protein on USG and osmolality, and the impact of storage time up to 6 mo. We examined 252 canine and 126 feline samples. Bland–Altman analysis revealed higher USG values of the single-scale refractometer than the dual-scale refractometer, with a mean difference (bias) of < 0.001 for canine and 0.003 for feline specimens. Inter- and intra-observer variability were acceptable. Good agreement was shown between USG of whole urine and supernatant. Correlations between USG and osmolality were excellent (0.98–0.99, p < 0.001). Proteinuria up to 1 g/L had no major impact on USG or osmolality. Storage time had no significant effect on USG. The difference between the refractometers is clinically irrelevant, and the use of a refractometer with separate feline and canine scales is unnecessary. Whole urine and supernatant stored up to 6 mo can both be used for USG measurement. The influence of proteinuria <1 g/L on USG and osmolality is negligible.

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