scholarly journals Acute Kidney Injury Adjusted for Parenchymal Mass Reduction and Long-Term Renal Function after Partial Nephrectomy

2019 ◽  
Vol 8 (9) ◽  
pp. 1482
Author(s):  
Hyun-Kyu Yoon ◽  
Ho-Jin Lee ◽  
Seokha Yoo ◽  
Sun-Kyung Park ◽  
Yongsuk Kwon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Serum Creatinine ◽  
Partial Nephrectomy ◽  
Functional Recovery ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Mass Reduction ◽  
Baseline Serum

We sought to evaluate the association of postoperative acute kidney injury (AKI) adjusted for parenchymal mass reduction with long-term renal function in patients undergoing partial nephrectomy. A total of 629 patients undergoing partial nephrectomy were reviewed. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, by using either the unadjusted or adjusted baseline serum creatinine level, accounting for renal parenchymal mass reduction. Estimated glomerular filtration rates (eGFRs) were followed up to 61 months (median 28 months) after surgery. The primary outcome was the functional change ratio (FCR) of eGFR calculated by the ratio of the most recent follow-up value, at least 24 months after surgery, to eGFR at 3–12 months after surgery. Multivariable linear regression analysis was performed to evaluate whether unadjusted or adjusted AKI was an independent predictor of FCR. As a sensitivity analysis, functional recovery at 3–12 months after surgery compared to the preoperative baseline was analyzed. Median parenchymal mass reduction was 11%. Unadjusted AKI occurred in 16.5% (104/625) and adjusted AKI occurred in 8.6% (54/629). AKI using adjusted baseline creatinine was significantly associated with a long-term FCR (β = −0.129 ± 0.026, p < 0.001), while unadjusted AKI was not. Adjusted AKI was also a significant predictor of functional recovery (β = −0.243 ± 0.106, p = 0.023), while unadjusted AKI was not. AKI adjusted for the parenchymal mass reduction was significantly associated with a long-term functional decline after partial nephrectomy. A creatinine increase due to remaining parenchymal ischemic injury may be important in order to predict long-term renal functional outcomes after partial nephrectomy.

scholarly journals Impact of Acute Kidney Injury and Its Duration on Long-term Renal Function After Partial Nephrectomy

2019 ◽  
Vol 76 (3) ◽  
pp. 398-403 ◽  
Author(s):  
Carlo Andrea Bravi ◽  
Emily Vertosick ◽  
Nicole Benfante ◽  
Amy Tin ◽  
Daniel Sjoberg ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Partial Nephrectomy ◽  
Kidney Injury

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P &lt; 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P &lt; 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine &gt;2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P &lt; 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

scholarly journals PD20-11 ACUTE KIDNEY INJURY AFTER PARTIAL NEPHRECTOMY: IMPACT ON LONG-TERM STABILITY OF RENAL FUNCTION

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Joseph Zabell ◽  
Wen Dong ◽  
Diego Aguilar Palacios ◽  
Joseph Abraham ◽  
Sudhir Isharwal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Partial Nephrectomy ◽  
Kidney Injury ◽  
Term Stability ◽  
Long Term Stability

Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function

2018 ◽  
Vol 200 (6) ◽  
pp. 1295-1301 ◽  
Author(s):  
Joseph Zabell ◽  
Sudhir Isharwal ◽  
Wen Dong ◽  
Joseph Abraham ◽  
Jitao Wu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Partial Nephrectomy ◽  
Kidney Injury ◽  
Term Stability ◽  
Long Term Stability

scholarly journals The Impact of Early Post-Transplant Cyclosporine Induced Acute Nephrotoxicity on Long Term Renal Function in 2-Year Survivors of Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Retrospective Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3358-3358
Author(s):  
Reem Alharbi ◽  
Mahmoud Aljurf ◽  
Raid El Fakih ◽  
Mohammad Al Nahedh ◽  
Majed Huessein ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Stem Cell ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Hematopoietic Stem Cell ◽  
Kidney Injury ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct

Abstract Introduction:Acute kidney injury (AKI) and chronic kidney disease (CKD) affect 10-70% of transplant recipients. Onset of kidney injury varies from days to months or years after transplantation. Kidney injury may be caused by multiple factors. Long-term data on cyclosporine induced nephrotoxicity post HSCT are limited. It is unclear if cyclosporine induced nephrotoxicity at early phase post HSCT will impact long term renal function. The objective of this study is to evaluate the progression of renal function in allogeneic hematopoietic stem cell transplant (HSCT) patients, before, during and after cyclosporine therapy. Methods:This is a retrospective single arm cohort study evaluating the impact of cyclosporine on renal function in patients who underwent allogeneic HSCT from 2003 through 2013. Patients age≥ 14 years who underwent allogeneic HSCT and received cyclosporine as graft-versus-host disease (GVHD) prophylaxis and alive two years post HSCT without disease relapse or GVHD were included in the study. Primary outcome was the change in serum creatinine and estimated creatinine clearance. Delta creatinine (baseline creatinine - creatinine on day 25, day 100, day 180, year 1 and year 2 post HSCT) was used to calculate the change in the serum creatinine and estimated creatinine clearance. Estimated creatinine clearance was calculated using Cockcroft and Gault formula (CG) for patients aged ≥ 18 years. Schwartz formula was used to estimate creatinine clearance for patients aged ≥ 14 years till 18 years. The secondary outcome was the incidence of acute kidney injury. AKI was defined as per RIFLE criteria. The severity grades were defined on the basis of the changes in serum creatinine. CKD was defined if estimated glomerular filtration rate (GFR) <60 ml/minute per 1.73 m2 for 3 months. All patient during the study period were screened. Descriptive statistics were used to describe the data, continuous variables were reported as mean ± stander deviation and categorical variables were summarized as frequencies and percentages. The study was approved by the Office of Research Affairs in our institution. Results: Out of 912 patients who underwent allogeneic HSCT from 2003 to 2013, 121 patients were included who met the inclusion criteria listed above in the method section (Figure 1). The majority of patients were males (55%) with sever aplastic anemia as primary disease (31%). Mean baseline serum creatinine was 52±16 µmol/l, mean baseline estimated creatinine clearance was 116±58 ml/minute per 1.73 m2 (Table 1). Mean duration of cyclosporine levels monitoring was 232±180 days. Serum creatinine increased from the baseline at day 25, day 100, day 180, 1 year and 2 years post HSCT (Mean± SD; 45.7 ±39, 66.2 ±45.9, 37.8±27.1, 31.9±22.55, 28±22.5 µmol/l, respectively) (Figure 2). This translated into reductions in the estimated creatinine clearance at day 25, day 100, day 180, 1 year and 2 years post HSCT (Mean± SD; -61.6±51 , -89.6 ±55.7,-67. ±55.34,-62.5±55.4,-57.6±56.ml/minute per 1.73 m2, respectively) (Figure 3). The highest incidence of AKI was at day 100 post HSCT in the included patients. 40% of them had supratherapeutic cyclosporine levels. There was association between developing acute kidney injury at day 100 and CKD at 2 years post HSCT, 23% of the included patients had acute kidney injury and 13 % of them found to have CKD at 2 years post HSCT as illustrated table 2. Conclusion:Our study demonstrated that cyclosporine represents a primary risk factor for progression of renal impairment in hematopoietic stem cell transplant recipients particularly in those who developed acute kindly injury at 100 days. Disclosures No relevant conflicts of interest to declare.

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