scholarly journals Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department

2021 ◽  
Vol 14 (9) ◽  
pp. 843
Author(s):  
Anne Byriel Walls ◽  
Anne Kathrine Bengaard ◽  
Esben Iversen ◽  
Camilla Ngoc Nguyen ◽  
Thomas Kallemose ◽  
...  
Keyword(s):  
Early Detection ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Discriminatory Power ◽  
Medical Patients ◽  
Urokinase Plasminogen Activator Receptor ◽  
Plasminogen Activator Receptor ◽  
Neutrophil Gelatinase ◽  
The Impact

Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.

scholarly journals Acute Kidney Injury Pharmacokinetic Changes and Its Impact on Drug Prescription

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
Victoria Blanco ◽  
Carolina Hernandorena ◽  
Paula Scibona ◽  
Waldo Belloso ◽  
Carlos Musso
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Drug Prescription ◽  
Kidney Injury ◽  
Drug Dosage ◽  
Tubular Secretion ◽  
Metabolizing Enzymes ◽  
Drug Concentrations ◽  
The Impact

Acute kidney injury (AKI) is a common problem in hospitalized patients that is associated with significant morbid-mortality. The impact of kidney disease on the excretion of drugs eliminated by glomerular filtration and tubular secretion is well established, as well as the requirement for drug dosage adjustment in impaired kidney function patients. However, since impaired kidney function is associated with decreased activity of several hepatic and gastrointestinal drug-metabolizing enzymes and transporters, drugs doses adjustment only based on kidney alteration could be insufficient in AKI. In addition, there are significant pharmacokinetics changes in protein binding, serum amino acid levels, liver, kidney, and intestinal metabolism in AKI, thus the determination of plasma drug concentrations is a very useful tool for monitoring and dose adjustment in AKI patients. In conclusion, there are many pharmacokinetics changes that should be taken into account in order to perform appropriate drug prescriptions in AKI patients.

scholarly journals Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: Secondary analysis of a randomized trial

PLoS Medicine ◽  
2019 ◽  
Vol 16 (7) ◽  
pp. e1002852 ◽  
Author(s):  
Mikel L. Sáez de Asteasu ◽  
Nicolás Martínez-Velilla ◽  
Fabricio Zambom-Ferraresi ◽  
Álvaro Casas-Herrero ◽  
Eduardo L. Cadore ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Physical Exercise ◽  
Randomized Trial ◽  
Secondary Analysis ◽  
Medical Patients ◽  
Acute Hospitalization ◽  
The Impact

scholarly journals Systemic and Urinary Neutrophil Gelatinase-Associated Lipocalins Are Poor Predictors of Acute Kidney Injury in Unselected Critically Ill Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Annick A. Royakkers ◽  
Catherine S. Bouman ◽  
Pauline M. Stassen ◽  
Joke C. Korevaar ◽  
Jan M. Binnekade ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Observational Cohort ◽  
Neutrophil Gelatinase

Background. Neutrophil gelatinase-associated lipocalin (NGAL) in serum and urine have been suggested as potential early predictive biological markers of acute kidney injury (AKI) in selected critically ill patients.Methods. We performed a secondary analysis of a multicenter prospective observational cohort study of unselected critically ill patients.Results. The analysis included 140 patients, including 57 patients who did not develop AKI, 31 patients who developed AKI, and 52 patients with AKI on admission to the ICU. Levels of sNGAL and uNGAL on non-AKI days were significantly lower compared to levels of sNGAL on RIFLERISKdays, RIFLEINJURYdays, and RIFLEFAILUREdays. The AUC of sNGAL for predicting AKI was low: 0.45 (95% confidence interval (CI) 0.27–0.63) and 0.53 (CI 0.38–0.67), 2 days and 1 day before development of AKI, respectively. The AUC of uNGAL for predicting AKI was also low: 0.48 (CI 0.33–0.62) and 0.48 (CI 0.33–0.62), 2 days and 1 day before development of AKI, respectively. AUC of sNGAL and uNGAL for the prediction of renal replacement therapy requirement was 0.47 (CI 0.37–0.58) and 0.26 (CI 0.03–0.50).Conclusions. In unselected critically ill patients, sNGAL and uNGAL are poor predictors of AKI or RRT.

scholarly journals Serial urinary neutrophil gelatinase associated lipocalin in pediatric diabetic ketoacidosis with acute kidney injury

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Vijai Williams ◽  
Muralidharan Jayashree ◽  
Karthi Nallasamy ◽  
Devi Dayal ◽  
Amit Rawat ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Diabetic Ketoacidosis ◽  
Characteristic Curve ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Positive Linear Correlation ◽  
Neutrophil Gelatinase

Abstract Background Acute kidney injury (AKI) due to Diabetic Ketoacidosis (DKA) is rather common. Novel biomarkers to diagnose AKI are being increasingly used in different settings. The use of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) in predicting persistent AKI in pediatric DKA cases is still not thoroughly investigated. Methods This was a secondary analysis of Saline versus Plasma-Lyte in Ketoacidosis (SPinK) trial data; 66 children (> 1 month-12 years) with DKA, defined by the International Society for Pediatric and Adolescent Diabetes (ISPAD), were analyzed. Children with cerebral edema, chronic kidney disease and those who received pre-referral fluids and/or insulin were excluded. uNGAL and urine NGAL-creatinine ratio (uNCR) at 0 and 24 h were measured in all. Persistent AKI was defined as a composite outcome of continuance of AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3 beyond 48 h from AKI onset, progression of AKI from either KDIGO stage 0 or 1 to a worse stage, need of renal replacement therapy or death. Main outcomes Thirty-five (53%) children had AKI at admission; 32 (91.4%) resolved within 48 h. uNGAL was significantly higher in the AKI group at admission [79.8 ± 27.2 vs 54.6 ± 22.0, p = 0.0002] and at 24 h [61.4 ± 28.3 vs 20.2 ± 14.5, p = 0.0003]. Similar trend was observed with uNCR at admission [6.7 ± 3.7 vs 4.1 ± 2.6, p = 0.002] and at 24 h [6.3 ± 2.5 vs 1.2 ± 1.0, p = 0.01]. Furthermore, uNGAL at admission showed a moderate positive linear correlation with serum creatinine. Additionally, elevated uNGAL at 0 and 24 h correlated with corresponding KDIGO stages. Admission uNGAL >88 ng/ml and uNCR of >11.3 ng/mg had a sensitivity of 66% and 67%, specificity of 76% and 95%, and Area under the receiver operating characteristic curve (AUC) of 0.78 and 0.89 respectively for predicting persistent AKI at 48 h. Conclusions Majority of AKI resolved with fluid therapy. While uNGAL and uNCR both correlated with serum creatinine and AKI stages, serial uNCR was a better predictor of persistent AKI than uNGAL alone. However, feasibility of routine uNGAL measurement to predict persistent AKI in DKA needs further elucidation. Trial registration This was a secondary analysis of the data of SPinK trial [CTRI/2018/05/014042 (ctri.nic.in)].

Biochemical markers in the prediction of contrast-induced acute kidney injury

2020 ◽  
Vol 27 ◽  
Author(s):  
Magdalena Zdziechowska ◽  
Anna Gluba-Brzózka ◽  
Beata Franczyk ◽  
Jacek Rysz
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
High Concentrations ◽  
Kidney Injury Molecule 1 ◽  
Neutrophil Gelatinase ◽  
Overall Mortality

: For many years clinicians have been searching for “kidney troponin”- a simple diagnostic tool to assess risk of acute kidney injury (AKI). Recently, the rise in the variety of contrast-related procedures (contrast computed tomography [CT], percutaneous coronary intervention [PCI] and angiography) have resulted in increased number of contrast-induced acute kidney injuries (CI-AKI). CI-AKI remains important cause of overall mortality, prolonged hospitalization and it increases total costs of therapy. The consequences of kidney dysfunction affect the quality of life and they may lead to disability as well. Despite extensive worldwide research, there are no sensitive and reliable method of CI-AKI prediction. Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Lipocalin (NGAL) have been considered as kidney specific molecules. High concentrations of these substances before the implementation contrast-related procedures have been suggested to enable the estimation of kidney vulnerability to CI-AKI and they seem to have predictive potential for cardiovascular events and overall mortality. According to other authors, routine determination of known inflammation factors (e.g. CRP, WBC, neutrophil count) may be helpful in prediction of CI-AKI. However, the results of clinical trials provide contrasting results. The pathomechanism of contrast-induced nephropathy remains unclear. Due to its prevalence, the evaluation of the risk of acute kidney injury remains serious problem to be solved. This paper reviews pathophysiology and suggested optimal markers facilitating the prediction of contrast-induced acute kidney injury.

Soluble urokinase plasminogen activator receptor (suPAR) as a novel serum biomarker for patients undergoing resection of colorectal liver metastases.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 309-309
Author(s):  
Sven H Loosen ◽  
Marcel Binneboesel ◽  
Christian Klink ◽  
Tom Florian Ulmer ◽  
Thomas Longerich ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Metastases ◽  
Plasminogen Activator ◽  
Surgical Resection ◽  
Colorectal Liver Metastases ◽  
Kidney Injury ◽  
Serum Levels ◽  
Healthy Controls ◽  
Urokinase Plasminogen Activator Receptor ◽  
Plasminogen Activator Receptor

309 Background: In colorectal cancer (CRC), the liver is the most common site of metastasis. Surgical resection represents the standard potentially curative therapy for patients with colorectal liver metastases (CRLM). However, 5-year survival rates after resection do not exceed 50%, and despite existing preoperative stratification algorithms it is still not fully understood which patients benefit most from surgery. The soluble urokinase plasminogen activator receptor (suPAR) has recently evolved as a promising biomarker for distinct clinical conditions. Here, we examined a potential role of circulating suPAR as a biomarker in patients undergoing resection of CRLM. Methods: Expression levels of uPAR, the membrane-bound source of circulating suPAR, were analysed in tissue samples of CRLM using RT-PCR and IHC. SuPAR serum levels were measured by ELISA in 104 patients undergoing surgical resection of CRLM as well as 50 healthy controls. Results were correlated with clinical data. Results: In line with an upregulation of uPAR in the CRLM tissue, serum levels of suPAR were significantly elevated in patients with CRLM compared to healthy controls. Patients with preoperative suPAR serum levels above our defined ideal cut-off value of 4.83 ng/ml showed a strikingly reduced overall survival after resection of CRLM, which could be confirmed for right- and left-sided primary CRC. Importantly, none of these patients reached long-term survival compared to patients with preoperative suPAR serum concentrations below the cut-off value. Moreover, multivariate Cox-regression analysis revealed preoperative suPAR serum levels as an independent prognostic factor in this setting. Additionally, elevated preoperative suPAR but not creatinine levels were a predictor of acute kidney injury after CRLM resection, correlating with a longer postoperative hospitalization. Conclusions: Serum levels of suPAR represent a promising novel biomarker in patients with resectable CRLM that might help to guide preoperative treatment decisions with regards to patients’ outcome and the identification of patients particularly susceptible to postoperative acute kidney injury.

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