scholarly journals Complement activation fragments are increased in critically ill pediatric patients with severe acute kidney injury

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004542021
Author(s):  
Erin K Stenson ◽  
Zhiying You ◽  
Ron Reeder ◽  
Jesse Norris ◽  
Halden F. Scott ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Complement Activation ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
High Morbidity ◽  
Increased Risk ◽  
Severity Scores

Background:Critically ill children with acute kidney injury (AKI) suffer from high morbidity and mortality rates, and lack treatment options. Emerging evidence implicates the role of complement activation in AKI pathogenesis, which could potentially be treated with complement inhibitors. The purpose of this study is to evaluate the association between complement activation fragments and severity of AKI in critically ill children. Methods:A biorepository of critically ill children from a prior multi-site study was leveraged to identify children with stage 3 AKI and matched to patients without AKI based on PELOD-2 (illness severity) scores. Specimens were analyzed for plasma and urine complement activation fragments of factor B, C3a, C4a, and sC5b-9. The primary outcomes were MAKE30 and severe AKI rates. Results:14 patients with stage 3 AKI (5 requiring renal replacement therapy [RRT]) were matched to 14 patients without AKI. Urine factor Ba and plasma C4a levels increased stepwise as severity of AKI increased, from no AKI to stage 3 AKI, to stage 3 AKI with RRT need. Plasma C4a levels were independently associated with increased risk of MAKE30 outcomes (OR 3.2; IQR 1.1-8.9), and urine Ba and plasma Bb, C4a, and C3a were independently associated with risk of severe stage 2-3 AKI on day 3 of admission. Conclusions:Multiple complement fragments increase as magnitude of AKI severity increases. Very high levels of urine Ba or plasma C4a may identify patients at risk for severe AKI, hemodialysis, and MAKE30 outcomes. The fragments may be useful as a functional biomarker of complement activation and may identify those patients to study complement inhibition to treat or prevent AKI in critically ill children. These findings suggest the need for further specific investigations of the role of complement activation in critically ill children at risk of AKI.

Incidence, Risk Factors, the Role of Plasma NGAL and Outcome of Contrast-Induced Acute Kidney Injury in Critically Ill Children

2020 ◽  
Vol 88 (1) ◽  
pp. 34-40
Author(s):  
Yamini Agarwal ◽  
Ramachandran Rameshkumar ◽  
Sriram Krishnamurthy ◽  
Gandhipuram Periyasamy Senthilkumar
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Plasma Ngal ◽  
Incidence Risk

scholarly journals GDF-15 Predicts In-Hospital Mortality of Critically Ill Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Prospective Study

2021 ◽  
Vol 10 (16) ◽  
pp. 3660
Author(s):  
Jeong-Hoon Lim ◽  
Yena Jeon ◽  
Ji-Sun Ahn ◽  
Sejoong Kim ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Apache Ii ◽  
Increased Risk ◽  
Severity Scores

Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine. This study evaluated the association between GDF-15 and in-hospital mortality among patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Among the multicenter prospective CRRT cohort between 2017 and 2019, 66 patients whose blood sample was available were analyzed. Patients were divided into three groups according to the GDF-15 concentrations. The median GDF-15 level was 7865.5 pg/mL (496.9 pg/mL in the healthy control patients). Baseline characteristics were not different among tertile groups except the severity scores and serum lactate level, which were higher in the third tertile. After adjusting for confounding factors, the patients with higher GDF-15 had significantly increased risk of mortality (second tertile: adjusted hazards ratio [aHR], 3.67; 95% confidence interval [CI], 1.05–12.76; p = 0.041; third tertile: aHR, 6.81; 95% CI, 1.98–23.44; p = 0.002). Furthermore, GDF-15 predicted in-hospital mortality (area under the curve, 0.710; 95% CI, 0.585–0.815) better than APACHE II and SOFA scores. Serum GDF-15 concentration was elevated in AKI patients requiring CRRT, higher in more severe patients. GDF-15 is a better independent predictor for in-hospital mortality of critically ill AKI patients than the traditional risk scoring system such as APACHE II and SOFA scores.

Increased Risk of Acute Kidney Injury in Critically Ill Children Treated With Vancomycin and Piperacillin/Tazobactam*

2017 ◽  
Vol 18 (12) ◽  
pp. e585-e591 ◽  
Author(s):  
Maya R. Holsen ◽  
Calvin J. Meaney ◽  
Amanda B. Hassinger ◽  
Nicholas M. Fusco
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Increased Risk

scholarly journals Derivation and Validation of Urinary TIMP-1 for Prediction of Acute Kidney Injury and Mortality in Critically Ill Children

2021 ◽  
Author(s):  
Hui Huang ◽  
Qiang Lin ◽  
Xiaomei Dai ◽  
Jiao Chen ◽  
Zhenjiang Bai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Urinary Biomarkers ◽  
Critically Ill Children ◽  
High Morbidity ◽  
Predictive Values ◽  
Derivation Cohort ◽  
Prospective Cohorts

Abstract Background: Acute kidney injury (AKI) is associated with high morbidity and mortality. Multiple urinary biomarkers have been identified to associate with the prediction of AKI and outcomes. However, the accuracy of these urinary biomarkers for AKI and associated outcomes has not been clearly defined, especially in heterogeneous populations. The aims of the study were to compare the ability of 10 existing or potential urinary biomarkers for prediction of AKI and pediatric intensive care unit (PICU) mortality, and identify and validate the best biomarker of urinary tissue inhibitor of metalloproteinases-1 (uTIMP-1) for early prediction in heterogeneous critically ill children.Methods: A derivation-validation approach with separate critically ill cohorts was designed. We first conducted a prospective cohort study to determine the ability of 10 candidate urinary biomarkers serially measured in 123 children during the first 7 days of PICU stay and identify the best biomarker for predicting AKI and PICU mortality (derivation study). The best biomarker of uTIMP-1 from derivation was validated in a separate cohort of 357 critically ill children (validation study). AKI diagnosis was based on KDIGO classification with serum creatinine and urine output.Results: In the derivation cohort, 17 of 123 (13.8%) children developed AKI stage 3 or died during PICU stay, and both the initial and peak uTIMP-1 displayed the highest AUC of 0.87 (0.79-0.94) and 0.90 (0.84-0.96), respectively, for predicting AKI stage 3 or death. In the validation cohort, 47 of 357 (13.2%) developed AKI during the first week after admission, and 38 (10.6%) died during PICU stay. The initial uTIMP-1 level was validated to be independently associated with AKI (AOR=1.88, P=0.001), severe AKI (AOR=2.35, P<0.001), AKI stage 3 (AOR=2.87, P<0.001) and PICU mortality (AOR=1.92, P=0.019) after adjustment for potential confounders. The predictive values of uTIMP-1 for AKI, severe AKI, AKI stage 3 and PICU mortality were 0.82 (0.75-0.88), 0.84 (95%CI 0.77-0.91), 0.87 (0.81-0.94) and 0.83 (0.76-0.89), respectively.Conclusions: Urinary TIMP-1 level has been identified and validated to be independently associated with AKI and PICU mortality in independent prospective cohorts, and may be an early potential indicator of AKI and PICU mortality in critically ill children.

OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

2015 ◽  
Vol 34 ◽  
pp. S2
Author(s):  
J.C. Silva ◽  
U.G. Kyle ◽  
M. Treviño ◽  
J.L. Lusk ◽  
G. Dardon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Nutrition Support ◽  
Critically Ill Children ◽  
Support Guidelines

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

scholarly journals Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

2019 ◽  
Vol 3 (2) ◽  
pp. 093-099 ◽  
Author(s):  
Ali Mohammed Abu Zeid ◽  
Doaa Youssef Mohammed* ◽  
Amal Saeed AbdAlazeem ◽  
Anas Saad Elsayed Mohammed Seddeeq ◽  
Ashraf Mohamed Elnaany
Keyword(s):  
Acute Kidney Injury ◽  
Early Detection ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Urinary Ngal ◽  
Renal Angina Index ◽  
Renal Angina
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