scholarly journals Effect of continuous renal replacement therapy on kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury

2017 ◽  
Vol 13 (6) ◽  
pp. 3594-3602 ◽  
Author(s):  
Yiming Shao ◽  
Yinqiang Fan ◽  
Yuliu Xie ◽  
Lu Yin ◽  
Yuanli Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Septic Acute Kidney Injury ◽  
Kidney Injury Molecule 1 ◽  
Neutrophil Gelatinase

scholarly journals Acute Kidney Injury in Critically Ill Patients

2021 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Yuswanto Setyawan
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Kidney Injury Molecule 1 ◽  
Neutrophil Gelatinase ◽  
Urinary Cystatin C

Abstrak: Gagal ginjal akut (GGA) sering ditemukan dalam praktek klinik namun diagnosisnya dapat tertunda oleh karena keterbatasan alat diagnostik. Dewasa ini, kriteria diagnostik RIFLE, AKIN, dan KDIGO untuk menilai adanya GGA dan keparahannya dianggap tidak cukup untuk menggambarkan kompleksitas sindrom GGA. Proteinuria dan mikroalbuminuria yang merupa-kan marker klasik progresi cedera ginjal kronik, telah dipergunakan dan divalidasi untuk progresi GGA ke CKD. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), dan urinary cystatin C dapat berperan dalam memrediksi pemulihan ginjal. Indikasi biopsi ginjal pada pasien kritis ialah gangguan ginjal yang tidak jelas atau progresi CKD dengan hematuria glomerulus dan proteinuria lebih dari 1 gram per hari, manifestasi ginjal dari penyakit sistemik yang mengancam nyawa, kecurigaan penolakan akut atau kronik dari ginjal transplan. Mempertahankan hemodinamik yang adekuat seharusnya bermanfaat dalam pence-gahan onset atau perburukan GGA, namun kelebihan cairan harus dihindari. Sampau saat ini penentuan saat inisiasi acute renal replacement therapy (ARRT) masih kontroversial, demikian pula nilai ambang spesifik untuk memulainya belum sepenuhnya disepakati. Kata kunci: gagal ginjal akut; penyakit kritis' laju filtrasi glomerulus (LFG)  Abstract: Acute kidney injury (AKI) is a common problem in clinical practice, but its diagnosis could be delayed due to the inherent limitation of current diagnostic tools. Current practice suggests that RIFLE, AKIN, and KDIGO diagnostic criteria used to assess the presence of AKI and its severity are insufficient to illustrate the complexity of the AKI syndrome. Proteinuria and micro-albuminuria, classical markers of chronic kidney disease (CKD) progression, have been used and validated for the progression of AKI to CKD. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and urinary cystatin C could play a role in prediction of renal recovery. Indication of renal biopsy in critically ill patients are unexplained renal impairment or progression of CKD with both glomerular hematuria and proteinuria more than 1 gr per day, renal manifestations of life threathening systemic disease, suspected acute or chronic rejection of a transplanted kidney. The maintenance of adequate hemodynamics should be beneficial in preventing the onset or the worsening of AKI, but fluid overload should be avoided. Timing of acute renal replacement therapy (ARRT) initiation is still controversial, moreover, specific thresholds for starting are still unclear.Keywords: acute kidney injury (AKI); critically ill; glomerular filtration rate (GFR)

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

2019 ◽  
Vol 48 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Xiaohan Chen ◽  
Zhiwen Chen ◽  
Tiantian Wei ◽  
Peiyun Li ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background: To determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) by evaluating serum neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI). Methods: A prospective observational study was conducted from September 2015 to March 2018. AKI patients treated with CRRT for at least 24 h were divided into “success” and “failure” groups according to their RRT requirement within 7 days after the initial discontinuation of CRRT. The prefilter and effluent NGAL concentrations were measured to calculate the sieving coefficient (SC) of NGAL in all included subjects from 0 to 72 h. Results: In total, 110 patients were divided into success (n = 78) and failure groups (n = 32). The mean SC of NGAL during CRRT was less than 0.05. The patients in the failure group were associated with higher mortality compared with patients in the success group (37.5 vs. 12.8%, respectively, p = 0.013). There were significant differences in serum NGAL, creatinine, and urine output at discontinuation. In patients without sepsis (n = 70), serum NGAL and urine output were significant predictors of successful cessation. The area under the receiver operating characteristic to predict the successful discontinuation of CRRT was 0.88 for NGAL and 0.86 for urine output. An NGAL level of 403 ng/mL had the highest sensitivity (81%) and specificity (89%) and a urine output of 695 mL/day had the highest sensitivity (83%) and specificity (88%). However, in septic patients (n = 40), urine output but not serum NGAL (OR 0.999, p = 0.69) was a significant variable (OR 1.002, p = 0.005), with a cutoff of 796 mL/day (sensitivity 83%, specificity 88%). Conclusions: Serum NGAL was a significant factor for predicting successful CRRT discontinuation in nonseptic AKI patients. However, urine output, rather than serum NGAL, was a significant predictor in septic AKI patients.

Impact of Continuous Renal Replacement Therapy Intensity on Septic Acute Kidney Injury

Shock ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Kengo Mayumi ◽  
Tetsushi Yamashita ◽  
Yoshifumi Hamasaki ◽  
Eisei Noiri ◽  
Masaomi Nangaku ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Septic Acute Kidney Injury

scholarly journals How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury?

2018 ◽  
Vol 46 (4) ◽  
pp. 326-331 ◽  
Author(s):  
Jingxiao Zhang ◽  
Jiakun Tian ◽  
Hongzhi Sun ◽  
Kumar Digvijay ◽  
Mauro Neri ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Water Balance ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Journal Club ◽  
Kidney Injury ◽  
Extra Energy ◽  
Septic Acute Kidney Injury ◽  
Metabolic Products

Sepsis is the leading cause of acute kidney injury (AKI) in the intensive care unit. As the most common treatment of septic AKI, it is believed that continuous renal replacement therapy (CRRT) can not only maintain the water balance and excrete the metabolic products but also regulate the inflammation and promote kidney recovery. CRRT can remove the inflammatory cytokines to regulate the metabolic adaption in kidney and restore the kidney recovery to protect the kidney in septic AKI. Second, CRRT can provide extra energy supply in septic AKI to improve the kidney energy balance in septic AKI. Third, the anticoagulant used in CRRT also regulates the inflammation in septic AKI. CRRT is not only a treatment to deal with the water balance and metabolic products, but also a method to regulate the inflammation in septic AKI. Video Journal Club ‘Cappuccino with Claudio Ronco’ at https://www.karger.com/Journal/ArticleNews/223997?​sponsor=52.

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