Biomarkers of acute kidney injury: time to learn from implementation

Background: Acute Kidney Injury (AKI) is one of the major clinical problem in hospitalised neonates having variable outcomes. Prognosis depends on early diagnosis, associated risk factors and type of renal failure. The present study was undertaken to evaluate and compare risk factors, biochemical derangements and outcome of AKI in outborn and inborn neonates.Methods: For this hospital based prospective study 100 neonates were enrolled who were admitted in the NICU, diagnosed as AKI who had serum creatinine >1.5mg/dl. Study was done for 1 year from June 2016 onwards.Results: A large majority (72.3%) cases were outborn neonates (extramural) whereas (27.7%) cases were inborn neonates (intramural). Most of (79.8%) cases were term and were admitted during summer months. In outborn, type of AKI in descending order was prerenal (64.7%), renal (33.8%) and postrenal (1.5%) while in inborn neonates, cases were equally (50%) divided in between renal and prerenal. Among outborn neonates risk factors for AKI was dehydration (44%), sepsis (28%) and shock (16%) whereas in inborn, perinatal asphyxia (31%), dehydration (27%), shock (23%) and sepsis (11.5%) were risk factors. In outborn 36.8% cases were oliguric whereas in inborn 53.9% cases were oliguric.Conclusions: The maximum cases of AKI were outborn neonates in which outborn dehydration was the commonest cause while in inborn neonates perinatal asphyxia was the commonest cause. Sepsis and shock were other causes in both groups. Presence of oliguria, intrinsic AKI and shock carried poor prognosis.

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The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury

BMC Nephrology ◽

10.1186/1471-2369-12-30 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 39

Author(s):

Qionghong Xie ◽

Ying Zhou ◽

Zhongye Xu ◽

Yanjiao Yang ◽

Dingwei Kuang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Hospital Acquired

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Docosahexaenoic Acid-Acylated Astaxanthin Esters Exhibit Superior Renal Protective Effect to Recombination of Astaxanthin with DHA via Alleviating Oxidative Stress Coupled with Apoptosis in Vancomycin-Treated Mice with Nephrotoxicity

Marine Drugs ◽

10.3390/md19090499 ◽

2021 ◽

Vol 19 (9) ◽

pp. 499

Author(s):

Hao-Hao Shi ◽

Ying Guo ◽

Li-Pin Chen ◽

Cheng-Cheng Wang ◽

Qing-Rong Huang ◽

...

Keyword(s):

Oxidative Stress ◽

Acute Kidney Injury ◽

Fatty Acid ◽

Docosahexaenoic Acid ◽

Kidney Injury ◽

Clinical Problem ◽

Kidney Dysfunction ◽

Serum Biochemical ◽

And Oxidative Stress ◽

Pro Inflammatory Cytokines

Prevention of acute kidney injury caused by drugs is still a clinical problem to be solved urgently. Astaxanthin (AST) and docosahexaenoic acid (DHA) are important marine-derived active ingredients, and they are reported to exhibit renal protective activity. It is noteworthy that the existing forms of AST in nature are mainly fatty acid-acylated AST monoesters and diesters, as well as unesterified AST, in which DHA is an esterified fatty acid. However, no reports focus on the different bioactivities of unesterified AST, monoesters and diesters, as well as the recombination of DHA and unesterified AST on nephrotoxicity. In the present study, vancomycin-treated mice were used to evaluate the effects of DHA-acylated AST monoesters, DHA-acylated AST diesters, unesterified AST, and the recombination of AST and DHA in alleviating nephrotoxicity by determining serum biochemical index, histopathological changes, and the enzyme activity related to oxidative stress. Results found that the intervention of DHA-acylated AST diesters significantly ameliorated kidney dysfunction by decreasing the levels of urea nitrogen and creatinine, alleviating pathological damage and oxidative stress compared to AST monoester, unesterified AST, and the recombination of AST and DHA. Further studies revealed that dietary DHA-acylated AST esters could inhibit the activation of the caspase cascade and MAPKs signaling pathway, and reduce the levels of pro-inflammatory cytokines. These findings indicated that the administration of DHA-acylated AST esters could alleviate vancomycin-induced nephrotoxicity, which represented a potentially novel candidate or therapeutic adjuvant for alleviating acute kidney injury.

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An Assessment of AKIN Criteria for Hospital-Acquired Acute Kidney Injury: A Prospective Observational Cohort Study

Nephron Clinical Practice ◽

10.1159/000317202 ◽

2010 ◽

Vol 116 (3) ◽

pp. c217-c223 ◽

Cited By ~ 9

Author(s):

Soon Hyo Kwon ◽

Hyunjin Noh ◽

Jin Seok Jeon ◽

Yongbae Kim ◽

Dong Cheol Han

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Kidney Injury ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Observational Cohort ◽

Hospital Acquired

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Nephrology In-Reach Services Lead to Improvement in Mortality in Acute Kidney Injury – 3 (AKI-3)

10.21203/rs.3.rs-119034/v1 ◽

2020 ◽

Author(s):

E. Gkekas ◽

TYT. Tang ◽

M. Brazell ◽

M. Brennan ◽

H. Ayub ◽

...

Keyword(s):

Acute Kidney Injury ◽

Mortality Rate ◽

District Hospital ◽

Care Pathway ◽

Kidney Injury ◽

Evaluation Study ◽

Community Settings ◽

Inclusion Criteria ◽

Hospital Acquired ◽

Overall Mortality

Abstract Background: Acute Kidney Injury (AKI) is a sudden decline in kidney function. Early detection and prompt treatment of AKI is vital in improving the outcome of patients. We introduced in-reach nephrology services at South Tyneside District Hospital (STDH) as part of a reconfiguration of local NHS services. Aims: The principal aim of this study is to analyse patient outcomes relating to service developments and to explore prognostic characteristics among a cohort of AKI-3 patients Design: This was a single centre retrospective impact evaluation study.Methods: We studied all patients (n=246) who either presented with or developed AKI-3 during their admission at South Tyneside District Hospital from 2016 to 2018. The inclusion criteria included age 18-95 years and a diagnosis of AKI-3 as per KDIGO classification. Exclusion include those on established dialysis regime or on palliative care. Results: A total of 246 patients were admitted with AKI-3. There were 64 deaths from AKI-3 over the three-year period. Mortality decreased from 29.5% to 20.7% from 2016 to 2018. In patients with Community Acquired (CA-AKI3) the overall mortality rate was 24.2% (n=182), whereas the overall mortality rate of those with Hospital Acquired (HA-AKI3) was 31.3% (n=64). The pre-AKI use of ACEi, A2RB or diuretics increased from 39.7% in 2016 (n=78), to 59.3% in 2017 (n=86) and 64.6% in 2018 (n=82). Conversely, mortality associated with the use of these medications reduced each consecutive year (32.3%, 25.5%, 18.9%).Conclusion: Development of nephrology in-reach services, staff education measures and a primary care pathway could reduce AKI-3 mortality among patients in inpatient and community settings.

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Community- and Hospital-Acquired Acute Kidney Injury

Acute Kidney Injury and Regenerative Medicine ◽

10.1007/978-981-15-1108-0_10 ◽

2020 ◽

pp. 125-144

Author(s):

Sadudee Peerapornratana ◽

Nattachai Srisawat

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Hospital Acquired

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Admission plasma uromodulin and the risk of acute kidney injury in hospitalized patients with cirrhosis: a pilot study

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00158.2019 ◽

2019 ◽

Vol 317 (4) ◽

pp. G447-G452

Author(s):

Kavish R. Patidar ◽

Pranav S. Garimella ◽

Etienne Macedo ◽

James E. Slaven ◽

Marwan S. Ghabril ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Predictive Biomarker ◽

Hospitalized Patients ◽

Susceptible Population ◽

Baseline Creatinine ◽

Low Levels ◽

Time Of Admission ◽

Hospital Acquired

Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as hospitalized patients with cirrhosis. Thus, we investigated whether plasma uromodulin measured at the time of admission is associated with subsequent hospital-acquired AKI (defined by a rise in serum creatinine >0.3mg/dL within 48 h or ≥ 1.5 times baseline) in patients with cirrhosis. A total of 98 patients [mean age 54 yr, Model for Endstage Liver Disease Sodium (MELD-Na) score 19, and baseline creatinine of 0.95 mg/dL] were included, of which 13% ( n = 13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared with patients who did not (9.30 vs. 13.35 ng/mL, P = 0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score as covariates on multivariable logistic regression, uromodulin was independently associated with AKI [odd ratios of 1.19 (95% confidence interval 1.02, 1.37; P = 0.02)]. Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis. Further studies are needed to better understand the role of uromodulin in the pathogenesis and as a predictive biomarker of AKI in this population. NEW & NOTEWORTHY In this study, we found that admission plasma uromodulin levels are significantly lower in patients who developed subsequent acute kidney injury (AKI) during their hospital stay compared with patients who did not. Additionally, uromodulin is independently associated with AKI development after adjusting for clinically relevant parameters such as age, sex, diabetes, hypertension, severity of cirrhosis, and kidney function. To our knowledge, this is the first study linking plasma uromodulin with AKI development in patients with cirrhosis.

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