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Acute Kidney Injury (acute + kidney_injury)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Nephrology	25%
Anesthesia & Pain Management	19%
Cardiovascular Disease	13%
11 Other Subdomains	43%

Selected Abstracts

TISSUE HYPOXIA AS A THERAPEUTIC TARGET IN ACUTE KIDNEY INJURY

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 9 2009
Roger G Evans
No abstract is available for this article. [source]

From kidney to cardiovascular diseases: NGAL as a biomarker beyond the confines of nephrology

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2010
D. Bolignano
Eur J Clin Invest 2010; 40 (3): 273,276 Abstract Neutrophil gelatinase-associated lipocalin (NGAL), a small 25 kDa stress-protein released from injured tubular cells after various damaging stimuli, is already known by nephrologists as one of the most promising biomarkers of incoming Acute Kidney Injury. Moreover, recent studies seem to suggest a potential involvement of this factor also in the genesis and progression of chronic kidney diseases. This brief review explores the new interesting involvement of NGAL in the experimental and clinical field of cardiovascular diseases, such as the pathogenesis and clinical manifestations of atherosclerosis, acute myocardial infarction and heart failure. It does not seem difficult that, in the next future, NGAL may become a new missing link between the kidney and the cardiovascular system. [source]

Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney Injury

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009
L. K. Kayler
Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ,1.5, 1.6,2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6,2.0 and >2.0 mg/dL, compared to ,1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5,7.6) and 1.6,2.0 mg/dL (AOR 2.7; CI 2.5,2.9) relative to sCr ,1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury. [source]

Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

ARTIFICIAL ORGANS, Issue 4 2010
Masanori Abe
Abstract Despite improvements in medical care, the mortality of critically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT) remains high. We describe a new approach, sustained hemodiafiltration, to treat patients who suffered from acute kidney injury and were admitted to intensive care units (ICUs). In our study, 60 critically ill patients with AKI who required RRT were treated with either continuous venovenous hemodiafiltration (CVVHDF) or sustained hemodiafiltration (S-HDF). The former was performed by administering a postfilter replacement fluid at an effluent rate of 35 mL/kg/h, and the latter was performed by administering a postfilter replacement fluid at a dialysate-flow rate of 300,500 mL/min. The S-HDF was delivered on a daily basis. The baseline characteristics of the patients in the two treatment groups were similar. The primary study outcome,survival until discharge from the ICU or survival for 30 days, whichever was earlier,did not significantly differ between the two groups: 70% after CVVHDF and 87% after S-HDF. The hospital-survival rate after CVVHDF was 63% and that after S-HDF was 83% (P < 0.05). The number of patients who showed renal recovery at the time of discharge from the ICU and the hospital and the duration of the ICU stay significantly differed between the two treatments (P < 0.05). Although there was no significant difference between the mean number of treatments performed per patient, the mean duration of daily treatment in the S-HDF group was 6.5 ± 1.0 h, which was significantly shorter. Although the total convective volumes,the sum of the replacement-fluid and fluid-removal volumes,did not differ significantly, the dialysate-flow rate was higher in the S-HDF group. Our results suggest that in comparison with conventional continuous RRT, including high-dose CVVHDF, more intensive renal support in the form of postdilution S-HDF will decrease the mortality and accelerate renal recovery in critically ill patients with AKI. [source]

Acute kidney injury in cirrhosis,

HEPATOLOGY, Issue 6 2008
Guadalupe Garcia-Tsao
Acute renal failure (ARF), recently renamed acute kidney injury (AKI), is a relatively frequent problem, occurring in approximately 20% of hospitalized patients with cirrhosis. Although serum creatinine may underestimate the degree of renal dysfunction in cirrhosis, measures to diagnose and treat AKI should be made in patients in whom serum creatinine rises abruptly by 0.3 mg/dL or more (,26.4 ,mol/L) or increases by 150% or more (1.5-fold) from baseline. The most common causes of ARF (the term is used interchangeably with AKI) in cirrhosis are prerenal azotemia (volume-responsive prerenal AKI), acute tubular necrosis, and hepatorenal syndrome (HRS), a functional type of prerenal AKI exclusive of cirrhosis that does not respond to volume repletion. Because of the progressive vasodilatory state of cirrhosis that leads to relative hypovolemia and decreased renal blood flow, patients with decompensated cirrhosis are very susceptible to developing AKI with events associated with a decrease in effective arterial blood volume. HRS can occur spontaneously but is more frequently precipitated by events that worsen vasodilatation, such as spontaneous bacterial peritonitis. Conclusion: Specific therapies of AKI depend on the most likely cause and mechanism. Vasoconstrictors are useful bridging therapies in HRS. Ultimately, liver transplantation is indicated in otherwise reasonable candidates in whom AKI does not resolve with specific therapy. (HEPATOLOGY 2008;48:2064-2077.) [source]

Acute kidney injury with renal replacement therapy in trauma patients

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010
S. BEITLAND
Background: Acute kidney injury (AKI) with renal replacement therapy (RRT) is rare in trauma patients. The primary aim of the study was to assess incidence, mortality and chronic RRT dependency in this patient group. Methods: Adult trauma patients with AKI receiving RRT at a regional trauma referral center over a 12-year period were retrospectively reviewed. Results: Population-based incidence of post-traumatic AKI with RRT was 1.8 persons per million inhabitants per year (p.p.m./year) [95% confidence the interval (CI) 1.5,2.1 p.p.m./year]. In trauma patients admitted to hospital, incidence was 0.5, (95% CI 0.3,0.7,) of those treated in intensive care unit (ICU), it was 8.3% (95% CI 5.9,10.8%). The median age was 46 years. Odds ratio (OR) for post-traumatic AKI requiring RRT was higher in males than in females in general population (OR 5.6, 95% CI 2.2,14.0), and in trauma patients admitted to hospital (OR 4.4, 95% CI 1.9,10.3) and ICU (OR 4.5, 95% CI 1.9,10.7). The in-hospital mortality rate was 24% (95% CI 11,37%), 3-month mortality 36% (95% CI 21,51%) and 1-year mortality 40% (95% CI 25,55%). Age was a risk factor for death after 1 year, with 57% (95% CI 7,109%) increased risk for each 10 years added. None of the survivors was dialysis-dependent 3 months or 1 year after trauma. Conclusion: AKI in trauma patients requiring RRT was rare in this single-center study. More males than females were affected. Mortality was modest, and renal recovery was excellent as none of the survivors became dependent on chronic RRT. [source]

Review: Neutrophil gelatinase-associated lipocalin: A troponin-like biomarker for human acute kidney injury

NEPHROLOGY, Issue 4 2010
PRASAD DEVARAJAN
ABSTRACT Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which currently depends on functional markers such as serum creatinine measurements. Unfortunately, creatinine is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury (akin to troponin in acute myocardial injury) has hampered our ability to translate promising experimental therapies to human AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed. NGAL is emerging as an excellent stand-alone troponin-like structural biomarker in the plasma and urine for the early diagnosis of AKI, and for the prediction of clinical outcomes such as dialysis requirement and mortality in several common clinical scenarios. The approach of using NGAL as a trigger to initiate and monitor therapies for AKI, and as a safety biomarker when using potentially nephrotoxic agents, is also promising. In addition, it is hoped that the use of sensitive and specific biomarkers such as NGAL as endpoints in clinical trials will result in a reduction in required sample sizes, and hence the cost incurred. Furthermore, predictive biomarkers like NGAL may play a critical role in expediting the drug development process. However, given the complexity of AKI, additional biomarkers (perhaps a panel of plasma and urinary biomarkers) may eventually need to be developed and validated for optimal progress to occur. [source]

Early detection of acute kidney injury: Emerging new biomarkers (Review Article)

NEPHROLOGY, Issue 2 2008
ZOLTAN H ENDRE
SUMMARY: Acute kidney injury (AKI) has recently become the preferred term to describe the syndrome of acute renal failure (ARF) with ,failure' or ,ARF' restricted to patients who have AKI and need renal replacement therapy.1 This allows capture of the broader clinical spectrum of modest reductions in creatinine, which are themselves known to be associated with major increases in both short- and long-term mortality risk.2,5 It is hoped that this change in nomenclature will facilitate an expansion of our understanding of the underlying pathophysiology and also facilitate definitions of AKI, which allow comparisons among clinical trials of patients with similar duration and severity of illness. This review will cover the need for early detection of AKI and the role of urinary and plasma biomarkers, including enzymuria. The primary message is that use of existing criteria to diagnose AKI, namely elevation of the serum creatinine with or without oliguria, results in identification that is too late to allow successful intervention. New biomarkers are essential to change the dire prognosis of this common condition. [source]

Acute kidney injury and renal replacement therapy in the intensive care unit

NURSING IN CRITICAL CARE, Issue 4 2009
Peter Faber
Abstract Background:, Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof. Aims and objectives:, The objective of this review was to provide an accessible theoretical and practical update on the management of RRT. In addition to a detailed discussion of the underlying principles and indications for the various modes of RRT, we will discuss the assessment of kidney function, possible complications and anticoagulation during RRT, following a review of the current literature. Search strategies:, Pubmed, Medline and the Cumulative Index to Nursing and Allied Health Literature were searched using the keywords renal function, RRT, dialysis, renal failure kidney injury, together with intensive care, intensive therapy and critical care. We included only studies published in English from 1998 to 2008 and from these identified and included additional publications. The 12 most relevant publications are referenced in this review. Conclusion:, AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required. [source]

Acute kidney injury following elective endovascular aneurysm repair

ANAESTHESIA, Issue 2 2010
P. S. Lancaster
No abstract is available for this article. [source]

Volume Overload and Cardiorenal Syndromes

CONGESTIVE HEART FAILURE, Issue 2010
Claudio Ronco MD
To include the vast array of interrelated derangements and to stress the bidirectional nature of the heart-kidney interactions, the classification of the cardiorenal syndrome today includes 5 subtypes whose terminology reflects their primary and secondary pathology, time frame, and the presence of concomitant cardiac and renal dysfunction. Cardiorenal syndromes (CRSs) are pathophysiologic disorders of the heart and kidneys whereby acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function leading to acute kidney injury. Type 2 CRS describes chronic abnormalities in cardiac function causing progressive chronic kidney disease. Type 3 CRS consists in an abrupt worsening of renal function causing acute cardiac disorder. Type 4 CRS describes a state of chronic kidney disease contributing to decreased cardiac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events. Type 5 CRS reflects a systemic condition (eg, sepsis) simultaneously causing both cardiac and renal dysfunction. Biomarkers can help characterize the subtypes of CRS as well as suggest the timing of treatment initiation and its likely effectiveness. The identification of patients and the pathophysiologic mechanisms underlying each syndrome subtype, including fluid overload or, in general, altered conditions of fluid status, can help physicians understand clinical derangements, provide the rationale for management strategies, and allow the design of future clinical trials with more accurate selection and stratification of the population under investigation. Congest Heart Fail. 2010;16(4)(suppl 1):Si,Siv. ©2010 Wiley Periodicals, Inc. [source]

Utility of citrate dialysate in management of acute kidney injury in children

HEMODIALYSIS INTERNATIONAL, Issue 2010
Coral HANEVOLD
Abstract Dialysis concentrate acidified with citrate as opposed to acetate has been reported to prevent clotting in hemodialysis circuits, and improve dialysis efficiency in adults. There is no information on its use in children. The purpose of the study was to evaluate the utility of citrate dialysate for renal replacement therapy in a pediatric population with acute kidney injury. We performed a retrospective review of our experience using Citrasate® concentrate from December 2007 to August 2009. All treatments were provided using the Fresenius 2008 dialysis machine. Citrasate® was utilized in 7 children aged 60.3±51.0 months (mean±SD), range 13 months to 12 years. The number of treatments varied from 4 to 31 (mean 12±8 treatments) for a total of 89 treatments. Rare sporadic mild hypocalcemia was noted but could not be definitively linked with the use of Citrasate®. Four children also required low-dose heparin (3.6,15 U/kg/h) due to clotting. Activated clotting times (when checked) were not affected by this low-dose heparin therapy. Some degree of clotting occurred in 21 of 89 (23.5%) treatments. Early termination of treatment due to thrombosis was required in 7 of 89 (7.8%) treatments. In summary, use of Citrasate® dialysis concentrate was well tolerated in critically ill children with acute kidney injury. Citrasate® reduced but did not completely eliminate the need for heparin in our population. Further study in a more diverse population would be helpful. [source]

Acute kidney injury in cirrhosis,

The impact of pre-operative serum creatinine on short-term outcomes after liver resection

HPB, Issue 8 2009
Thomas Armstrong
Abstract Background:, The aim of the present study was to determine whether raised pre-operative serum creatinine increased the risk of renal failure after liver resection. Method:, Data were studied from 1535 consecutive liver resections. Outcomes in patients with pre-operative creatinine ,124 µmol/l (Group 1) were compared with those with pre-operative creatinine ,125 µmol/l (Group 2). Results:, The median age of the 1446 (94.3%) patients resected in Group 1 was 62 years compared with 67 years in the 88 (5.7%) patients in Group 2 (P < 0.0001). Similarly this latter group had double the number of patients who were American Society of Anesthesiologists (ASA) III or IV (34.1% vs. 15.2%, P= 0.00004). Overall, the incidence of post-operative renal failure requiring haemofiltration was low (0.9%) but significantly more in Group 2 patients (5.7% vs. 0.6, P= 0.0007). In addition, patients in Group 2 were more likely to suffer acute kidney injury post-operatively (18.2% vs. 4.3%, P < 0.0001). Patients with acute kidney injury had significantly higher blood loss. Although there was no difference in mortality, patients in Group 2 had higher post-operative morbidity (37.5%) than Group 1 (21.7%, P= 0.0006), with the incidence of cardiorespiratory complications being higher in Group 2 (25.9% vs. 8.9%, P= 0.0025). Conclusions:, After liver resection, renal failure is rare but patients with an elevated creatinine pre-operatively are at an increased risk of both renal and non-renal complications. [source]

Sodium Bicarbonate versus Sodium Chloride and Oral N-Acetylcysteine for the Prevention of Contrast-Induced Nephropathy in Advanced Chronic Kidney Disease

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2009
LINDA SHAVIT M.D.
Introduction: Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of hospital-acquired acute kidney injury. Multiple clinical studies have proposed several preventive strategies. Aims: To examine the efficacy of sodium bicarbonate compared with sodium chloride and oral N-acetylcysteine (NAC) for preventive hydration after cardiac catheterization. Methods: We conducted a prospective, single-center trial. Patients with chronic kidney disease (CKD) stage III,IV undergoing cardiac catheterization were allocated to receive either an infusion of 0.9% sodium chloride and oral NAC or 154 mEq/L sodium bicarbonate. Main: Outcome measure CI-AKI, defined as an increase of 25% or 0.3 mg/dL or more in plasma creatinine within 2 days of contrast administration. Results: Ninety-three patients were allocated to one of the two groups: 42 patients in the saline plus NAC group and 51 patients in the bicarbonate group. There were no statistically significant differences between the groups in the most important clinical and procedural characteristics. Baseline plasma creatinine levels, estimated glomerular filtration rate, incidence of diabetes mellitus, hypertension, congestive heart failure, and contrast medium volume were similar. Mean plasma creatinine concentration was 1.76 ± 0.54 mg/dL in the saline and NAC group and 1.9 ± 1 mg/dL in the bicarbonate group (P = 0.23). The rate of CI-AKI was 9.8% in the bicarbonate group and 8.4% in the saline plus NAC group. No patient required renal replacement therapy. Conclusion: Hydration with sodium bicarbonate is not more effective than hydration with sodium chloride and oral NAC for prophylaxis of CI-AKI in patients with CKD stage III,IV undergoing cardiac catheterization. [source]

In vivo magnetic resonance imaging of iron oxide,labeled, arterially-injected mesenchymal stem cells in kidneys of rats with acute ischemic kidney injury: Detection and monitoring at 3T

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2007
Harald Ittrich MD
Abstract Purpose To evaluate MRI for a qualitative and quantitative in vivo tracking of intraaortal injected iron oxide,labeled mesenchymal stem cells (MSC) into rats with acute kidney injury (AKI). Materials and Methods In vitro MRI and R2* measurement of nonlabeled and superparamagnetic iron oxide (SPIO)-labeled MSC (MSCSPIO) was performed in correlation to cellular iron content and cytological examination (Prussian blue, electron microscopy). In vivo MRI and R2* evaluation were performed before and after ischemic/reperfusion AKI (N = 14) and intraaortal injection of 1.5 × 106 MSCSPIO (N = 7), fetal calf serum (FCS) (medium, N = 6), and SPIO alone (N = 1) up to 14 days using a clinical 3T scanner. Signal to noise ratios (SNR), R2* of kidneys, liver, spleen, and bone marrow, renal function (creatinine [CREA], blood urea nitrogen [BUN]), and kidney volume were measured and tested for statistical significance (Student's t -test, P < 0.05) in comparison histology (hematoxylin and eosin [H&E], Prussian blue, periodic acid-Schiff [PAS], CD68). Results In vitro, MSCSPIO showed a reduction of SNR and T2* with R2* , number of MSCSPIO (R2 = 0.98). In vivo MSCSPIO administration resulted in a SNR decrease (35 ± 15%) and R2* increase (101 ± 18.3%) in renal cortex caused by MSCSPIO accumulation in contrast to control animals (P < 0.01). Liver, spleen, and bone marrow (MSCSPIO) showed a delayed SNR decline/R2* increase (P < 0.05) resulting from MSCSPIO migration. The increase of kidney volume and the decrease in renal function (P < 0.05) was reduced in MSC-treated animals. Conclusion Qualitative and quantitative in vivo cell-tracking and monitoring of organ distribution of intraaortal injected MSCSPIO in AKI is feasible in MRI at 3T. J. Magn. Reson. Imaging 2007;25:1179,1191. © 2007 Wiley-Liss, Inc. [source]

The burden of kidney disease in Indigenous children of Australia and New Zealand, epidemiology, antecedent factors and progression to chronic kidney disease

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2010
Andrew White
Aims: To review and present the most important issues related to kidney disease in Aboriginal, Torres Strait Islander, Maori and Pacific Islander children from Australia and New Zealand. Methods: A review of medical literature about: 1. incidence of kidney disease in Indigenous children in Australia and New Zealand, especially where rates are different from the general populations, 2. factors in early life which increase risk for chronic kidney disease in adult life, and 3. early identification and primary and secondary interventions in childhood which may prevent chronic kidney disease in adults. Results: Kidney diseases, both acute and chronic are more common in Maori, Pacific Islander, Australian Aboriginal and Torres Strait Islander people. The reasons are multiple and include genetic, environmental and socio-economic factors. In childhood post streptococcal glomerulonephritis, haemolytic uraemic syndrome, renal stones and acute kidney injury all occur at higher frequency in at least some of the Indigenous populations. Chronic kidney disease CKD occurs more commonly, and at a younger age in Indigenous than non Indigenous people. Factors involved may include reduced nephron endowment at birth, and subsequent insults including nephritis, obesity, and early onset type 2 diabetes, as well as underlying socioeconomic and environmental determinants. Conclusion: A lifecourse understanding allows one to conceptualise multiple risk factors and target interventions. [source]

Review: Neutrophil gelatinase-associated lipocalin: A troponin-like biomarker for human acute kidney injury

Experiences with acute kidney injury complicating non-fulminant hepatitis A

NEPHROLOGY, Issue 6 2008
HYUN W KIM
SUMMARY: Aim: To describe the clinical features and to identify factors related to development of acute kidney injury in acute hepatitis A patients. Methods: The study and control groups consisted of 21 and 425 patients who did or did not develop acute kidney injury, respectively, after acute hepatitis A from January 1997 to May 2007. Results: There were 13 men and eight women; their mean age at diagnosis was 28.8 ± 8.2 years in the study group. Peak values for renal and liver function impairment consisted of a median serum creatinine of 4.6 mg/dL (range, 1.5,15.3 mg/dL) on day 6 (range, days 1,20) and a median total bilirubin of 10.7 mg/dL (range, 2.6,57.5 mg/dL) on day 8 (range, day 1,19). Serum creatinine concentrations returned to baseline level by a median of 16 days and total bilirubin levels returned to normal by a median of 62 days. Six of 21 (29%) patient underwent haemodialysis. Renal biopsies performed in two patients showed acute tubular necrosis and interstitial nephritis, respectively. Logistic regression analysis showed that a lower haematocrit, the presence of coagulopathy and high C-reactive protein concentration on admission, and higher peak bilirubin value during the illness were associated with development of acute kidney injury. Conclusion: Acute hepatitis A should be considered in the differential diagnosis of patients with acute kidney injury, even without fulminant hepatic failure. A lower haematocrit, the presence of coagulopathy and high C-reactive protein level at presentation, and higher peak bilirubin level during the illness were associated with development of acute kidney injury in acute hepatitis A patients. [source]

Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury

NEPHROLOGY, Issue 5 2008
JOSE R PEREZ VALDIVIESO
SUMMARY: Aim: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor. Methods: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed. Results: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality. Conclusion: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system. [source]

Early detection of acute kidney injury: Emerging new biomarkers (Review Article)

Acute kidney injury and renal replacement therapy in the intensive care unit

Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney Injury

Benefits and risks of furosemide in acute kidney injury

ANAESTHESIA, Issue 3 2010
K. M. Ho
Summary Furosemide, a potent loop diuretic, is frequently used in different stages of acute kidney injury, but its clinical roles remain uncertain. This review summarises the pharmacology of furosemide, its potential uses and side effects, and the evidence of its efficacy. Furosemide is actively secreted by the proximal tubules into the urine before reaching its site of action at the ascending limb of loop of Henle. It is the urinary concentrations of furosemide that determine its diuretic effect. The severity of acute kidney injury has a significant effect on the diuretic response to furosemide; a good ,urinary response' may be considered as a ,proxy' for having some residual renal function. The current evidence does not suggest that furosemide can reduce mortality in patients with acute kidney injury. In patients with acute lung injury without haemodynamic instability, furosemide may be useful in achieving fluid balance to facilitate mechanical ventilation according to the lung-protective ventilation strategy. [source]

Point of care measurement of plasma creatinine in critically ill patients with acute kidney injury

ANAESTHESIA, Issue 4 2009
A. Udy
Summary We report the utility of an enzymatic point of care system for estimation of plasma creatinine concentration in critically ill patients with acute kidney injury. Multiple measurements were obtained from a heterogenous population admitted to a multi-disciplinary intensive care unit. The acute kidney injury network guidelines were used to identify and stratify patients based on the creatinine concentration. Central laboratory values were used as comparators to assess the precision and bias of the system. Overall, point of care measurements correlated well with central pathology results (R2 = 0.991, p < 0.001), although there tended to be a small negative bias in patients with acute kidney injury (3 ,mol.l,1). The accuracy of point of care measurement is within clinically acceptable limits and given the much shorter turn around time can be used to identify and monitor patients with acute kidney injury in the critical care environment. [source]

Urinary neutrophil gelatinase,associated lipocalin as a biomarker of nephritis in childhood-onset systemic lupus erythematosus

ARTHRITIS & RHEUMATISM, Issue 8 2006
Hermine I. Brunner
Objective Renal involvement in systemic lupus erythematosus (SLE) is associated with poor prognosis. Currently available renal biomarkers are relatively insensitive and nonspecific for diagnosing SLE nephritis. Previous research suggests that neutrophil gelatinase,associated lipocalin (NGAL) is a high-quality renal biomarker of acute kidney injury, while its usefulness in SLE is unclear. We undertook this study to determine the relationship between urinary NGAL excretion and SLE disease activity or damage, with a focus on nephritis. Methods A cohort of 35 patients diagnosed as having SLE prior to age 16 years (childhood-onset SLE) was assessed for disease activity (using the Systemic Lupus Erythematosus Disease Activity Index 2000 update) and damage (using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology SLE Damage Index) in a double-blind, cross-sectional study. Information on current markers of renal function and disease was obtained and compared with NGAL levels (ng/mg of urinary creatinine) measured by enzyme-linked immunosorbent assay. Eight children with juvenile idiopathic arthritis (JIA) served as controls. Results NGAL levels did not differ with the age, weight, height, sex, or race of the patients. Patients with childhood-onset SLE had significantly higher NGAL levels than did those with JIA (P < 0.0001). NGAL levels were strongly to moderately correlated with renal disease activity and renal damage (Spearman's r , 0.47, P < 0.0001 for both comparisons), but not with extrarenal disease activity or extrarenal damage. NGAL levels of >0.6 ng/mg urinary creatinine were 90% sensitive and 100% specific for identifying childhood-onset SLE patients with biopsy-proven nephritis. Conclusion Urinary NGAL is a promising potential biomarker of childhood-onset SLE nephritis. The results of the current study require validation in a larger cohort to more accurately delineate urinary NGAL excretion in relation to the diverse SLE phenotypes. [source]

Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

Gadolinium-induced nephrogenic systemic fibrosis in a patient with an acute and transient kidney injury

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2008
R.E. Kalb
Summary Nephrogenic systemic fibrosis (NSF) describes a characteristic fibrosing disorder which typically presents with indurated plaques on the trunk and extremities of patients with advanced renal disease. We present a case of biopsy-confirmed NSF in a patient with severe acute kidney injury with no prior history of renal disease. A 64-year-old man with an acute and severe decrease in glomerular filtration rate underwent magnetic resonance imaging studies with gadolinium contrast (OmniscanÔ) and subsequently developed NSF. His renal disease had normalized at the time his skin disease developed. Skin biopsies revealed findings of NSF and scanning electron microscopy with energy-dispersive X-ray spectroscopy confirmed insoluble gadolinium within lesional tissue. [source]

Prevention of Atrial Fibrillation in Cardiac Surgery: Time to Consider a Multimodality Pharmacological Approach

CARDIOVASCULAR THERAPEUTICS, Issue 1 2010
Kwok M. Ho
Atrial fibrillation (AF) is very common within the first 5 days of cardiac surgery. It is associated with significant morbidity including stroke, ventricular arrhythmias, myocardial infarction, heart failure, acute kidney injury, prolonged hospital stay, and also short- and long-term mortality. The underlying mechanisms of developing AF after cardiac surgery are multifactorial; risk factors may include advanced age, withdrawal of beta-blockers and angiotensin-converting-enzyme inhibitors, valve surgery, obesity, increased left atrial size, and diastolic dysfunction. There are many pharmacological options in preventing AF, but none of them are effective for all patients and they all have significant limitations. Beta-blockers may reduce the incidence of AF by more than a third, but bradycardia, hypotension, or exacerbation of heart failure often limit their utility postoperatively. Recent evidence suggests that class III antiarrhythmic drugs, sotalol and amiodarone, are more effective than beta-blockers, but they both share similar hemodynamic side effects of beta-blockers. Magnesium, antiinflammatory drugs such as statins, omega fatty acids, and low-dose corticosteroids also have some efficacy and they have the advantages of not causing significant hemodynamic side effects. Data on effectiveness of calcium channel blockers, digoxin, alpha-2 agonists, sodium nitroprusside, and N-acetylcysteine are more limited. Because the pathogenesis of AF is multifactorial, a combination of drugs with different pharmacological actions may have additive or synergistic effect in preventing AF after cardiac surgery. Randomized controlled trials evaluating the effectiveness of a multimodality pharmacological approach in patients at high-risk of AF after cardiac surgery are needed. [source]

Contrast-induced Kidney Injury: Focus on Modifiable Risk Factors and Prophylactic Strategies

CLINICAL CARDIOLOGY, Issue 2 2010
Anna Kagan MD
Contrast-induced nephropathy, also known as contrast-induced acute kidney injury, is associated with rapid and often irreversible decline in kidney function following the administration of iodinated contrast agents. Contrast-induced nephropathy is the third leading cause of acute kidney injury in hospitalized patients, and substantially increases mortality, morbidity, and length of hospitalization. Contrast-induced nephropathy follows a predictable time of onset and is potentially preventable. It has been the subject of numerous studies addressing characteristics of the populations at risk and prophylactic strategies. This evidence-based review summarizes recent literature and provides a nephrologists' perspective on contrast-induced nephropathy, focusing on: the pathophysiology of contrast-induced nephropathy; identification of populations at risk; correlation between contrast-induced nephropathy and the type of contrast agent used; and finally, measures to prevent contrast-induced nephropathy, including intravenous fluids, sodium bicarbonate, N-acetylcysteine, and hemofiltration/hemodialysis. Copyright © 2010 Wiley Periodicals, Inc. [source]