The abrupt pathological deterioration of cisplatin‐induced acute kidney injury: Emerging of a critical time point

Qin Gong; Mulan Wang; Ya Jiang; Chengliang Zha; Dong Yu; Fan Lei; Yingying Luo; Yulin Feng; Shilin Yang; Jun Li; Lijun Du

doi:10.1002/prp2.895

Urinary Metabolome Analyses of Patients with Acute Kidney Injury Using Capillary Electrophoresis-Mass Spectrometry

Metabolites ◽

10.3390/metabo11100671 ◽

2021 ◽

Vol 11 (10) ◽

pp. 671

Author(s):

Rintaro Saito ◽

Akiyoshi Hirayama ◽

Arisa Akiba ◽

Yushi Kamei ◽

Yuyu Kato ◽

...

Keyword(s):

Mass Spectrometry ◽

Acute Kidney Injury ◽

Capillary Electrophoresis ◽

Kidney Injury ◽

Urine Samples ◽

Rapid Decline ◽

Time Points ◽

Flight Mass Spectrometry ◽

Best Value ◽

Time Point

Acute kidney injury (AKI) is defined as a rapid decline in kidney function. The associated syndromes may lead to increased morbidity and mortality, but its early detection remains difficult. Using capillary electrophoresis time-of-flight mass spectrometry (CE-TOFMS), we analyzed the urinary metabolomic profile of patients admitted to the intensive care unit (ICU) after invasive surgery. Urine samples were collected at six time points: before surgery, at ICU admission and 6, 12, 24 and 48 h after. First, urine samples from 61 initial patients (non-AKI: 23, mild AKI: 24, severe AKI: 14) were measured, followed by the measurement of urine samples from 60 additional patients (non-AKI: 40, mild AKI: 20). Glycine and ethanolamine were decreased in patients with AKI compared with non-AKI patients at 6–24 h in the two groups. The linear statistical model constructed at each time point by machine learning achieved the best performance at 24 h (median AUC: 89%, cross-validated) for the 1st group. When cross-validated between the two groups, the AUC showed the best value of 70% at 12 h. These results identified metabolites and time points that show patterns specific to subjects who develop AKI, paving the way for the development of better biomarkers.

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Risk of overanticoagulation during acute kidney injury in patients treated with vitamin K antagonists

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab008 ◽

2021 ◽

Author(s):

Luisa Süfling ◽

Daniel Greinert ◽

Matthias Girndt

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Kidney Function ◽

Vitamin K ◽

Case Reports ◽

Vitamin K Antagonists ◽

Kidney Injury ◽

Bleeding Complications ◽

Reference Time ◽

Time Point

Abstract Background Vitamin K antagonists (VKAs) are still in use for oral anticoagulation, but not all indications allow their replacement by direct oral anticoagulants. Although formal dose reduction is not required in patients with impaired kidney function, case reports indicate that acute kidney injury (AKI) might be associated with derailment of VKA therapy. Methods The study retrospectively collected patients from a tertiary nephrology care centre who experienced AKI while being treated with VKA. In these individuals, the international normalized ratio (INR) as a measure of anticoagulant effect during renal failure was compared with a reference time point with stable kidney function. Results A total of 100 patients with AKI and ongoing VKA therapy met the inclusion criteria. The majority (76%) of patients had AKI with CKD. Volume depletion (n = 43), septic renal failure (n = 22), decompensated heart failure (n = 18) and toxic renal damage (n = 11) were the most important causes of AKI. The average INR values at the time of AKI were higher than at the reference time point [median 3.17 (range 1.10–13.0) versus 2.24 (1.07–5.17); P < 0.0001]. Fifty-four patients had INR values above the recommended therapeutic range for their indication at the time point of AKI. Bleeding complications occurred in 24 patients during AKI and the VKA dose had to be reduced in 55. Women, patients with low body mass index and patients with diabetes were predisposed to overanticoagulation during AKI. Conclusions The effect of AKI on anticoagulation by VKA has not been systematically described. This risk should be considered in patients at high risk for AKI.

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Diagnostic Utility of Serum Neutrophil Gelatinase-Associated Lipocalin in Polytraumatized Patients Suffering Acute Kidney Injury: A Prospective Study

BioMed Research International ◽

10.1155/2018/2687584 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Lukas Leopold Negrin ◽

Reinhard Hahn ◽

Thomas Heinz ◽

Stefan Hajdu

Keyword(s):

Acute Kidney Injury ◽

Prospective Study ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Patients At Risk ◽

Level I ◽

A Prospective Study ◽

Neutrophil Gelatinase ◽

Observation Period ◽

Time Point

Introduction. The incidence of acute kidney injury (AKI) considerably increases the mortality rate in polytrauma victims. Undoubtedly, early identification of patients at risk is crucial for timely implementation of preventive strategies in order to improve their prognosis. Therefore, we aimed to investigate if serum neutrophil gelatinase-associated lipocalin (sNGAL) may serve as a diagnostic biomarker of early AKI in polytrauma victims, especially considering patients needing renal replacement theory (RRT).Material and Methods. Forty consecutive polytrauma victims (ISS ≥ 16,AISThorax≥ 1, age ≥ 18 years, survival time ≥ 48 hours), directly admitted to our level I trauma center within one posttraumatic hour, were enrolled in our prospective study. sNGAL-levels were assessed at admission (initial) and on day 2 after trauma. AKI was diagnosed by an increase of serum creatinine (sCr) level of at least 0.3 mg/dl within 48 hours.Results. Out of 30 men and 10 women (mean age, 43 years; mean ISS, 29), seven patients developed AKI, four of them needing RRT. AKI was diagnosed in 86% of the affected individuals until day 2. Day2-sNGAL-levels were higher in the AKI-group, compared to the no-AKI-group (p=0.049), and in patients treated with RRT than in individuals not needing RRT (p=0.037). Noteworthy, in patients not needing RRT sNGAL-levels significantly decreased from initial to day2-measurement (p=0.040). Furthermore, at any time point during our observation period polytraumatized patients with AKI and day2-sNGAL-levels of at least 181.0 ng/mL presented with higher sCr-levels compared to polytraumatized patients without AKI and day2-sNGAL-levels lower than 181.0 ng/mL (p≤0.029).Conclusion. In polytrauma victims suffering AKI an increase in sNGAL-level from initial to day2-assessment may signalize deterioration in kidney function and thus indicate AKI progression. Unlike initial sNGAL-levels day2-sNGAL-levels might be an appropriate tool to define AKI and to signify the need of RRT in polytraumatized patients.

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