scholarly journals Urinary kidney injury biomarkers and urine creatinine normalization: a false premise or not?

2010 ◽  
Vol 78 (5) ◽  
pp. 433-435 ◽  
Author(s):  
Stuart L. Goldstein
Keyword(s):  
Kidney Injury ◽  
Urine Creatinine ◽  
False Premise

scholarly journals Reduced urinary levels of angiotensin-converting enzyme 2 activity predict acute kidney injury in critically ill patients

2020 ◽  
Vol 22 (4) ◽  
pp. 344-354
Author(s):  
Laurent Bitker ◽  
◽  
Sheila K Patel ◽  
Intissar Bittar ◽  
Glenn M Eastwood ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Angiotensin Converting Enzyme ◽  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Urine Collection ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Urine Creatinine

Objective: Angiotensin-converting enzyme 2 activity reflects non-classical renin–angiotensin system upregulation. We assessed the association of urinary angiotensin-converting enzyme 2 (uACE2) activity with acute kidney injury (AKI). Design, setting and participants: A prospective observational study in which we measured uACE2 activity in 105 critically ill patients at risk of AKI. We report AKI stage 2 or 3 at 12 hours of urine collection (AKI12h) and AKI stage 2 or 3 at any time during intensive care unit stay in patients free from any stage of AKI at inclusion (AKIICU). AKI prediction was assessed using area under the receiver-operating characteristics curve (AUROC) and net reclassification indices (NRIs). Main outcome measure: AKI stage 2 or 3 at 12 hours of urine collection. Results: Within 12 hours of inclusion, 32 of 105 patients (30%) had developed AKI12h. Corrected uACE2 activity was significantly higher in patients without AKI12h compared with those with AKI12h (median [interquartile range], 13 [6–24] v 7 [4–10] pmol/min/mL per mmol/L of urine creatinine; P < 0.01). A 10-unit increase in uACE2 was associated with a 28% decrease in AKI12h risk (odds ratio [95% CI], 0.72 [0.46–0.97]). During intensive care unit admission, 39 of 76 patients (51%) developed AKIICU. uACE2 had an AUROC for the prediction of AKI12h of 0.68 (95% CI, 0.57–0.79), and correctly reclassified 28% of patients (positive NRI) to AKI12h. Patients with uACE2 > 8.7 pmol/min/mL per mmol/L of urine creatinine had a significantly lower risk of AKIICU on log-rank analysis (52% v 84%; P < 0.01). Conclusions: Higher uACE2 activity was associated with a decreased risk of AKI stage 2 or 3. Our findings support future evaluations of the role of the non-classical renin–angiotensin system during AKI.

Nephrocheck after cardiac surgery: Does it play a role in daily practice? A sequel of “Nephrocheck results should be corrected for dilution”

2019 ◽  
Vol 42 (11) ◽  
pp. 665-667 ◽  
Author(s):  
Camilla L’Acqua ◽  
Erminio Sisillo ◽  
Luca Salvi ◽  
Giovanni Introcaso ◽  
Maria Luisa Biondi
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Daily Practice ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inclusion Criteria ◽  
Ventricular Ejection Fraction ◽  
Cycle Arrest ◽  
Urine Creatinine

Acute kidney injury is a well-recognized complication after cardiac surgery and significantly affects morbidity and mortality. Although the mechanisms of acute kidney injury are not fully understood, Nephrocheck (Astute Medical, San Diego, CA, USA) is a meter for early detection of acute kidney injury based on bedside urinalysis of two cell-cycle arrest biomarkers. However, considerable overlap in the AKIRiskTM score of different RIFLE groups makes interpretation of the score uncertain. A possible reason for the overlap in the AKIRisk score between different RIFLE groups could be that the score is not corrected for dilution. We performed a pilot study to explore the applicability of the test in our daily practice. A total of 68 patients electively scheduled for cardiac surgery with at least two of the following inclusion criteria: age > 70 years, glomerular filtration rate <60 mL/min, left ventricular ejection fraction <41%, redo procedure and combined procedures have been enrolled in the study, and 25 of them developed acute kidney injury. We described the correlation between urine creatinine and Nephrocheck, all the samples with low Nephrocheck (<0.2) also have low urine creatinine, less than 50 mg/dL, detecting a potential diluted sample. In conclusion, in our daily practice AKIRisk score, together with an assessment of whether urine is diluted or concentrated can better discriminate between various degrees of acute kidney injury.

Urine Biomarkers of Kidney Tubule Health, Injury, and Inflammation are Associated with Progression of CKD in Children

2021 ◽  
pp. ASN.2021010094
Author(s):  
Jason H. Greenberg ◽  
Alison G. Abraham ◽  
Yunwen Xu ◽  
Jeffrey R. Schelling ◽  
Harold I. Feldman ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Ckd Progression ◽  
Creatinine Concentration ◽  
Clinical Model ◽  
Content Type ◽  
Monocyte Chemoattractant Protein 1 ◽  
Urine Biomarkers ◽  
Urine Creatinine ◽  
Kidney Injury Molecule 1

BackgroundNovel urine biomarkers may improve identification of children at greater risk of rapid kidney function decline, and elucidate the pathophysiology of CKD progression.MethodsWe investigated the relationship between urine biomarkers of kidney tubular health (EGF and α-1 microglobulin), tubular injury (kidney injury molecule-1; KIM-1), and inflammation (monocyte chemoattractant protein-1 [MCP-1] and YKL-40) and CKD progression. The prospective CKD in Children Study enrolled children aged 6 months to 16 years with an eGFR of 30–90ml/min per 1.73m2. Urine biomarkers were assayed a median of 5 months [IQR: 4–7] after study enrollment. We indexed the biomarker to urine creatinine by dividing the urine biomarker concentration by the urine creatinine concentration to account for the concentration of the urine. The primary outcome was CKD progression (a composite of a 50% decline in eGFR or kidney failure) during the follow-up period.ResultsOverall, 252 of 665 children (38%) reached the composite outcome over a median follow-up of 6.5 years. After adjustment for covariates, children with urine EGF concentrations in the lowest quartile were at a seven-fold higher risk of CKD progression versus those with concentrations in the highest quartile (fully adjusted hazard ratio [aHR], 7.1; 95% confidence interval [95% CI], 3.9 to 20.0). Children with urine KIM-1, MCP-1, and α-1 microglobulin concentrations in the highest quartile were also at significantly higher risk of CKD progression versus those with biomarker concentrations in the lowest quartile. Addition of the five biomarkers to a clinical model increased the discrimination and reclassification for CKD progression.ConclusionsAfter multivariable adjustment, a lower urine EGF concentration and higher urine KIM-1, MCP-1, and α-1 microglobulin concentrations were each associated with CKD progression in children.

scholarly journals Acute kidney injury in asphyxiated neonates

2013 ◽  
Vol 53 (4) ◽  
pp. 232
Author(s):  
Roy Amardiyanto ◽  
Partini Pudjiastuti Trihono ◽  
Lily Rundjan ◽  
Hardiono D. Pusponegoro
Keyword(s):  
Acute Kidney Injury ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Cross Sectional ◽  
Neonatal Asphyxia ◽  
Urine Creatinine ◽  
The Difference ◽  
Severe Degree

Background Asphyxia neonatorum may result in multiorgandysfunction including renal involvement. There is no consensuson the determination of acute kidney injury (AKI) in neonatesmaking establishment of the diagnosis and its managementbecomes difficult. The Acute Kidney Injury Network (AKIN)recommends AKI criteria based on increased serum creatininelevel and reduced urine output.Objectives To identify the prevalence of AKI in asphyxiatedneonates using the AKIN criteria, to compare the difference ofAKI stages, and the glomerular filtration rates (GFR) betweenmoderate and severe asphyxia.Methods This was a cross-sectional analytical study conductedbetween July 2012 and January 2013. Subjects were all asphyxiatedneonates (Apgar score < 7 at fifth minute) with gestational age of>35 weeks delivered and hospitalized in Cipto MangunkusumoHospital and Koja District Hospital, Jakarta, Indonesia.Glomerular filtration rate was calculated using the componentsof urine creatinine, serum creatinine, and urine output; whileAKI stages were determined according to AKIN criteria. Urinaryoutput was measured via urethral catheterization.Results Of 94 subjects, there were 70 neonates with moderateand 24 neonates with severe asphyxia, with the prevalence of AKIwas 63%. Twenty one out of 24 neonates with severe asphyxiaexperienced AKI, while neonates with moderate asphyxia whoexperienced AKI was 38 out of 70 subjects (54%). Two third ofneonates with severe asphyxia who experienced AKI had stage3 of AKI. More severe AKI stages and lower median GFR werefound in neonates with severe compared to moderate asphyxia(P<0.001) .Conclusion The prevalence of AKI in neonatal asphyxia is high(63%). The more severe degree of neonatal asphyxia, the moresevere AKI stage and the lower median GFR.

Urine cystatin C (uCyC) as a predictor for acute kidney injury (AKI) in urothelial cancer (UC) patients (pts) treated with cisplatin (CDDP).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 317-317
Author(s):  
Michael J Jelinek ◽  
Alicia J Wyche ◽  
Claudia Wing ◽  
Jay L Koyner ◽  
Walter Michael Stadler ◽  
...  
Keyword(s):  
Urothelial Cancer ◽  
Case Control Study ◽  
Kidney Injury ◽  
Entire Cohort ◽  
Urine Creatinine ◽  
Increased Risk ◽  
Average Maximum ◽  
Pre Treatment ◽  
Nested Case Control ◽  
Control Study

317 Background: CDDP-based treatment is limited by AKI. We aimed to test whether a novel AKI biomarker, uCyC, measured before and immediately after CDDP administration could permit earlier identification of UC pts at risk for AKI. Methods: In a nested case-control study, pts treated with CDDP were prospectively enrolled. uCyC was measured 2 hours pre- and 3 hours post-CDDP doses, with values normalized to urine creatinine. AKI was defined as an increase in serum creatinine (sCr) by ≥50% (severe cases) or ≥0.3 mg/dL above pre-CDDP baseline. Controls were pts with no significant sCr rise (sCr change <25% and <0.3 mg/dL). A sample size of 98 patients provided 80% power to detect a true difference in biomarker change pre- and post-CDDP between cases and controls. Results: 102 pts were enrolled: 47 had UC, and 55 had other cancers; 76 were male; 82 Caucasians/15 African Americans. 4 pts not providing urine samples were excluded from analysis. For the entire cohort, average pre-CDDP sCr was 0.98 mg/dL and mean cumulative CDDP dose was 220 mg/m2. Controls were younger (mean 59.2 vs 65.9 yrs, p=0.01). 25 pts (26%) developed AKI; 15 (15%) were severe cases. UC pts had a significantly increased risk of AKI compared with non-UC pts (UC n=17 [37%] vs non-UC n=8 [16%], Relative Risk 2.2, 95% CI 1.08-4.73; p=0.03). AKI risk did not correlate with total CDDP dose received. In AKI pts, uCyC increased temporally in accordance with sCr and did not increase in controls, but immediate uCyC changes (3 hrs post-CDDP) were not detectable in cases or controls. However, in UC severe cases, pre-CDDP uCyC was consistently higher than in UC controls (183 ng/mg vs 109 ng/mg, p=0.04). Additionally, in UC AKI pts compared to UC controls, average maximum (peak) uCyC was higher (1812 ng/mg vs 244 ng/mg, p=0.04). Baseline uCyC did not correlate with age, and there were no significant differences in age or baseline sCr between UC cases and controls. Conclusions: UC pts are over two times more likely to develop AKI with CDDP chemotherapy than pts with other cancers, even when pre-CDDP sCr is normal. Pre-treatment uCyC levels may have value in predicting which UC pts are at highest risk of developing CDDP-induced renal injury.

On normalizing of urinary KIM-1 level to urine creatinine in patients with renal cell cancer

2021 ◽  
Vol 66 (9) ◽  
pp. 517-524
Author(s):  
N. S. Sergeeva ◽  
K. Yu. Kanukoev ◽  
T. A. Karmakova ◽  
I. I. Alentov ◽  
N. V. Marshutina ◽  
...  
Keyword(s):  
Renal Cell ◽  
Healthy Subjects ◽  
Cell Cancer ◽  
Kidney Injury ◽  
Correlation Coefficients ◽  
Stage Iv ◽  
Urine Creatinine ◽  
Male Patients ◽  
Kidney Injury Molecule 1 ◽  
Spearman’S Correlation

KIM-1 (kidney injury molecule 1), a marker of acute kidney injury, is produced by epithelial cells of renal proximal tubules. Elevated KIM-1 levels in urine and plasma are associated with renal cell carcinoma (RCC). The aim of this study was to compare the significance of non-normalized uKIM-1 values and those normalized to urine creatinine, as urinary biomarkers in RCC. The uKIM-1, urine creatinine and their ratio (uKIM-1/Cre) were studied in 118 RCC patients and 58 apparently healthy subjects. The median of uKIM-1 in the healthy group was 0.71 ng/ml (1st and 3rd quartiles were 0.35 and 1.23, respectively) and in RCC patients it was 2.36 (1.43; 5.93) ng/ml. The medians of uKIM-1/Cre were 0.77 (0.49; 1.18) and 2.42 (1.41; 4.61) ng/mgCre, respectively. Stage I RCC is statistically significantly different from stages II-III and stage IV using uKIM-1/Cre values (p = 0.0056 and p = 0.0012, respectively); using uKIM-1 values significant differences occur only when comparing stages I and IV (p = 0.015). In both healthy individuals and RCC patients, uKIM-1/Cre levels were slightly lower in subgroups younger than 50 years than in subgroups older than 50 years, whereas a similar trend was observed for uKIM-1 only in patients. In healthy men and male patients, uKIM-1 levels were higher than in the corresponding groups of women (the differences were not statistically significant), but the use of uKIM-1/Cre values eliminated the gender differences. A high correlation was found between the concentrations of uKIM-1 and urine creatinine in three healthy subjects followed up for 3 weeks (Spearman’s correlation coefficients were 0.758, 0.825 and 0.933, respectively). The data obtained are clear evidence of the need for normalization uKIM-1 to urine creatinine in RCC patients.

scholarly journals Preoperative Concentrated Urine Increases the Incidence of Plasma Creatinine Elevation After Major Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Dominique Engel ◽  
Lukas M. Löffel ◽  
Patrick Y. Wuethrich ◽  
Robert G. Hahn
Keyword(s):  
Kidney Injury ◽  
Perioperative Period ◽  
Plasma Creatinine ◽  
Receiver Operating Curve ◽  
Major Surgery ◽  
Urinary Concentration ◽  
Consecutive Series ◽  
Creatinine Concentration ◽  
Urine Creatinine ◽  
Receiver Operating Curve Analysis

Background: Postoperative elevation of plasma creatinine is a frequent complication to major surgery. A rise by 50% fulfills the criterion for Acute Kidney Injury. We studied the relationship between concentrated urine before surgery, which is usually a sign of chronically low intake of water, and the perioperative change in plasma creatinine.Methods: The creatinine concentration was measured in plasma and urine just before and at 6 h, 1 day, and 2 days after major abdominal surgery in a consecutive series of 181 patients. Receiver operating curve analysis was used to find the optimal cut-off to separate concentrated from diluted urine.Results: Urine creatinine of 11.3 mmol/L before the surgery started was exceeded in one third of the patients and associated with greater increase in plasma creatinine at 6 h (median 21 vs. 10%) and at 1 day postoperatively (21 vs. 7%; P &lt; 0.0001). Elevation of plasma creatinine of &gt;25% occurred in 41% and 19% in those with high and low urine creatinine, respectively (P &lt; 0.001) and an increase by &gt;50% in 16% and 10% (P = 0.27). Patients with high urine creatinine before surgery failed to further concentrate their urine during the perioperative period, which is normally associated with intensified renal fluid conservation.Conclusion: High urinary concentration of creatinine before surgery should be considered as a risk factor for postoperative elevation of plasma creatinine. The mechanism is probably that the renal threshold is then more easily reached.

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