scholarly journals Point‐of‐care creatinine measurements to predict acute kidney injury

2020 ◽  
Vol 64 (6) ◽  
pp. 766-773
Author(s):  
Suvi T. Vaara ◽  
Neil Glassford ◽  
Glenn M. Eastwood ◽  
Emmanuel Canet ◽  
Johan Mårtensson ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Point Of Care ◽  
Kidney Injury

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

scholarly journals Diagnostic relevance of neutrophil gelatinase-associated lipocalin in early detection of acute kidney injury

2020 ◽  
Vol 7 (2) ◽  
pp. 88-92
Author(s):  
Madhusudhan Mahadevaiah ◽  
Murali Mohan Nidasale Thimmaiah ◽  
Venu Sashank Yerramsetty ◽  
Jeevan Kumar ◽  
Ranjith Kumar
Keyword(s):  
Acute Kidney Injury ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Point Of Care Test ◽  
Reliable Marker ◽  
Neutrophil Gelatinase

Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker. Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC). Results: In this study, 100 patients with the mean age of 49.56±19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n=55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65±734.72 vs. 255.62±440.09 μg/L; P<0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%. Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.

Point-of-Care Echocardiography Unveils Misclassification of Acute Kidney Injury as Hepatorenal Syndrome

2019 ◽  
Vol 50 (3) ◽  
pp. 204-211 ◽  
Author(s):  
Juan Carlos Q. Velez ◽  
Bradley Petkovich ◽  
Nithin Karakala ◽  
J. Terrill Huggins
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Volume Expansion ◽  
Hepatorenal Syndrome ◽  
Point Of Care ◽  
Kidney Injury ◽  
Volume Status ◽  
Early Improvement ◽  
Abdominal Hypertension ◽  
The Mean

Introduction: Fulfillment of the diagnostic criteria for ­hepatorenal syndrome type 1 (HRS-1) requires prior failure of 2 days of intravenous volume expansion and/or diuretic withdrawal. However, no parameter of volume status is used to guide the need for volume expansion in patients with suspected HRS-1. We hypothesized that point-of-care echocardiography (POCE) may better characterize the volume status in patients with acute kidney injury (AKI) and cirrhosis to ascertain or disprove the diagnosis of HRS-1. Methods: A pilot observational study was conducted to determine the clinical utility of POCE-based examination of inferior vena cava diameter (IVCD) and collapsibility index (IVCCI) to assess intravascular volume status in patients with cirrhosis and AKI who had been deemed adequately volume-repleted and thereby assigned a clinical diagnosis of HRS-1. Early improvement in kidney function was defined as ≥20% decrease in serum creatinine (sCr) at 48–72 h. Results: A total of 53 patients were included. The mean sCr at the time of volume assessment was 3.2 ± 1.5 mg/dL, and the mean Model for End-Stage Liver Disease score was 29 ± 8. Fifteen (23%) patients had an IVCD <1.3 cm and IVCCI >40% and were reclassified as fluid-depleted, 11 (21%) had an IVCD >2 cm and IVCCI <40% and were reclassified as fluid-expanded, and 8 (15%) had and IVCD <1.3 cm and IVCCI <40% and were reclassified as having intra-abdominal hypertension (IAH). Twelve (23%) patients exhibited early improvement in kidney function following a POCE-guided therapeutic maneuver, that is, volume expansion, diuresis, or paracentesis for those deemed fluid-depleted, fluid-expanded or having IAH, respectively. Conclusion: POCE-based assessment of volume status in cirrhotic individuals with AKI reveals marked heterogeneity. Unguided volume expansion in these patients may lead to premature or delayed diagnosis of HRS-1.

scholarly journals P0619POINT OF CARE CREATININE FOR EARLY DIAGNOSIS OF COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN NIGERIA. TECHNOLOGY EVALUATION AND DESIGN OF QUALITY IMPROVEMENT PROJECT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dimitrios Poulikakos ◽  
Ibi Erekosima ◽  
Pedro Emem-Chioma ◽  
Prelador Fakrogha ◽  
R I Oko-Jaja ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Primary Health Care ◽  
Early Diagnosis ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Kidney Injury ◽  
Improvement Project ◽  
Primary Health ◽  
Port Harcourt

Abstract Background and Aims Acute Kidney Injury (AKI) in low- and middle-income countries is mostly a community-acquired potentially reversible syndrome and has high morbidity and mortality. Due to limited laboratory infrastructure diagnosis of AKI is often delayed until life threatening complications have developed and dialysis treatment is largely unavailable. Decisions for hospital referral from primary health care centers and triage decisions for hospital admission are not based on laboratory results in Port Harcourt Nigeria. To address the need for early diagnosis and treatment of AKI we established a collaboration between the Renal Unit of the University of Port Harcourt Teaching Hospital, Primary Health Care Board Rivers State and the Renal Department of Salford Royal NHS Foundation Trust, aiming at the evaluation of the use of point of care (POC) Creatinine (Cr) for early detection and management of community acquired AKI. Method The first stage of the project evaluated the accuracy of POC Cr technology. Following informed consent patients underwent concurrent measurement of Cr using the central laboratory (Lab) assay (Jaffe) from a venous sample and a point of care Cr measurement using a capillary sample (fingerstick) with the NOVA Stasensor Xpress Cr analyser. Pearson Correlation and Bland-Altman plots were used to assess correlation and agreement between the two methods. During the second stage, the results were discussed at a focused AKI workshop and guidance for the use of POC Cr was developed. Results During the first phase 96 concurrent POC Cr capillary and venous Lab Cr samples were analysed. Mean age was 49±14 years and 66 subjects were females. POC Cr values were 127±122 umol/l and Lab Cr values were 100 ±85 umol/L, mean positive bias of 27.2±47.94 umol/L. Overall, correlation between POC Cr and Lab Cr was very good, with Pearson correlation r=0.956) Figure 1A. All 4 out of 96 values that were outside the limits of agreement (set at mean ±2 standard deviations) were for Lab Cr values &gt;200 umol/L. A Bland-Altman Plot is presented for paired samples with Lab Cr values &lt;200 umol/L (Figure 1B).

scholarly journals Unadjusted point of care creatinine results overestimate acute kidney injury incidence during field testing in Guatemala

PLoS ONE ◽  
2018 ◽  
Vol 13 (9) ◽  
pp. e0204614 ◽  
Author(s):  
Benjamin R. Griffin ◽  
Jaime Butler-Dawson ◽  
Miranda Dally ◽  
Lyndsay Krisher ◽  
Alex Cruz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Point Of Care ◽  
Kidney Injury ◽  
Field Testing ◽  
Injury Incidence

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

Anaesthesia ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 403-407 ◽  
Author(s):  
A. Udy ◽  
S. O’Donoghue ◽  
V. D’Intini ◽  
H. Healy ◽  
J. Lipman
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Plasma Creatinine

scholarly journals Evaluation of serum neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in critically ill patients

2017 ◽  
Vol 45 (3) ◽  
pp. 1231-1244 ◽  
Author(s):  
Chen-Chen Hang ◽  
Jun yang ◽  
Shuo Wang ◽  
Chun-Sheng Li ◽  
Zi-Ren Tang
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Objective This investigation evaluated the real-time point-of-care testing (RT-POCT) of neutrophil gelatinase-associated lipocalin (NGAL) for detecting acute kidney injury (AKI) and prognosis of critically ill patients. Methods A total of 249 critically ill patients in the emergency department (ED), who were diagnosed with acute decompensated heart failure, sepsis or diabetic ketoacidosis were enrolled in this study. All enrolled patients were followed up for 28 days or to death and the mortalities were recorded. Serum creatinine (sCr) and NGAL were measured. Results 40.6% enrolled patients deteriorated to AKI during the observation period. The NGAL level was significantly higher in the AKI versus non-AKI group. The NGAL levels in the non-survivors group at 7-day and 28-day were significantly higher than in the survivors group. NGAL was detected as an independent risk factor of AKI, and 7-day and 28-day morality. The receiver operating characteristic curve of NGAL was calculated for diagnosing AKI; the area under the curve (AUC) was significantly higher than that of 1-day eGFR. Conclusions NGAL is an independent predictor of AKI, and 7-day and 28-day mortality in critically ill ED patients, and can be an early alert for AKI and useful for determining prognosis.

scholarly journals Point of care ultrasound in acute kidney injury – rapid and reliable imaging at the point of admission

2020 ◽  
Vol 20 (Suppl 2) ◽  
pp. s91-s91
Author(s):  
Samiksha Nepal ◽  
Nicholas Smallwood ◽  
Martin Dachsel
Keyword(s):  
Acute Kidney Injury ◽  
Point Of Care ◽  
Kidney Injury ◽  
Point Of Care Ultrasound

scholarly journals POCUS Evaluation in Acute Kidney Injury

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 67-69
Author(s):  
Vanessa Hoytfox ◽  
Brittney Ward ◽  
Emily Cox ◽  
Kang Zhang
Keyword(s):  
Acute Kidney Injury ◽  
Point Of Care ◽  
Fluid Collection ◽  
Complicated Urinary Tract Infection ◽  
Kidney Injury ◽  
Clinical History ◽  
Clinical Problem ◽  
Point Of Care Ultrasound ◽  
Renal Sinus ◽  
General Internal

Acute kidney injury is a common clinical problem encountered in general internal medicine. The evaluation of acute kidney injury is mainly driven by the patient’s clinical history, physical exam and basic urinary/laboratory investigation. Point of care ultrasound (POCUS) may be a useful tool to help clinicians to narrow and/or prioritize differential diagnosis in patients presenting with acute kidney injury. Here we present a case of a 67-year old male presenting with dysuria, fevers, and flank pain along with elevation in serum creatinine who was admitted for acute kidney injury secondary to complicated urinary tract infection. Subsequent renal POCUS showed bilateral anechoic fluid collection within the renal sinus with dilated calyces suggestive of bilateral hydronephrosis most likely due to a new diagnosis of benign prostatic hyperplasia. This case demonstrates the use of POCUS added valuable diagnostic information and therapeutic management for this patient presenting with acute kidney injury.

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