Back to Basics: Is There a Good Reason to Not Systematically Measure Urine Creatinine in Acute Kidney Injury Monitoring?

Alexandre Toledo Maciel;

doi:10.1159/000446666

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

Critical Care and Resuscitation ◽

10.51893/2020.4.oa7 ◽

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.

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

The International Journal of Artificial Organs ◽

10.1177/0391398819852958 ◽

2019 ◽

Vol 42 (11) ◽

pp. 665-667 ◽

Cited By ~ 2

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.

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Acute kidney injury in asphyxiated neonates

Paediatrica Indonesiana ◽

10.14238/pi53.4.2013.232-8 ◽

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.

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