scholarly journals Iron Homeostasis and Ferritin in Sepsis-Associated Kidney Injury

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 616-620
Author(s):  
Kayla McCullough ◽  
Subhashini Bolisetty
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Clinical Data ◽  
Iron Homeostasis ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Hospitalized Patients ◽  
Circulating Levels

Sepsis associated acute kidney injury (SA-AKI) is a common clinical syndrome that occurs among hospitalized patients and significantly impacts mortality. Furthermore, survival after sepsis is intricately dependent on recovery of kidney function. In this review, we discuss the role of iron imbalance in mediating the pathogenic events during sepsis. Intracellular ferritin serves as a repository for iron and prevents iron-mediated injury and may limit the availability of iron to pathogens. Circulating levels of ferritin also increase during sepsis and often correlate with severity of sepsis. Herein, we examine preclinical and clinical data and discuss recent findings that suggest immunomodulatory roles for ferritin. We also discuss the possible mechanistic roles for ferritin in mitigating the pathogenic sequelae of sepsis and highlight current gaps in knowledge.

scholarly journals Admission plasma uromodulin and the risk of acute kidney injury in hospitalized patients with cirrhosis: a pilot study

2019 ◽  
Vol 317 (4) ◽  
pp. G447-G452
Author(s):  
Kavish R. Patidar ◽  
Pranav S. Garimella ◽  
Etienne Macedo ◽  
James E. Slaven ◽  
Marwan S. Ghabril ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Predictive Biomarker ◽  
Hospitalized Patients ◽  
Susceptible Population ◽  
Baseline Creatinine ◽  
Low Levels ◽  
Time Of Admission ◽  
Hospital Acquired

Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as hospitalized patients with cirrhosis. Thus, we investigated whether plasma uromodulin measured at the time of admission is associated with subsequent hospital-acquired AKI (defined by a rise in serum creatinine >0.3mg/dL within 48 h or ≥ 1.5 times baseline) in patients with cirrhosis. A total of 98 patients [mean age 54 yr, Model for Endstage Liver Disease Sodium (MELD-Na) score 19, and baseline creatinine of 0.95 mg/dL] were included, of which 13% ( n = 13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared with patients who did not (9.30 vs. 13.35 ng/mL, P = 0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score as covariates on multivariable logistic regression, uromodulin was independently associated with AKI [odd ratios of 1.19 (95% confidence interval 1.02, 1.37; P = 0.02)]. Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis. Further studies are needed to better understand the role of uromodulin in the pathogenesis and as a predictive biomarker of AKI in this population. NEW & NOTEWORTHY In this study, we found that admission plasma uromodulin levels are significantly lower in patients who developed subsequent acute kidney injury (AKI) during their hospital stay compared with patients who did not. Additionally, uromodulin is independently associated with AKI development after adjusting for clinically relevant parameters such as age, sex, diabetes, hypertension, severity of cirrhosis, and kidney function. To our knowledge, this is the first study linking plasma uromodulin with AKI development in patients with cirrhosis.

scholarly journals Role of Urinary Beta 2 Microglobulin and Kidney Injury Molecule-1 in Predicting Kidney Function at One Year Following Acute Kidney Injury

2021 ◽  
Vol Volume 14 ◽  
pp. 225-234
Author(s):  
Dhanin Puthiyottil ◽  
PS Priyamvada ◽  
Mattewada Naveen Kumar ◽  
Anand Chellappan ◽  
Bobby Zachariah ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Kidney Injury ◽  
Beta 2 ◽  
One Year ◽  
Beta 2 Microglobulin ◽  
Kidney Injury Molecule 1

Acute kidney injury

2020 ◽  
pp. 135-156
Author(s):  
Cristina Osorio ◽  
Theofanis Fotis
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Nursing Care ◽  
Early Identification ◽  
Kidney Injury ◽  
Anatomy And Physiology ◽  
Renal Replacement Therapies ◽  
Life Threatening ◽  
Kidney Anatomy

Assessing and supporting kidney function is an integral aspect of acute care. AKI (acute kidney injury) may cause sudden, life-threatening biochemical disturbances and hence the early identification, escalation to treatment and management of AKI is an important focus in the management of acutely ill patients. This chapter reviews kidney anatomy and physiology followed by the nursing care involved in assessing and managing abnormal kidney function. The focus is on relevance and applicability to clinical practice and understanding of kidney function as protective measures and early detection of anomalies greatly reduces the risk of acute kidney injury. Common renal pathologies are explored and the role of renal replacement therapies is discussed.

scholarly journals Glycogen Synthase Kinase-3 Signaling in Acute Kidney Injury

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 609-612
Author(s):  
Abeda Jamadar ◽  
Reena Rao
Keyword(s):  
Acute Kidney Injury ◽  
Molecular Mechanisms ◽  
Glycogen Synthase ◽  
Kidney Injury ◽  
Tubular Epithelial Cell ◽  
Clinical Syndrome ◽  
Glycogen Synthase Kinase ◽  
Glycogen Synthase Kinase 3 ◽  
Renal Tubular

Acute kidney injury (AKI) is a common clinical syndrome that involves renal tubular epithelial cell death and leads to acute decline in renal function. Improper tubular regeneration following AKI often leads to CKD. We discuss the role of a serine/threonine protein kinase called glycogen synthase kinase-3 (GSK3) in renal tubular injury and renal fibrosis. We also highlight the importance of GSK3 as a potential drug target in AKI patients and molecular mechanisms promoting tissue regeneration.

scholarly journals Role of microRNA in the detection, progression, and intervention of acute kidney injury

2017 ◽  
Vol 243 (2) ◽  
pp. 129-136 ◽  
Author(s):  
Yan-Fang Zou ◽  
Wen Zhang
Keyword(s):  
Acute Kidney Injury ◽  
Injury Severity ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
High Morbidity ◽  
Microrna Target ◽  
Diagnostic Biomarkers ◽  
Pathological Mechanism ◽  
Multiple Signaling

Acute kidney injury, characterized by sharply decreased renal function, is a common and important complication in hospitalized patients. The pathological mechanism of acute kidney injury is mainly related to immune activation and inflammation. Given the high morbidity and mortality rates of hospitalized patients with acute kidney injury, the identification of biomarkers useful for assessing risk, making an early diagnosis, evaluating the prognosis, and classifying the injury severity is urgently needed. Furthermore, investigation into the development of acute kidney injury and potential therapeutic targets is required. While microRNA was first discovered in Caenorhabditis elegans, Gary Ruvkun’s laboratory identified the first microRNA target gene. Together, these two important findings confirmed the existence of a novel post-transcriptional gene regulatory mechanism. Considering that serum creatinine tests often fail in the early detection of AKI, testing for microRNAs as early diagnostic biomarkers has shown great potential. Numerous studies have identified microRNAs that can serve as biomarkers for the detection of acute kidney injury. In addition, as microRNAs can control the expression of multiple proteins through hundreds or thousands of targets influencing multiple signaling pathways, the number of studies on the functions of microRNAs in AKI progression is increasing. Here, we mainly focus on research into microRNAs as biomarkers and explorations of their functions in acute kidney injury. Impact statement Firstly, we have discussed the potential advantages and limitations of miRNA as biomarkers. Secondly, we have summarized the role of miRNA in the progress of AKI. Finally, we have made a vision of miRNA’s potential and advantages as therapeutic target intervention AKI.

scholarly journals The Role of Urinary Biomarkers as Diagnostic and Prognostic Predictors of Acute Kidney Injury Associated With Vancomycin

2021 ◽  
Vol 12 ◽  
Author(s):  
Durval Sampaio de Souza Garms ◽  
Karina Zanchetta Cardoso Eid ◽  
Emmanuel A. Burdmann ◽  
Lia Junqueira Marçal ◽  
Leila Antonângelo ◽  
...  
Keyword(s):  
Cell Cycle ◽  
Acute Kidney Injury ◽  
Cell Cycle Arrest ◽  
Kidney Function ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Urinary Ngal ◽  
Prognostic Predictors ◽  
Cycle Arrest

Introduction: The incidence of acute kidney injury (AKI) related to vancomycin is variable, and several risk factors related to the treatment and patients may explain the nephrotoxicity. The role of urinary biomarkers in AKI related to vancomycin is unknown.Objective: The aim of this study was to evaluate the role of urinary IL-18, KIM-1, NGAL, TIMP-2, and IGFBP7 as diagnostic and prognostic predictors of AKI related to vancomycin.Methods: A prospective cohort study of patients receiving vancomycin and admitted to wards of a public university hospital from July 2019 to May 2020 was performed. We excluded patients that had AKI before starting vancomycin, hemodynamic instability, inability to collect urine, and chronic kidney disease stage 5.Results: Ninety-four patients were included, and the prevalence of AKI was 24.5%, while the general mortality was 8.7%. AKI occurred 11 ± 2 days after the first vancomycin dose. The most frequent KDIGO stage was 1 (61%). There was no difference between patients who developed and did not develop AKI due to gender, length of hospital stay, dose, and time of vancomycin use. Logistic regression identified age (OR 6.6, CI 1.16–38.22, p = 0.03), plasmatic vancomycin concentrations between 96 and 144 h (OR 1.18, CI 1.04-1.40, p = 0.04), and urinary NGAL levels between 96 and 144 h (OR 1.123, CI 1.096–1.290, p = 0.03) as predictors of AKI. The time of vancomycin use (OR 4.61, CI 1.11–22.02, p = 0.03), higher plasmatic vancomycin concentrations between 192 and 240 h (OR 1.02, CI 0.98–1.06, p = 0.26), and higher cell cycle arrest urinary biomarkers TIMP-2 multiplied by IGFBP-7 between 144 and 192 h (OR 1.33, CI 1.10–1.62, p = 0.02; OR 1.19, CI 1.09–1.39, p = 0.04, respectively) were identified as prognostic factors for non-recovery of kidney function at discharge.Conclusion: AKI related to vancomycin was frequent in patients hospitalized in wards. Age, plasmatic vancomycin concentrations, and NGAL between 96 and 144 h were identified as predictors of AKI related to vancomycin use. Plasmatic vancomycin concentrations and urinary NGAL were predictors of AKI diagnosis within the next 5 days. The urinary biomarkers of cell cycle arrest TIMP-2 and IGFBP-7 and the duration of vancomycin use were associated with non-recovery of kidney function at hospital discharge moment.

scholarly journals The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project

2019 ◽  
Vol 39 (4) ◽  
pp. 379-387
Author(s):  
Pedro Jesús Labrador Gómez ◽  
Silvia González Sanchidrián ◽  
Jorge Labrador Gómez ◽  
Juan Ramón Gómez-Martino Arroyo ◽  
María Carmen Jiménez Herrero ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Alert System

scholarly journals The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project

Nefrología ◽  
2019 ◽  
Vol 39 (4) ◽  
pp. 379-387 ◽  
Author(s):  
Pedro Jesús Labrador Gómez ◽  
Silvia González Sanchidrián ◽  
Jorge Labrador Gómez ◽  
Juan Ramón Gómez-Martino Arroyo ◽  
María Carmen Jiménez Herrero ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Alert System

scholarly journals Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review

BMJ Open ◽  
2015 ◽  
Vol 5 (1) ◽  
pp. e006497-e006497 ◽  
Author(s):  
S. Sawhney ◽  
M. Mitchell ◽  
A. Marks ◽  
N. Fluck ◽  
C. Black
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Kidney Function ◽  
Kidney Injury ◽  
Long Term Prognosis

scholarly journals Acute Kidney Injury in Hospitalized Patients with COVID-19

2020 ◽  
Author(s):  
Lili Chan ◽  
Kumardeep Chaudhary ◽  
Aparna Saha ◽  
Kinsuk Chauhan ◽  
Akhil Vaid ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Predictive Model ◽  
Kidney Function ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Acute Kidney Disease

ABSTRACTImportancePreliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID)-19 patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described.ObjectiveTo provide information about frequency, outcomes and recovery associated with AKI and dialysis in hospitalized COVID-19 patients.DesignObservational, retrospective study.SettingAdmitted to hospital between February 27 and April 15, 2020.ParticipantsPatients aged ≥18 years with laboratory confirmed COVID-19ExposuresAKI (peak serum creatinine increase of 0.3 mg/dL or 50% above baseline).Main Outcomes and MeasuresFrequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) with mortality. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation.ResultsA total of 3,235 hospitalized patients were diagnosed with COVID-19. AKI occurred in 1406 (46%) patients overall and 280 (20%) with AKI required renal replacement therapy. The incidence of AKI (admission plus new cases) in patients admitted to the intensive care unit was 68% (553 of 815). In the entire cohort, the proportion with stages 1, 2, and 3 AKI were 35%, 20%, 45%, respectively. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41% overall and 52% in intensive care. The aOR for mortality associated with AKI was 9.6 (95% CI 7.4-12.3) overall and 20.9 (95% CI 11.7-37.3) in patients receiving intensive care. 56% of patients with AKI who were discharged alive recovered kidney function back to baseline. The area under the curve (AUC) for the machine learned predictive model using baseline features for dialysis requirement was 0.79 in a validation test.Conclusions and RelevanceAKI is common in patients hospitalized with COVID-19, associated with worse mortality, and the majority of patients that survive do not recover kidney function. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation.Key PointsQuestionWhat is incidence and outcomes of acute kidney injury (AKI) in patients hospitalized with COVID-19?FindingsIn this observational study of 3,235 hospitalized patients with COVID-19 in New York City, AKI occurred in 46% of patients and 20% of those patients required dialysis. AKI was associated with increased mortality. 44% of patients discharged alive had residual acute kidney disease. A machine learned predictive model using baseline features for dialysis requirement had an AUC Of 0.79.MeaningAKI was common in patients with COVID-19, associated with increased mortality, and nearly half of patients had acute kidney disease on discharge.

Sign in / Sign up

Export Citation Format

Share Document