scholarly journals Clinical Progress Note: Pediatric Acute Kidney Injury

2019 ◽  
Vol 14 (9) ◽  
Author(s):  
Jean-Philippe Roy ◽  
Catherine S Forster
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Research Perspectives ◽  
Uniform Definition ◽  
Novel Biomarkers ◽  
Pediatric Acute Kidney Injury ◽  
Definition Of ◽  
Clinical Advances ◽  
Early Detection And Prevention

Acute kidney injury (AKI) occurs in 5%-30% of noncritically ill hospitalized children. Initially thought to be simply a symptom of more severe pathologies, it is now recognized that AKI independently increases mortality and is associated with the development of chronic kidney disease (CKD), even in children. The wide acceptance of the Kidney Disease Improving Global Outcome (KDIGO) diagnostic criteria has enabled a more uniform definition of AKI from both clinical and research perspectives. A better understanding of the pathophysiology and risk factors for AKI has led to new methods for early detection and prevention efforts. While serum creatinine (SCr) was historically one of the sole markers of AKI, novel biomarkers can facilitate earlier diagnosis of AKI, identify subclinical AKI, and guide clinical management. This clinical practice update addresses the latest clinical advances in risk assessment, diagnosis, and prevention of pediatric AKI, with a focus on AKI biomarkers.

Postoperative Acute Kidney Injury: Focus on Renal Recovery Definitions, Kidney Disease Progression and Survival

2019 ◽  
Vol 49 (3) ◽  
pp. 175-185 ◽  
Author(s):  
Thorir E. Long ◽  
Solveig Helgadottir ◽  
Dadi Helgason ◽  
Gisli H. Sigurdsson ◽  
Tomas Gudbjartsson ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Propensity Score ◽  
Matched Control ◽  
Kidney Injury ◽  
Renal Recovery ◽  
University Hospital ◽  
Control Group ◽  
One Year ◽  
Definition Of

Background: The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD). Methods: This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 × baseline, (ii) 1.1–1.25 × baseline, (iii) 1.25–1.5 × baseline, and (iv) > 1.5 × baseline. One-year survival and the development or progression of CKD within 5 years was compared with a propensity score-matched control groups. Results: In total, 2,520 AKI patients were evaluated for renal recovery. Risk of incident and progressive CKD within 5 years was significantly increased if patients did not achieve a reduction in SCr to < 1.5 × baseline (hazard ratio [HR] 1.50; 95% CI 1.29–1.75) and if renal recovery was limited to a fall in SCr to 1.25–1.5 × baseline (HR 1.32; 95% CI 1.12–1.57) within 30 days. The definition of renal recovery that best predicted survival was a reduction in SCr to < 1.5 × baseline within 30 days. One-year survival of patients whose SCr decreased to < 1.5 × baseline within 30 days was significantly better than that of a propensity score-matched control group that did not achieve renal recovery (85 vs. 71%, p < 0.001). Conclusions: These findings should be considered when a consensus definition of renal recovery after AKI is established.

scholarly journals Acute kidney injury and acute kidney recovery following Transcatheter Aortic Valve Replacement

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255806
Author(s):  
Marilou Peillex ◽  
Benjamin Marchandot ◽  
Kensuke Matsushita ◽  
Eric Prinz ◽  
Sebastien Hess ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Dismal Prognosis ◽  
Definition Of

Background Acute kidney injury (AKI) is associated with a dismal prognosis in Transcatheter Aortic Valve replacement (TAVR). Acute kidney recovery (AKR), a phenomenon reverse to AKI has recently been associated with better outcomes. Methods Between November 2012 to May 2018, we explored consecutive patients referred to our Heart Valve Center for TAVR. AKI was defined according to the VARC-2 definition. Mirroring the VARC-2 definition of AKI, AKR was defined as a decrease in serum creatinine (≥50%) or ≥25% improvement in GFR up to 72 hours after TAVR. Results AKI and AKR were respectively observed in 8.3 and 15.7% of the 574 patients included. AKI and AKR patients were associated to more advanced kidney disease at baseline. At a median follow-up of 608 days (range 355–893), AKI and AKR patients experienced an increased cardiovascular mortality compared to unchanged renal function patients (14.6% and 17.8% respectively, vs. 8.1%, CI 95%, p<0.022). Chronic kidney disease, (HR: 3.9; 95% CI 1.7–9.2; p < 0.001) was the strongest independent factor associated with AKI similarly to baseline creatinine level (HR: 1; 95% CI 1 to 1.1 p < 0.001) for AKR. 72-hours post procedural AKR (HR: 2.26; 95% CI 1.14 to 4.88; p = 0.021) was the strongest independent predictor of CV mortality. Conclusions Both AKR and AKI negatively impact long term clinical outcomes of patients undergoing TAVR.

scholarly journals Biomarkers of acute kidney disease. potential application in practice

2021 ◽  
Vol 23 (1) ◽  
pp. 15-19
Author(s):  
Ekaterina S. Schelkanovtseva ◽  
◽  
Ekaterina S. Schelkanovtseva ◽  
Olga Iu. Mironova ◽  
Viktor V. Fomin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Potential Application ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Acute Kidney Disease ◽  
Definition Of ◽  
New Biomarkers

Acute kidney injury (AKI) is a common clinical syndrome. Its variety of presentation explains the absence of “kidney troponin”. Many research projects of new biomarkers are ongoing now. The enormous number of biomarkers has been identified already. It makes difficult to choose the correct test and dictates the importance of the fastest and most accurate introduction of AKI biomarkers into clinical practice. The integration of appropriately selected biomarkers in routine clinical practice for high-risk patients of AKI is very important. Currently, serum creatinine (sCr) and urine output are used to define AKI in accordance with the definition of KDIGO (Kidney Disease: Improving Global Outcomes), which have a number of significant limitations for practitioners, including the inability to diagnose AKI before serum creatinine levels increase. Practitioners need systematic information about the latest AKI markers and possible situations, when and for which patient groups they can be used. This is the main goal of our review. Keywords: acute kidney injury, biomarkers, NGAL, TIMP-2, IGFBP7, cystatin C, markers, injury, kidney stress For citation: Schelkanovtseva ES, Mironova OIu, Fomin VV. Biomarkers of acute kidney disease. Potential application in practice. Consilium Medicum. 2021; 23 (1): 15–19. DOI: 10.26442/20751753.2021.1.200729

Chronic Kidney Disease

2016 ◽  
pp. 565-570
Author(s):  
Carrie A. Schinstock
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Relative Increase ◽  
Absolute Increase ◽  
Definition Of ◽  
Stage 1

The term acute kidney injury (AKI) has replaced acute renal failure in contemporary medical literature. AKI denotes a rapid deterioration of kidney function within hours to weeks, resulting in the accumulation of nitrogenous metabolites in addition to fluid, electrolyte, and acid-base imbalances. The definition of AKI was refined to a 3-stage definition, with criteria for stage 1 as follows: 1) an absolute increase in serum creatinine (SCr) by at least 0.3 mg/dL from baseline within 48 hours; or 2) a relative increase in SCr to at least 1.5 times baseline within the past 7 days; or 3) urine output decreased to less than 0.5 mL/kg/h for 6 hours.

Contrast-induced acute kidney injury

2018 ◽  
pp. 447-452
Author(s):  
Peter A. McCullough
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Kidney Injury ◽  
Disease Stage ◽  
Glomerular Function ◽  
Catheterization Laboratory ◽  
Sustained Reduction ◽  
Contrast Exposure ◽  
Definition Of

Contrast-induced acute kidney injury, previously known as contrast-induced nephropathy, is an important complication in the catheterization laboratory. The definition of contrast-induced acute kidney injury should be harmonized with the Kidney Disease International Global Outcomes criteria which calls for >=0.3 mg/dl (26.5 micromol/L) rise in serum creatinine within 48 hours of contrast exposure. If there is a sustained reduction in estimated glomerular function from a baseline above 60 to a new baseline below 60 ml/min/1.73 m2 at 90 days after the procedure, then a definition of chronic kidney disease (Stage 3) would be met as a late outcome of this complication.

Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm?

2018 ◽  
Vol 33 (11) ◽  
pp. 2047-2055 ◽  
Author(s):  
Vaka K. Sigurjonsdottir ◽  
Swasti Chaturvedi ◽  
Cherry Mammen ◽  
Scott M. Sutherland
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Pediatric Acute Kidney Injury ◽  
Subsequent Risk

The use of nesiritide in patients with critical cardiac disease

2017 ◽  
Vol 27 (8) ◽  
pp. 1577-1584
Author(s):  
Ronald A. Bronicki ◽  
Michele Domico ◽  
Paul A. Checchia ◽  
Curtis E. Kennedy ◽  
Ayse Akcan-Arikan
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Urine Output ◽  
Diuretic Therapy ◽  
Kidney Injury ◽  
Pulmonary Congestion ◽  
Central Venous ◽  
Number Of Patients ◽  
Acute Kidney Disease ◽  
Definition Of

AbstractObjectiveWe evaluated the use of nesiritide in children with critical CHD, pulmonary congestion, and inadequate urine output despite undergoing conventional diuretic therapy.DesignWe conducted a retrospective analysis of 11 patients with critical CHD, comprising 18 infusions, each of which occurred during separate hospitalisations. Haemodynamic parameters were assessed, and the stage of acute kidney injury was determined before and throughout the duration of therapy using a standardised definition of acute kidney injury – The Kidney Disease: Improving Global Outcomes criteria.PatientsChildren with critical CHD, pulmonary congestion, and inadequate urinary output despite undergoing diuretic therapy were included.Measurements and main resultsThe use of nesiritide was associated with a significant decrease in the maximum and minimum heart rate values and with a trend towards a significant decrease in maximum systolic blood pressure and maximum and minimum central venous pressures. Urine output increased but was not significant. Serum creatinine levels decreased significantly during the course of therapy (−0.26 mg/dl [−0.50, 0.0], p=0.02), and the number of patients who experienced a decrease in the stage of acute kidney injury of 2 or more – where a change in the stage of acute kidney disease of 2 or more was possible, that is, baseline stage >1 – was highly significant (five of 12 patients, 42%, p<0.001).ConclusionsNesiritide had a favourable impact on haemodynamics, and its use was not associated with deterioration of renal function in patients with critical CHD.

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