Current concepts and advances in biomarkers of acute kidney injury

Critical Reviews in Clinical Laboratory Sciences, Journal Year: 2021, Volume and Issue: 58(5), P. 354 - 368

Published: Feb. 8, 2021

Despite advancements in standardizing the criteria for acute kidney injury (AKI), its definition remains based on changes serum creatinine and urinary output that do not specifically represent tubular function or have significant limitations hospital setting. Much effort nephrology has centered identifying biomarkers of AKI to address these limitations. This review summarizes recent advances our knowledge involved pathophysiological processes during describes their potential clinical implications. Blood urine are released via various mechanisms renal injury. Urinary molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), insulin-like growth factor-binding protein-7 (IGFBP-7), tissue inhibitor metalloprotease-2 (TIMP-2) from proximal tubule while uromodulin (UMOD) is secreted loop Henle neutrophil gelatinase-associated lipocalin (NGAL) distal tubule. These could therefore be used localize specific segments injured tubules. Biomarkers also diverse roles AKI, including inflammation, repair, fibrosis. Current evidence suggests predict transition chronic disease (CKD), decrease discard kidneys, differentiate between dysfunction injury, guide management, improve diagnosis diseases such as interstitial nephritis (AIN). They phenotypes, facilitate inclusion a homogenous patient population future trials shed light therapeutic pathways prevent CKD. However, major limitation current biomarker research lack correlation. The Kidney Precision Medicine Project, large-scale national effort, currently underway construct atlas expand use assess nephron health. Numerous distinct after demonstrated risk stratification well provide prognosis patients with AKI. Some ready management settings. Further investigation will insight can applied develop novel agents

Language: Английский

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A Randomized Trial of Intravenous Amino Acids for Kidney Protection

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: 391(8), P. 687 - 698

Published: June 12, 2024

Acute kidney injury (AKI) is a serious and common complication of cardiac surgery, for which reduced perfusion key contributing factor. Intravenous amino acids increase recruit renal functional reserve. However, the efficacy in reducing occurrence AKI after surgery uncertain.

Language: Английский

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Cardiac Surgery–Associated Acute Kidney Injury

Kidney360, Journal Year: 2024, Volume and Issue: 5(6), P. 909 - 926

Published: May 1, 2024

AKI is a common and serious complication of cardiac surgery that has significant impact on patient morbidity mortality. The Kidney Disease Improving Global Outcomes definition widely used to classify identify associated with (cardiac surgery-associated [CSA-AKI]) the basis changes in serum creatinine and/or urine output. There are various preoperative, intraoperative, postoperative risk factors for development CSA-AKI which should be recognized addressed as early possible expedite its diagnosis, reduce occurrence, prevent or ameliorate devastating complications. Crucial issues inaccuracy surrogate parameter kidney function perioperative setting cardiothoracic necessity discover more representative markers pathophysiology AKI. However, except tissue inhibitor metalloproteinase-2 insulin-like growth factor binding protein 7 ratio, other diagnostic biomarkers an acceptable sensitivity specificity still lacking. This article provides comprehensive review aspects CSA-AKI, including pathogenesis, factors, biomarkers, classification, prevention, treatment management.

Language: Английский

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Diabetic Proteinuria Revisited: Updated Physiologic Perspectives

Cells, Journal Year: 2022, Volume and Issue: 11(18), P. 2917 - 2917

Published: Sept. 18, 2022

Albuminuria, a hallmark of diabetic nephropathy, reflects not only injury and dysfunction the filtration apparatus, but is also affected by altered glomerular hemodynamics hyperfiltration, as well inability renal tubular cells to fully retrieve filtered albumin. Albuminuria further plays role in progression suppression albumin leak key factor its prevention. Although microalbuminuria classic manifestation often progressing macroalbuminuria or overt proteinuria over time, it does always precede function loss diabetes. The various components leading albuminuria their associations are herein reviewed, physiologic rationale efficacy therapeutic interventions that reduce hyperfiltration discussed. With these perspectives, we propose measures should be initiated early, before develops, substantial may already present absence proteinuria. We advocate inhibition renin-angiotensin axis sodium-glucose co-transport likely permits administration normal recommended even high-protein diet, highly desirable for sarcopenic patients.

Language: Английский

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The renal effect of 20% human albumin solution fluid bolus therapy in patients after cardiac surgery. A secondary analysis of the HAS FLAIR II randomised clinical trial

Journal of Cardiothoracic and Vascular Anesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Kidney Transplantation in Congenital Abnormalities of Kidney and Urinary Tract (CAKUT)

Biomedicines, Journal Year: 2025, Volume and Issue: 13(4), P. 932 - 932

Published: April 10, 2025

Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause chronic disease in children. Most patients will reach end-stage renal function dialysis or transplantation childhood early adulthood. Patients with CAKUT deserve careful evaluation before transplant; detailed imaging functional studies necessary, particularly presence lower abnormalities, surgical procedures advisable selected cases. A higher incidence complications has been reported after transplant CAKUT, mainly infections. However, long term, prognosis seems to be comparable other diseases. large number reports available literature on medical management before, during, almost all recommendations based retrospective not controlled personal opinions; prospective needed. In this narrative, nonsystematic review, we report results recently published underline questions that should addressed future guidelines.

Language: Английский

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The effects of recruitment of renal functional reserve on renal cortical and medullary oxygenation in non‐anesthetized sheep

Acta Physiologica, Journal Year: 2023, Volume and Issue: 237(4)

Published: Jan. 4, 2023

Abstract Aim Recruitment of renal functional reserve (RFR) with amino acid loading increases blood flow and glomerular filtration rate. However, its effects on cortical medullary oxygenation have not been determined. Accordingly, we tested the recruitment RFR in non‐anesthetized sheep. Methods Under general anesthesia, instrumented 10 sheep to enable subsequent continuous measurements systemic hemodynamics, oxygen delivery consumption, tissue tension (PO 2 ). We then measured an intravenous infusion 500 ml a clinically used solution (10% Synthamin® 17) state. Results Compared baseline, 17 significantly increased mean ± SD maximum increase: (from 0.79 0.17 1.06 0.16 ml/kg/min, p < 0.001), consumption 0.08 0.01 0.15 0.02 rate (+45.2 2.7%, 0.001). Renal PO by 26.4 1.1% ( = 0.001) 23.9 2.8% 0. 001). Conclusions In healthy sheep, improved oxygenation. These observations might implications for use diagnostic therapeutic purposes.

Language: Английский

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The effect of COVID-19 public health measures on nationally notifiable diseases in Australia: preliminary analysis

Communicable Diseases Intelligence, Journal Year: 2020, Volume and Issue: 44

Published: Nov. 5, 2020

Since the introduction of COVID-19-related public health measures, notifications for most nationally notifiable diseases have declined when compared to previous years. Physical distancing, travel restrictions, and emphasis on hygiene are likely affected number expected notifications, with greatest reductions observed among disease spread via person-to-person contact such as influenza, overseas-acquired infections dengue virus measles. However, quantifying magnitude effect COVID-19 measures communicable in Australia will be difficult, due confounding factors as: changes testing priorities laboratories; diversion resources response; health-seeking behaviours; greater utilisation telehealth practices; financial impacts income loss ability afford healthcare. It is considered that these other also impacted notification numbers.

Language: Английский

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Changing serum creatinine in the detection of acute renal failure and recovery following radiocontrast studies among acutely ill inpatients: Reviewing insights regarding renal functional reserve gained by large-data analysis

Practical Laboratory Medicine, Journal Year: 2022, Volume and Issue: 30, P. e00276 - e00276

Published: April 18, 2022

A rise in serum creatinine (SCr) is widely used for the detection and definition of evolving acute kidney injury (AKI). Yet, it takes time SCr to re-adjust response changes glomerular filtration rate (GFR), subtle transient GFR may remain concealed. Additionally, cannot differentiate altered hemodynamics pre-renal failure from true renal tissue injury, necessitating additional clinical laboratory diagnostic tools. While these features limit usefulness subsequently estimated (eGFR) at a single point individual patient, their overall pattern along large cohort hospitalized patients provide powerful perspective regarding assessment shifting function this population. Herein we review our experience running data analyses, evaluating patterns day-to-day among inpatients, occurring around exposure iodinated radiocontrast agents. These evaluations helped substantiating existence contrast-induced nephropathy with advanced failure, underscoring impact predisposing confounding factors. It also provides novel insights phenomenon "acute functional recovery" (AKR), illustrate that incidence AKI AKR scale baseline co-associates inversely proportional function. This can be attributed reserve, which serves as buffer up-and-down GFR, forming physiologic explanation concealed subclinical AKI.

Language: Английский

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Biomarkers in Cardiorenal Syndrome

Journal of Clinical Medicine, Journal Year: 2021, Volume and Issue: 10(15), P. 3433 - 3433

Published: July 31, 2021

Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between heart and kidney diseases. Over last years, in patients with cardiovascular diseases, several biomarkers have been studied order to better assess renal function as well identify prone experiencing chronic or acute worsening function. The aim this review focus on possible usefulness most recent setting cardiorenal syndrome.

Language: Английский

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