Early diagnosis of acute kidney injury in a critically ill patient using a combination of blood and urinary physicochemical parameters

Maciel, Alexandre Toledo; Park, Marcelo

doi:10.6061/clinics/2012(05)21

Cited by 9 publications

(10 citation statements)

References 6 publications

(4 reference statements)

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“…The behavior of some biochemical variables in urine also seems to be closely related to AKI/ SIRS development and recovery, as suggested by previous studies [2,4,5,[8][9][10][11]. In the present case, NaU, as well as FENa and FEUr, had an abrupt decrease in the first 3 ICU days ( Figure 2B and, Table 1), an "artificial" increase secondary to diuretic use at D4, and then a true NaU recovery occurred at D9.…”

Section: Revealing Additional Possible Parameters To Monitor In the Asupporting

confidence: 85%

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Sequential Serum Phosphate and Urinary Biochemical Changes in Postoperative Systemic Inflammatory Response Syndrome: Potential Additional Diagnostic Tools in Acute Kidney Injury

Àlex¹,

Maciel²,

Vitorio³

2014

J Med Diagn Meth

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Systemic inflammatory response syndrome (SIRS) is frequent after major surgery and may lead to multiple organ failure. Many classical parameters such as leukocytes and platelets count, lactate and c-reactive protein are measured sequentially during SIRS in order to quantify the severity of the inflammatory/metabolic stress. Blood urea nitrogen and creatinine are usually assessed to evaluate renal function since acute kidney injury (AKI) is a frequent complication of SIRS. The aim of this case report is to describe sequential serum phosphate and sodium and potassium measurement in urine in parallel with AKI development and recovery. The aim is to suggest that these parameters may help in AKI monitoring in the context of SIRS.

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Section: Revealing Additional Possible Parameters To Monitor In the Asupporting

confidence: 85%

“…Besides blood parameters, urinary parameters also follow this same behavior. We have previously reported the urinary biochemical changes that occur after cardiac surgery [11] and also in sepsis [8,9], according to AKI development and recovery.…”

Section: Resultsmentioning

confidence: 99%

Sequential Serum Phosphate and Urinary Biochemical Changes in Postoperative Systemic Inflammatory Response Syndrome: Potential Additional Diagnostic Tools in Acute Kidney Injury

Àlex¹,

Maciel²,

Vitorio³

2014

J Med Diagn Meth

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“…Unfortunately, we don't have the data regarding intra-operative fluid management and the types of fluids used. Although fluctuations in urinary values are expected in a 24-h period, we believe, based on recent publications, 5,13,19 that a single spot urine biochemistry assessment per day, usually at the same hour (together with the routine blood exams) is useful and quite more practical than in a 24-h urine sample.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously suggested that some of these parameters may be useful in the early AKI diagnosis. 5,13,14 However, in these studies, most AKI diagnoses were made at ICU admission, limiting the data available at the days preceding AKI. In the present study, we have found that a minority of the patients had AKI diagnosed at ICU admission (D0), which is not surprising in a population composed mainly by elective surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Simple blood and urinary parameters measured at ICU admission may sign for AKI development in the early postoperative period: a retrospective, exploratory study

2016

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Recent studies have suggested that some blood physicochemical and urinary biochemical parameters have a standardized behavior during acute kidney injury (AKI) development. The changes in these parameters frequently begin to occur before significant rises in serum creatinine (sCr) and may help in identifying patients with more subtle decreases in glomerular filtration rate (GFR). Surgical patients have an increased risk of AKI but renal impairment is usually not evident at ICU admission. We hypothesized that the surgical patients who have AKI diagnosed in the early postoperative period have an impaired GFR since ICU admission, indirectly inferred by alterations in these blood physicochemical and urinary biochemical parameters even in the presence of a still normal sCr. We retrospectively evaluated 112 surgical patients who were categorized according to AKI development during the first 3 ICU days. Twenty-eight patients developed AKI, most of them in the first day (D1) after ICU admission (D0). AKI patients had, at D0, lower serum pH and albumin, higher C -reactive protein (CRP), lower urine sodium (NaU) and fractional excretion of urea (FEUr). Fractional excretion of potassium (FEK) was high in both groups at D0 but remained high in the subsequent days only in AKI patients. Very low CRP and high serum albumin, high NaU and FEUr values at ICU admission had a significant negative predictive value for AKI. We concluded that some easily assessed parameters in blood and urine may help to identify patients with indirect signs of increased inflammatory response and decreased GFR at ICU admission, which could help to predict the risk of postoperative AKI development. ARTICLE HISTORY

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“…This hypothesis is being tested by the same group in a prospective study and has already been exemplified in a case report. (17) It is important to note that the disproportionate relationship between the resorption of sodium and anions is the critical factor in the determination of urinary pH and the excretion of acid. Several anions affect both urinary pH and acid excretion through their influence on the electrical gradient that is established by active sodium transport in renal tubular cells.…”

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confidence: 99%

As novas fronteiras da lesão renal aguda

Batista¹,

Passos²

2012

Rev. bras. ter. intensiva

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Acute kidney injury (AKI) is a poorly understood syndrome. AKI has definitions and concepts that are changeable, and it can not rely on the possibility of histological examination for diagnosis, either because of the difficulty in performing a kidney biopsy in critical patients or for its focal nature and its preference for the external layer of the medulla that comprises most of the juxtamedullary glomeruli, which are not frequently obtained. (1) The pathophysiology of AKI has many aspects and depends on many mechanisms involving the endothelium, glycocalyx, cytoskeleton, integrins, lymphokines and chemokines among others. In the most studied experimental animal models of ischemia and reperfusion (1) and even in recent studies of human kidneys from organ donors whose glycocalyces were analyzed in vivo, AKI has inflammatory components and involves neutrophils and macrophages/monocytes. (2) Experimental studies have helped to clarify many aspects of AKI, but it is only possible to evaluate one etiological agent and a small number of mechanisms and outcomes in each study. This limitation is the exact opposite of what happens to patients in which multiple known factors (ischemic or toxic) act in synchrony or chaotically and in which multiple interactions between organs take place. (3) It is possible that the phases of AKI, which are described as prerenal, initiation, extension, maintenance and recovery, do not occur homogeneously in all nephrons. Over times, this syndrome has had multiple definitions (over 30 according to certain reviews) based on serum creatinine levels. (4) Recently, new AKI classification methods (5,6) have been proposed that also use the serum creatinine levels and diuresis but in a manner that is dynamic and standardized. Several drugs have been tested with the objective of preventing and treating AKI, but the promising results obtained in animal studies were not achieved in studies with humans. Is shall be asked if it is possible that the problem with those studies was the diagnosis and severity of disease instead of the treatment tested? It has only recently become understood that that very small increases in serum creatinine (0.3 mg/dL) have an impact on mortality (7) , that the cost associated with these increases is high (8) and that AKI patients can progress to stage 5 chronic kidney disease and become dialysis-dependent (9). However, the implications of the elevated costs implied in treating severe patients by dialysis have been known for a long time and are thoroughly characterized and quantified, suggesting that the quality of life of the survivors is reasonably acceptable, despite the high mortality and cost. (10)

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Early diagnosis of acute kidney injury in a critically ill patient using a combination of blood and urinary physicochemical parameters

Cited by 9 publications

References 6 publications

Sequential Serum Phosphate and Urinary Biochemical Changes in Postoperative Systemic Inflammatory Response Syndrome: Potential Additional Diagnostic Tools in Acute Kidney Injury

Sequential Serum Phosphate and Urinary Biochemical Changes in Postoperative Systemic Inflammatory Response Syndrome: Potential Additional Diagnostic Tools in Acute Kidney Injury

Simple blood and urinary parameters measured at ICU admission may sign for AKI development in the early postoperative period: a retrospective, exploratory study

As novas fronteiras da lesão renal aguda

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