Acute coronary syndrome and acute kidney injury: role of inflammation in worsening renal function

Ortega-Hernandez, J A; Springall, Rashidi; Sánchez‐Muñoz, Fausto; Arana-Martínez, Julio C.; González‐Pacheco, Héctor; Bojalil, Rafael

doi:10.1186/s12872-017-0640-0

Cited by 30 publications

(27 citation statements)

References 58 publications

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“…In our STEMI patients, reduced EF was associated with Killip class ≥II, especially in the subset of patients who developed AKI. Clinical studies including STEMI patients showed that high NT-proBNP, associated with hypotension, hyponatremia, venous congestion and cardiorenal syndrome, is a risk factor for AKI [9,22,23]. AHF leads to reduced renal blood flow which activates the sympathetic and renin-angiotensin-aldosterone systems and induces ventricular remodeling [24].…”

Section: Discussionmentioning

confidence: 99%

“…Increased inflammatory markers, such as white blood cell (WBC)/leukocyte count and CRP, in STEMI patients may be due to infection or, more often, due to recruitment of leukocytes to the site of injury in the myocardium [9]. Infiltrating leukocytes are the source of inflammatory cytokines such FIGURE 1.…”

Section: Discussionmentioning

confidence: 99%

“…AKI: Acute kidney injury; STEMI: ST-elevation myocardial infarction. as interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor (TNF)-α, where especially IL-1β and IL-6 are associated with higher CRP levels [9,[28][29][30]. In AKI, activated inflammatory cells in the renal interstitium produce free oxygen radicals and potent vasoconstrictors leading to tubular or vascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…Structural and functional changes in the kidneys leading to AKI may be due to different pathological mechanisms, including renal hypoperfusion, ischemia and nephrotoxicity [1,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…In STEMI patients, systemic hypoperfusion, which occurs as a consequence of acute left ventricular (LV) systolic dysfunction and results in renal ischemia, appears to be important pathological mechanism underlying AKI [2,10,11]. Other factors that contribute to AKI in STEMI patients are contrast media volume (contrast-induced nephrotoxicity), increased sympathetic activity and neurohumoral activation (e.g., upregulation of angiotensin II, epinephrine and norepinephrine), enhanced inflammatory response, oxidative stress, hyperglycemia, bleeding, hypovolemia, and nephrotoxic drugs [1,2,8,9,12]. Risk factors for the development of AKI include, among others, older age, diabetes mellitus, prior or baseline chronic kidney disease, dehydration, and anemia [1,13].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

Sinkovič

Masnik

Mihevc

2019

Bosn J of Basic Med Sci

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Acute kidney injury (AKI) is a frequent complication in ST-elevation myocardial infarction (STEMI) patients. Factors other than contrast exposure have been suggested as major contributors to renal dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI). Our aim was to assess the incidence and risk factors of AKI in high-risk STEMI patients, mostly treated by PPCI with implemented measures to prevent contrast-induced AKI. We retrospectively analyzed data of 245 STEMI patients (165 men, mean age 63.9 ± 11.9 years) admitted to the Department of Medical Intensive Care Unit. Demographic, clinical, and mortality data were compared between AKI and non-AKI group. AKI was defined as a 1.5-fold increase in serum creatinine from baseline level within 24–48 hours. AKI developed in 34/245 (13.9%) patients. PPCI was performed in 226/245 (92.2%) of all STEMI cases, with no difference between AKI and non-AKI group. There were significant differences between AKI and non-AKI group in diabetes mellitus (41.2% vs. 20.9%), prior MI (26.5% vs. 11.8%), prior resuscitation (38.2% vs. 12.4%), admission acute heart failure [AHF] (44.1% vs. 12.8%), in-hospital AHF (70.6% vs. 17.5%), and hospital-acquired infection [HAI] (79.4% vs. 18.0%). Significantly more AKI patients had increased admission CRP ≥25 mg/L (38.2% vs. 11.8%), peak CRP ≥50 mg/L (91.2% vs. 36%), admission troponin I ≥10 mg/L (44.1% vs. 24.6%), peak troponin I ≥50 mg/L (64.7% vs. 44.1%), peak NT-proBNP ≥400 pmol/L (82.4% vs. 27.5%), and ejection fraction <45% (76.5% vs. 33.6%). Mortality was significantly increased in AKI group, including in-hospital (52.9% vs. 7.1%), 30-day (64.7% vs. 10.7%) and 6-month mortality (70.6% vs. 13.7%). Significant independent predictors of AKI were prior resuscitation (OR 4.171, 95% CI 1.088–15.998), HAI (OR 7.974, 95% CI 1.992–31.912), and peak NT-proBNP (OR 21.261, 95% CI 2.357–191.795). To reduce the risk of AKI in STEMI patients, early diagnosis and treatment of AHF and HAIs are advisable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Structural and functional changes in the kidneys leading to AKI may be due to different pathological mechanisms, including renal hypoperfusion, ischemia and nephrotoxicity [1,8,9].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

Sinkovič

Masnik

Mihevc

2019

Bosn J of Basic Med Sci

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Worsening renal function in hospitalized patients with systolic heart failure: prevalence and risk factors

Asbagh,

Sadeghi,

Ramazanilar

et al. 2023

ESC Heart Failure

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AimsHeart failure (HF) is usually associated with complications of other organs. Renal impairment is seen in a significant proportion of HF patients and is characterized by worsening renal function (WRF). WRF can be used for predicting symptom exacerbation in systolic HF. This study aimed to determine the prevalence and risk factors of WRF among hospitalized patients with systolic HF.Methods and resultsIn this cross‐sectional study, data from medical records of 347 hospitalized patients diagnosed with HFrEF from 2019 to 2020, admitted to Tabriz Shahid Madani Heart Hospital, who met the predefined inclusion criteria, were retrieved. Patients were divided into two groups based on the in‐hospital occurrence of WRF. Laboratory tests and para‐clinical findings were collected and analysed using SPSS Version 20.0. Statistical significance was accepted at a P value of <0.05. In this study, 347 hospitalized patients with HFrEF were included. The mean (standard deviation) age was 62.34 (±18.87) years. The mean (SD) length of stay was 6.34 (±4) days. According to our findings, 117 patients (33.71%) had WRF. Following multivariate analysis of potential predictors of WRF occurrence, hyponatremia, haemoglobin concentration, white blood cell count and prior diuretic use were found to be independent predictors for WRF occurrence in patients with systolic heart failure.ConclusionsThis study revealed that in patients with WRF, mortality rate and length of stay were significantly greater than those of patients without WRF. Initial clinical characteristics of HF patients who developed WRF can help physicians identify patients with a higher risk of WRF.

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Cardiorenal syndrome: Pathophysiology as a key to the therapeutic approach in an under‐diagnosed disease

Prastaro

Nardi

Paolillo

et al. 2022

J of Clinical Ultrasound

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Cardiorenal syndrome is a clinical condition that impacts both the heart and the kidneys. One organ's chronic or acute impairment can lead to the other's chronic or acute dysregulation. The cardiorenal syndrome has been grouped into five subcategories that describe the etiology, pathophysiology, duration, and pattern of cardiac and renal dysfunction. This classification reflects the large spectrum of interrelated dysfunctions and underlines the bidirectional nature of heart‐kidney interactions. However, more evidence is needed to apply these early findings in medical practice. Understanding the relationship between these two organs during each organ's impairment has significant clinical implications that are relevant for therapy in both chronic and acute conditions. The epidemiology, definition, classification, pathophysiology, therapy, and outcome of each form of cardiorenal syndrome are all examined in this review.

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Acute coronary syndrome and acute kidney injury: role of inflammation in worsening renal function

Cited by 30 publications

References 58 publications

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

Worsening renal function in hospitalized patients with systolic heart failure: prevalence and risk factors

Cardiorenal syndrome: Pathophysiology as a key to the therapeutic approach in an under‐diagnosed disease

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