Acute kidney injury: how do we define it?

Lewington, Andrew; Sayed, Ahmed Rabee

doi:10.1258/acb.2009.009249

Cited by 18 publications

(13 citation statements)

References 20 publications

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“…Acute kidney injury (AKI) 3 is common, harmful, and potentially preventable (1,2 ). Definitions of AKI, including the Risk, Injury, Failure, Loss, End-Stage (RIFLE) and Acute Kidney Injury Network (AKIN) criteria, are based on recognition of changes in plasma creatinine concentration (3 ).…”

confidence: 99%

Biological Variation of Plasma and Urinary Markers of Acute Kidney Injury in Patients with Chronic Kidney Disease

Carter¹,

Parker²,

Stevens

et al. 2016

Clinical Chemistry

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BACKGROUND Identification of acute kidney injury (AKI) is predominantly based on changes in plasma creatinine concentration, an insensitive marker. Alternative biomarkers have been proposed. The reference change value (RCV), the point at which biomarker change can be inferred to have occurred with statistical certainty, provides an objective assessment of change in serial tests results in an individual. METHODS In 80 patients with chronic kidney disease, weekly measurements of blood and urinary biomarker concentrations were undertaken over 6 weeks. Variability was determined and compared before and after adjustment for urinary creatinine and across subgroups stratified by level of kidney function, proteinuria, and presence or absence of diabetes. RESULTS RCVs were determined for whole blood, plasma, and urinary neutrophil gelatinase-associated lipocalin (111%, 59%, and 693%, respectively), plasma cystatin C (14%), creatinine (17%), and urinary kidney injury molecule 1 (497%), tissue inhibitor of metalloproteinases 2 (454%), N-acetyl-β-d-glucosaminidase (361%), interleukin-18 (819%), albumin (430%), and α1-microglobulin (216%). Blood biomarkers exhibited lower variability than urinary biomarkers. Generally, adjusting urinary biomarker concentrations for creatinine reduced (P < 0.05) within-subject biological variability (CVI). For some markers, variation differed (P < 0.05) between subgroups. CONCLUSIONS These data can form a basis for application of these tests in clinical practice and research studies and are applicable across different levels of kidney function and proteinuria and in the presence or absence of diabetes. Most of the studied biomarkers have relatively high CVI (noise) but also have reported large concentration changes in response to renal insult (signal); thus progressive change should be detectable (high signal-to-noise ratio) when baseline data are available.

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confidence: 99%

Biological Variation of Plasma and Urinary Markers of Acute Kidney Injury in Patients with Chronic Kidney Disease

Carter¹,

Parker²,

Stevens

et al. 2016

Clinical Chemistry

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“…1 Currently, diagnosis of AKI is made by a rise in serum creatinine concentration, which is a delayed and unreliable measure in the acute setting. 2,3 Muscle mass, gender, age and aggressive fluid resuscitation in critically ill patients, all affect serum creatinine, rendering it a suboptimal marker of AKI. A biomarker of AKI that is easily measured, unaffected by other biological variables and capable of both early detection and risk stratification would be highly desirable.…”

Section: Introductionmentioning

confidence: 99%

Establishment of a reference interval for urinary neutrophil gelatinase-associated lipocalin

2012

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Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a promising new biomarker for the early identification of acute kidney injury (AKI). We have determined a reference range in a large healthy population. In addition, as NGAL is a neutrophil-related protein, we investigated whether the presence of leukocyturia has the potential to significantly alter the specificity of NGAL in the diagnosis of AKI. Methods: One hundred and seventy-four subjects (100 men, 74 women ranging from 19 to 88 y) were included in the reference population. Urinary NGAL was analysed on the Abbott ARCHITECT and results expressed in mass (mg/L) and also normalized to urinary creatinine (mg/mmol). Fifty-two leukocyturic urine samples were also analysed for NGAL. Results: The 95th centile for NGAL was determined to be 107 mg/L (13 mg/mmol). There were significant gender-related differences for NGAL, with women having higher concentrations. There were significant age-related differences for NGAL between the 40-59 and 60-88 y age categories. There were significant age-related differences between the ,40 and 60-88 y categories when NGAL was normalized to creatinine. In addition, we found significantly higher concentrations of NGAL in leukocyturia (P , 0.0001). Conclusions: We have established a 95th centile cut-off for urinary NGAL in a reference population. We have demonstrated the important potential interference of leukocyturia in confounding the interpretation of NGAL in the diagnosis of AKI.

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“…1 Currently, the diagnosis of AKI is made by a rise in serum creatinine concentration or a fall in urine output. 2,3 Despite attempts to standardize the definition of AKI, serum creatinine remains at the core of these definitions but is known to be a delayed and unreliable marker of AKI. The pursuit of improved biomarkers of AKI is an area of intense contemporary research.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil gelatinase-associated lipocalin and albuminuria as predictors of acute kidney injury in patients treated with goal-directed haemodynamic therapy after major abdominal surgery

et al. 2013

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Background: Neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a new biomarker for the early identification of acute kidney injury (AKI). There is also increasing evidence of an association between urinary albumin/ creatinine ratio (ACR) and AKI. The primary aim of this study was to evaluate the clinical utility of these biomarkers to predict AKI in a population of perioperative patients treated with goal-directed haemodynamic therapy (GDHT). Secondary aims were to examine NGAL and ACR as sensitive biomarkers to detect the effects of GDHT and to investigate the association of these biomarkers with secondary outcomes. Methods: Urine was obtained from 109 patients admitted to a critical care unit following major abdominal surgery. Patients were treated with intravenous fluid, GDHT with intravenous fluid or GDHT with intravenous fluid and dopexamine. Urine was collected preoperatively, and at times 0, 8 and 24 h postoperatively and outcome monitored for 28 days. Results: There were no significant differences in NGAL or ACR concentrations between the cohorts treated with GDHT compared to standard care. However, both biomarker concentrations rose significantly in all cohorts over the time points. There were no significant differences in NGAL observed between patients who developed AKI and those who did not. However, there were significantly higher ACR preoperatively in patients who developed AKI. There were higher NGAL concentrations in patients who developed an infection and who died. Conclusions: NGAL has a poor predictive role in evaluating AKI in this clinical setting. Preoperative ACR may have a role as an AKI marker.

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Acute kidney injury: how do we define it?

Cited by 18 publications

References 20 publications

Biological Variation of Plasma and Urinary Markers of Acute Kidney Injury in Patients with Chronic Kidney Disease

Biological Variation of Plasma and Urinary Markers of Acute Kidney Injury in Patients with Chronic Kidney Disease

Establishment of a reference interval for urinary neutrophil gelatinase-associated lipocalin

Neutrophil gelatinase-associated lipocalin and albuminuria as predictors of acute kidney injury in patients treated with goal-directed haemodynamic therapy after major abdominal surgery

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