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

Gorelik, Yuri; Abassi, Zaid; Bloch-Eisenberg, Natali; Khamaisi, Morir; Heyman, Samuel N.

doi:10.1016/j.plabm.2022.e00276

Cited by 11 publications

(10 citation statements)

References 32 publications

(40 reference statements)

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“…Also illustrated in Table 2 are the odds ratios of the primary and secondary outcomes associated with patients’ characteristics. As anticipated [ 26 , 27 ], CKD, diabetes and acute infection were all associated with a substantially higher likelihood of developing AKI and AKR. Interestingly, increments in blood pressure were accompanied by a lower chance of AKI, AKR and mortality, while the use of beta-blockers predicted increased likelihood of AKI and decreased chance of AKR and mortality.…”

Section: Resultssupporting

confidence: 73%

Renal safety and survival among acutely ill hospitalized patients treated by blockers of the Renin-Angiotensin axis or loop diuretics: a single-center retrospective analysis

Assaly,

Gorelik,

Heyman

et al. 2023

Renal Failure

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Background Concern exists regarding the renal safety of blocking the renin-angiotensin system (RAS) during acute illness, especially in the presence of volume depletion and hemodynamic instability. Methods We explored the impact of loop diuretics and RAS blockers on the likelihood of developing acute kidney injury (AKI) or acute kidney functional recovery (AKR) among inpatients. Adjusted odds ratio for AKI, AKR and mortality was calculated, using logistic regression models, with subgroup analysis for patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2, corrected for blood pressure measurements. Results 53,289 patients were included. RAS blockade was associated with reduced adjusted odds ratio for both AKI (0.76, CI 0.70–0.83) AKR (0.55, 0.52–0.58), and mortality within 30 days (0.44, 0.41–0.48), whereas loop diuretics were associated with increased risk of AKI (3.75, 3.42–4.12) and mortality (1.71, 1.58–1.85) and reduced AKR (0.71, 0.66–0.75). Comparable impact of RAS blockers and loop diuretics on renal outcomes and death was found among 6,069 patients with eGFR < 30 ml/min/1.73m 2 . RAS inhibition and diuretics tended to increase the adjusted odds ratios for AKI and to reduce the likelihood of AKR in hypotensive patients. Conclusions Reduced blood pressure, RAS blockers and diuretics affect the odds of developing AKI or AKR among inpatients, suggesting possible disruption in renal functional reserve (RFR). As long as blood pressure is maintained, RAS inhibition seems to be safe and renoprotective in this population, irrespective of kidney function upon admission, and is associated with reduced mortality.

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Section: Resultssupporting

confidence: 73%

Renal safety and survival among acutely ill hospitalized patients treated by blockers of the Renin-Angiotensin axis or loop diuretics: a single-center retrospective analysis

Assaly,

Gorelik,

Heyman

et al. 2023

Renal Failure

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“…As methods of choice, providing more detailed anatomic information, contrast-enhanced CTA or MRA is usually proposed [3,10]. Administration of an iodine-based contrast medium during CTA may lead to acute deterioration of residual kidney function, and exposure to gadolinium-based contrast agents required for MRA may induce nephrogenic systemic fibrosis [11,12]. Therefore, non-contrast, high-resolution imaging techniques such as NC-MRA could be a beneficial alternative.…”

Section: Discussionmentioning

confidence: 99%

Non-contrast-enhanced magnetic resonance angiography as part of a kidney pretransplantation work-up in a 19-month-old boy – a case report

Postępska,

Pietura,

Wieczorkiewicz-Płaza

et al. 2023

polp

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Kidney transplantation (KT) is the optimal method of renal replacement therapy in children with end-stage kidney disease. An assessment of the anatomy of the recipient's abdominal and pelvic vasculature is an element of the pre-KT work-up. We present an uncommon application of non-contrast-enhanced magnetic resonance angiography (NC-MRA) within a pre-KT work-up of a young child with residual kidney function. Due to the history of multiple cannulations of the patient's femoral veins and the possible risk of inferior vena cava thrombosis, performance of contrast-enhanced computed tomography angiography (CCTA) was requested by the transplantation center. However, considering the significant risk of post-contrast loss of the patient's residual kidney function, we decided to perform NC-MRA. It accurately confirmed the preserved patency of the arterial and venous vessels of the abdomen and pelvis. We believe that NC-MRA may be considered as an alternative method to CCTA in selected pediatric KT candidates.

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“…S.cr level and urine output (UOP) have been considered as the main indicators of renal dysfunction. Of note, an increase in S.cr is broadly utilized for the identification of emerging AKI (20) .…”

Section: Figure (1): Roc Curve Of Gfr At Admission By the Mdrd Equati...mentioning

confidence: 99%

Acute Kidney Injury Among Severe Trauma Patients in ICU

Salama¹,

Abdel-Megeed²,

Ahmed³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Trauma is a major public health burble and is associated with a high mortality rate. Acute kidney injury (AKI) has been demonstrated to be accompanied by adverse outcomes among trauma cases and development of AKI is closely accompanied by increased mortality and length of stay (LOS). Objective: To determine the incidence and the associated risk factors of AKI in severe trauma patients and its outcome in the emergency intensive care unit (ICU). Patients and Methods: This was a prospective study conducted on 104 patients with severe trauma at Mansoura University Hospital. Entire cases were classified into 2 groups; AKI cases; patients who met the RIFLE criteria for AKI and non-AKI cases. Entire cases were subjected resuscitation followed by physical examination and laboratory investigations. In addition, trauma scores were assessed. Results: Forty-six percent of patients developed AKI by RIFLE criteria. There were significant differences among AKI and non-AKI in the context of sepsis, shock, coagulopathy and rhabdomyolysis. There were statistical significance serum creatinine (S.cr) levels at emergency room (ER), S.cr peak level at ICU, PH value at ICU, comorbidities, sepsis, shock, LOS, glomerular filtration rate (GFR) at ER and GFR with peak S.cr as independent predictors of AKI among sever trauma patients. Conclusion: Risk factors of trauma-associated AKI included rhabdomyolysis, coagulopathy, nephrotoxic drugs, shock and sepsis. Development of AKI after severe trauma is closely accompanied by increased mortality and LOS. Early detection of AKI and management of risk factors of AKI can improve the outcome.

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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

Cited by 11 publications

References 32 publications

Renal safety and survival among acutely ill hospitalized patients treated by blockers of the Renin-Angiotensin axis or loop diuretics: a single-center retrospective analysis

Renal safety and survival among acutely ill hospitalized patients treated by blockers of the Renin-Angiotensin axis or loop diuretics: a single-center retrospective analysis

Non-contrast-enhanced magnetic resonance angiography as part of a kidney pretransplantation work-up in a 19-month-old boy – a case report

Acute Kidney Injury Among Severe Trauma Patients in ICU

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