Metabonomics of acute kidney injury in children after cardiac surgery

Beger, Richard D.; Holland, Ricky D.; Sun, Jinchun; Schnackenberg, Laura K.; Moore, Page C.; Dent, Catherine L.; Devarajan, Prasad; Portilla, Didier

doi:10.1007/s00467-008-0756-7

Cited by 89 publications

(57 citation statements)

References 27 publications

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“…In these applications, statistical pattern recognition techniques were used for data reduction and analysis (23,26,29,41,43), thereby allowing extraction of metabolic information from the complexity of the information-rich data (4,9,14). Although much of this research addressed metabolic variations induced by toxicological exposures (18,24,32), early studies with human plasma demonstrated that 1 H-NMR spectroscopy can also be used to discriminate individuals with cardiovascular disease (4,8,40). In the latter study, differences were apparent in the intensities of proton signals associated with lipids, establishing the utility of NMR spectroscopy for study of physiological variations of lipids (1,15,37).…”

mentioning

confidence: 99%

Individual variation in macronutrient regulation measured by proton magnetic resonance spectroscopy of human plasma

Park¹,

Kim²,

Wang³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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DP. Individual variation in macronutrient regulation measured by proton magnetic resonance spectroscopy of human plasma. Am J Physiol Regul Integr Comp Physiol 297: R202-R209, 2009. First published May 20, 2009 doi:10.1152/ajpregu.90757.2008.-Proton nuclear magnetic resonance ( 1 H-NMR) spectroscopy of plasma provides a global metabolic profiling method that shows promise for clinical diagnostics. However, cross-sectional studies are complicated by a lack of understanding of intraindividual variation, and this limits experimental design and interpretation of data. The present study determined the diurnal variation detected by 1 H NMR spectroscopy of human plasma. Data reduction methods revealed three time-of-day metabolic patterns, which were associated with morning, afternoon, and night. Major discriminatory regions for these time-of-day patterns included the various kinds of lipid signals , and the region between 3 and 4 ppm heavily overlapped with amino acids that had ␣-CH and ␣-CH2. The phasing and duration of time-of-day patterns were variable among individuals, apparently because of individual difference in food processing/digestion and absorption and clearance of macronutrient energy sources (fat, protein, carbohydrate). The times of day that were most consistent among individuals, and therefore most useful for cross-sectional studies, were fasting morning (0830 -0930), postprandial afternoon (1430 -1630), and nighttime samples (0430 -0530). Importantly, the integrated picture of metabolism provided by 1 H-NMR spectroscopy of plasma suggests that this approach is suitable to study complex regulatory processes, including eating patterns/eating disorders, upper gastrointestinal functions (gastric emptying, pancreatic, biliary functions), and absorption/clearance of macronutrients. Hence, 1 H-NMR spectroscopy of plasma could provide a global metabolic tolerance test to assess complex processes involved in disease, including eating disorders and the range of physiological processes causing dysregulation of energy homeostasis. metabolomics; diurnal variation; eating disorders; gastrointestinal regulation GLOBAL METABOLIC PROFILING coupled with bioinformatic methods offers an approach to study the integration of macronutrient energy metabolism and can be useful to detect disease, toxicity, and nutritional deficiency (11,23,30,36). A variety of metabolic profiling methods are available, including gas chromatography-mass spectrometry, liquid chromatographymass spectrometry, and NMR spectroscopy (10,31,39). In view of its capability to handle multiple specimens in a high-throughput, semiautomated system, 1 H-NMR may offer unique insight into the in vivo metabolism of macronutrients (1, 2, 9). Dysfunction in macronutrient metabolism, i.e., carbohydrate, fat, protein, and alcohol, is relevant to obesity, metabolic syndrome, diabetes, cardiovascular disease and other common pathological conditions (19,25).Pioneering studies by Nicholson and coworkers (3, 24, 27, 35) established the utility of 1 H NMR spectroscopy f...

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mentioning

confidence: 99%

Individual variation in macronutrient regulation measured by proton magnetic resonance spectroscopy of human plasma

Park¹,

Kim²,

Wang³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Blinder with colleagues (9) retrospectively studied 430 infants who underwent heart surgery for congenital defects and observed AKI in 52% of patients. Even in the studies published after introduction of RIFLE and AKIN definitions, variability (27%-52%) of AKI incidence has been reported (5, 6,8,9,15). It was difficult to compare SCr and ClCr values of various ages due to wide distribution of specific values.…”

Section: Discussionmentioning

confidence: 99%

Open Heart Surgery Associated Acute Kidney Injury in Children

Krastiņš

Straume

Auziņš

et al. 2013

Acta Chirurgica Latviensis

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Summary.Introduction. Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function. Hypothermia, hypoxia, hypotension, non-pulsatile blood flow during CPB, use of ACE inhibitors, inotropic and (or) vasoactive support affects kidney and contributes to the acute kidney injury (AKI). Aim of the study. The purpose of this study was to evaluate the incidence, severity and outcome of CPB related AKI in children after open heart surgery. Materials and methods. We conducted prospective, non-randomized observational study at the tertiary care University Children's Hospital Pediatric ICU. We enrolled 30 patients, 12 boys and 18 girls with congenital heart disease (CHD). Their median body weight was 6,8 kg, (IQR 5,2<8,2 kg) and median age 7 months (IQR 5<10 months). SCr was determined and preoperative and postoperative creatinine clearance (ClCr) was estimated using Schwarz formula (eClCr). During surgical repair and till the end of the first 12 postoperative hours urine was collected to measure ClCr, using the difference in urine (UCr) and SCr concentrations (mClCr). Urine output, body temperature, duration of aortic cross clamping and cardiopulmonary bypass was recorded. Results. Median intraoperative urine output was 2,4 ml/kg/h (IQR 1,29<3,15 ml/kg/h). Median CPB time was 147 min., (IQR 116,75<205 min.), median aortic cross-clamping time was 95 min., (IQR 70,5<133 min.), cooling during CPB to 29,75°C. Postoperative SCr increased to 35 μmol/l (IQR 27,5<50,5 μmol/l) vs. preoperative SCr 29 μmol/l (IQR 24<32,9 μmol/l), P<0,0001. GFR declined from preoperative 98,4 ml/min./1,73 m2 (IQR 89,6<123,04) to postoperative 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2), P<0,0001. We find statistically significant difference (P=0,042) in measured 39,88 ml/min./1,73 m2 (IQR 21,96<67,82 ml/min./1,73 m2) versus estimated ClCr (eClCr) 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2). Observed prevalence of AKI was 46,6% (14/30 patients met KDIGO criteria for AKI). Conclusions. Open heart surgery in children has severe, but transient effect on expression of renal biomarkers. There was a marked difference between measured and estimated ClCr in our patients. Observed incidence of AKI was 46,6% (14 patients met KDIGO criteria of AKI from 30 of our patients). Before discharge from the hospital both biomarkers returned to normal values.

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“…Mass spectrometry-based metabolomics was used in a prospective cohort of pediatric cardiac surgery patients (n = 40). Twenty-one of these children developed acute kidney injury defined as an increase in serum creatinine concentrations 50% or greater from baseline after 48-72 h. Homovanillic acid sulfate (HVA-SO 4 ), a dopamine metabolite was identified as a marker indicating AKI with 90% sensitivity and 95% specificity using a cutoff value of 24 ng/ml at 12 h after surgery [20]. Atzori et al showed a correlation between urinary metabolic profiles and neutrophil gelatinase-associated lipocalin (NGAL) concentration in a cohort of young adults born with extremely lowbirth weight (ELBW), using partial least-squares discriminant analysis [21].…”

Section: Neonatal Kidney Injurymentioning

confidence: 99%

Metabolomics in Neonatology

Hanna¹,

Brophy²

2016

Metabolomics - Fundamentals and Applications

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Throughout recent decades, the incidence of preterm birth has risen worldwide, and although the majority of preterm neonates now survive infancy, many suffer from debilitating morbidities in the short term and/or increased disease risks in the long term. Traditional diagnostic biomarkers suffer from considerable confounders, limiting their use in the early identification of diseases. There is a need to develop novel biomarkers that can identify, in real time, the evolution of organ dysfunction in an early diagnostic, monitoring, and prognostic fashion. Use of "omics," particularly metabolomics, may provide valuable information regarding functional pathways underlying different pathologies and prediction of clinical outcomes. The emerging knowledge generated by the application of metabolomics in neonatology provides new insights that can help to identify markers of early diagnosis, disease progression, response to treatment, and new therapeutic targets. In this chapter, we review the current knowledge of different metabolomics technologies in neonatal-perinatal medicine, including biomarker discovery, defining as yet unrecognized biologic therapeutic targets, and linking of metabolomics to relevant standard indices and long-term outcomes.

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Metabonomics of acute kidney injury in children after cardiac surgery

Cited by 89 publications

References 27 publications

Individual variation in macronutrient regulation measured by proton magnetic resonance spectroscopy of human plasma

Individual variation in macronutrient regulation measured by proton magnetic resonance spectroscopy of human plasma

Open Heart Surgery Associated Acute Kidney Injury in Children

Metabolomics in Neonatology

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