Novel Biomarkers of Acute Kidney Injury in the General Adult ICU: A Review

Kokkoris, Stelios; Pipili, Chrysoula; Grapsa, Eirini; Kyprianou, Theodoros; Nanas, Serafim

doi:10.3109/0886022x.2013.773835

Cited by 37 publications

(41 citation statements)

References 77 publications

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“…Should a single biomarker or a combination of several be used? 24 A major issue concerning AKI criteria is their relevance to the perioperative period. Many surgical patients arrive in hospital without preoperative sCr concentrations.…”

Section: Definition Of Acute Kidney Injurymentioning

confidence: 99%

Perioperative acute kidney injury

Goren

Matot

2015

British Journal of Anaesthesia

191

157

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Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI. Certain types of surgeries, such as cardiac and transplantation surgeries, require special attention because they carry higher risk of AKI. Nephrotoxic drugs, contrast dye, and diuretics are commonly used in the perioperative period and are responsible for a significant amount of in-hospital AKI. Before surgery, the anaesthetist is required to identify patients at risk of AKI, optimize anaemia, and treat hypovolaemia. During surgery, normovolaemia is of utmost importance. Additionally, the surgical and anaesthesia team is advised to use measures to reduce blood loss and avoid unnecessary blood transfusion. Hypotension should be avoided because even short periods of mean arterial pressure<55-60 mm Hg carry a risk of postoperative AKI. Higher blood pressures are probably required for hypertensive patients. Urine output can be reduced significantly during surgery and is unrelated to perioperative renal function. Thus, fluids should not be given in excess for the sole purpose of avoiding or treating oliguria. Use of hydroxyethyl starch needs to be reconsidered. Recent evidence indicates a beneficial effect of administering low-chloride solutions.

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Section: Definition Of Acute Kidney Injurymentioning

confidence: 99%

Perioperative acute kidney injury

Goren

Matot

2015

British Journal of Anaesthesia

191

157

View full text Add to dashboard Cite

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“…Liver-type fatty acid-binding protein (L-FABP) has been considered as an important cellular antioxidant during oxidative stress by maintaining low levels of free fatty acids in the cytoplasm of tubular cells through facilitation of intracellular metabolism and excretion in urine. In a number of studies, urine L-FABP has been able to reliably predict the occurrence of AKI and death in ICU patients [64]. Recently, Costa et al found that erythrocyte superoxide dismutase (SOD1) activity could play a role as an early marker of septic AKI and could be seen as a new research avenue in the field of biomarker in AKI [67].…”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

Pavlakou

Liakopoulos

Eleftheriadis

et al. 2017

Oxidative Medicine and Cellular Longevity

118

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Acute kidney injury (AKI) is a multifactorial entity that occurs in a variety of clinical settings. Although AKI is not a usual reason for intensive care unit (ICU) admission, it often complicates critically ill patients' clinical course requiring renal replacement therapy progressing sometimes to end-stage renal disease and increasing mortality. The causes of AKI in the group of ICU patients are further complicated from damaged metabolic state, systemic inflammation, sepsis, and hemodynamic dysregulations, leading to an imbalance that generates oxidative stress response. Abundant experimental and to a less extent clinical data support the important role of oxidative stress-related mechanisms in the injury phase of AKI. The purpose of this article is to present the main pathophysiologic mechanisms of AKI in ICU patients focusing on the different aspects of oxidative stress generation, the available evidence of interventional measures for AKI prevention, biomarkers used in a clinical setting, and future perspectives in oxidative stress regulation.

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“…2,3 Novel biomarkers for acute renal failure are on the horizon. 4 Nevertheless, the variability in the clinical outcome makes it difficult to predict the risk for an individual patient. Former research suggests that genetic diversity contributes to CSA-AKI.…”

Section: Introductionmentioning

confidence: 99%

Apolipoprotein E genotype, TNF-α 308G/A and risk for cardiac surgery associated-acute kidney injury in Caucasians

et al. 2013

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Objectives: Acute kidney injury following cardiac surgery depicts a severe clinical problem that is strongly associated with adverse short-and long-term outcome. We analyzed two common genetic polymorphisms that have previously been linked to renal failure and inflammation, and have been supposed to be associated with cardiac surgery associated-acute kidney injury (CSA-AKI). Methods: A total of 1415 consecutive patients who underwent elective cardiac surgery with CPB at our institution were prospectively enrolled. Patients were genotyped for Apolipoprotein E (ApoE E2,E3,E4) (rs429358 and rs7412) and TNF-a-308 G4A (rs1800629). Results: Demographic characteristics and procedural data revealed no significant differences between genotypes. No association between ApoE (E2,E3,E4) and TNF-a-308 G4A genotypes and the RIFLE criteria could be detected. Several multiple linear regression analyses for postoperative creatinine increase revealed highly significant associations for aortic cross clamp time (p50.001), CPB-time (p50.001), norepinephrine (p50.001), left ventricular function (p ¼ 0.004) and blood transfusion (p50.001). No associations were found for ApoE (E2,E3,E4) and TNF-a-308 G4A genotypes or baseline creatinine. When the sample size is 1415, the multiple linear regression test of R 2 ¼ 0 for seven covariates assuming normal distribution will have at least 99% power with significance level 0.05 to detect an R 2 of 0.108 or 0.107 as observed in the data. Conclusions: ApoE (E2,E3,E4) polymorphism and the TNF-a-308 G4A polymorphism are not associated with renal injury after CPB.

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Novel Biomarkers of Acute Kidney Injury in the General Adult ICU: A Review

Cited by 37 publications

References 77 publications

Perioperative acute kidney injury

Perioperative acute kidney injury

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

Apolipoprotein E genotype, TNF-α 308G/A and risk for cardiac surgery associated-acute kidney injury in Caucasians

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