Plasma NGAL for the Diagnosis of AKI in Patients Admitted from the Emergency Department Setting

Soto, Karina; Papoila, Ana Luísa; Coelho, Sílvia; Bennett, Michael; Ma, Qing; Rodrigues, Bruno; Fidalgo, Pedro; Frade, Francisca; Devarajan, Prasad

doi:10.2215/cjn.12181212

Cited by 60 publications

(66 citation statements)

References 49 publications

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“…31 Nickolas et al 32 first showed that measurement of urinary NGAL at the time of initial patient encounter can differentiate those who subsequently develop intrinsic AKI from those who would follow a more benign course of pre-renal azotemia, with an AUC of 0.95. These findings have now been confirmed in studies involving >2000 patients, [33][34][35] confirming the diagnostic accuracy of NGAL in the early prediction of intrinsic AKI, with AUCs in the 0.81-0.87 range.…”

supporting

confidence: 53%

Pediatric acute kidney injury: prevalence, impact and management challenges

Ciccia¹,

Devarajan²

2017

IJNRD

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Abstract:The incidence of pediatric acute kidney injury (AKI) is increasing globally, as are the associated morbidities and mortality. A recent standardization of the definition of AKI has allowed for a more accurate assessment of the epidemiology of pediatric AKI. Recent advances in leveraging electronic medical health record systems have allowed for real-time risk stratification and prevention of pediatric AKI in the hospital setting. Newly developed and validated clinical scores have improved our ability to predict AKI and provide a rational context for biomarker utilization in hospitalized children. Novel non-invasive diagnostic and predictive biomarkers have been launched globally to improve our ability to diagnose and predict AKI and its adverse outcomes as well as recovery. This review summarizes the most current literature, focusing on the epidemiology, management, and early diagnostic strategies in pediatric AKI.

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supporting

confidence: 53%

Pediatric acute kidney injury: prevalence, impact and management challenges

Ciccia¹,

Devarajan²

2017

IJNRD

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“…These findings further support the notion that observed AKI is not merely due to intravascular volume depletion. The clinical utility of NGAL to differentiate between volume depletion and intrinsic AKI in NS presenting with an increased serum creatinine value remains to be explored, although it is established in other medical conditions (23,24).…”

Section: Discussionmentioning

confidence: 99%

AKI in Children Hospitalized with Nephrotic Syndrome

Rheault¹,

Zhang²,

Selewski³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome.Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition.Results AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001).Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

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“…As indicated in Figure 3, both urine RBP and β2-M decreased gradually after the early stage of renal tubular disorders. Therefore, other biomarkers have been examined, such as β2-M, RBP, kidney injury molecule-1, neutrophil gelatinase associated lipocalin, interleukin-18, and sodium/ hydrogen exchange form 3 [18] . These biomarkers show increased levels in the urine at an early stage after renal dysfunction occurs.…”

Section: Effect Of Switching Adv To Etv Treatment On Renal Impairmentmentioning

confidence: 99%

Early kidney injury during long-term adefovir dipivoxil therapy for chronic hepatitis B

Jia

Ding

Chen

et al. 2015

WJG

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AIM:To evaluate urine β2-microglobulin (β2-M), retinolbinding protein (RBP) excretion, and renal impairment with adefovir dipivoxil (ADV) for chronic hepatitis B. METHODS:We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy (n = 90) or ADV plus lamivudine combination therapy (n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate (eGFR) at the initiation of antiviral therapy and every 6 mo for a period of five years. RESULTS:Urine β2-M abnormalities were observed in patients during the first (n = 3), second (n = 7), third (n = 11), fourth (n = 16), and fifth (n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first (n = 2), second (n = 8), third (n = 12), fourth (n = 15), and fifth (n = 22) year of ADV treatment. eGFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in eGFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and eGFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment. CONCLUSION:Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.

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Plasma NGAL for the Diagnosis of AKI in Patients Admitted from the Emergency Department Setting

Cited by 60 publications

References 49 publications

Pediatric acute kidney injury: prevalence, impact and management challenges

Pediatric acute kidney injury: prevalence, impact and management challenges

AKI in Children Hospitalized with Nephrotic Syndrome

Early kidney injury during long-term adefovir dipivoxil therapy for chronic hepatitis B

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