Renal function after acute tubular necrosis.

Briggs, J. D.; Kennedy, A. C.; Young, LC; Luke, Robert G.; Gray, Mary Jane

doi:10.1136/bmj.3.5564.513

Cited by 72 publications

(37 citation statements)

References 18 publications

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“…In nontransplant patients, whereas ischemic renal injury results in a mortality of approximately 50%, usually related to accompanying multiple organ failure, most surviving patients are thought to recover nearly full renal function (12). Studies evaluating the long-term effects of ischemic injury report that between 35% and 71% of patients surviving acute tubular necrosis had incomplete recovery of native renal function as assessed by measurement of creatinine clearance or serum creatinine (18)(19)(20). A common feature in two studies was the persistent lack of urinary concentrating ability (18,20) and one study reported that a small percentage of patients manifested a loss of GFR between follow-up years 1 and 5 (19).…”

Section: Discussionmentioning

confidence: 99%

“…Studies evaluating the long-term effects of ischemic injury report that between 35% and 71% of patients surviving acute tubular necrosis had incomplete recovery of native renal function as assessed by measurement of creatinine clearance or serum creatinine (18)(19)(20). A common feature in two studies was the persistent lack of urinary concentrating ability (18,20) and one study reported that a small percentage of patients manifested a loss of GFR between follow-up years 1 and 5 (19). Despite the presence of residual or declining renal function, most patients in these follow-up studies were not symptomatic for renal disease.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes After Transplantation of Deceased-Donor Kidneys with Rising Serum Creatinine

Morgan¹,

Martin²,

Shapiro³

et al. 2007

American Journal of Transplantation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes After Transplantation of Deceased-Donor Kidneys with Rising Serum Creatinine

Morgan¹,

Martin²,

Shapiro³

et al. 2007

American Journal of Transplantation

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“…In the six who survived there was a return to normal of the serum creatinine, blood urea, and creatinine clearance rates after varying periods. The time taken for the creatinine clearance rates to return to normal suggests that the patients in category 1 had developed acute renal failure and that acute tubular necrosis had not supervened (Sevitt, 1959;Finckhl, Jeremy, and Whyte, 1962), whereas the delayed return to normal of the creatinine clearance'rates of the patients in category 2 indicates that they had developed acute tubular necrosis (Briggs, Kennedy, Young, Luke, and Gray, 1967). Even though data from the eight patients who died are necessarily incomplete, the abnormal biochemical findings had started to return to normal in the two who had completed the course of treatment (Cases 7 and 8).…”

Section: Discussionmentioning

confidence: 99%

Effects of Large Doses of Colistin Sulphomethate Sodium on Renal Function

Price¹,

Graham²

1970

BMJ

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“…In those who survive, there may be decline in function, in some cases leading to ESRD, either at the time of AKI or in the future. 51,[74][75][76][77] Even in patients with complete recovery there is still reduced survival and increased incidence of CKD in the years following AKI. 12,78 Patients experiencing AKI are likely to also have risk factors for CKD.…”

Section: Outcomes Of Acute Kidney Injurymentioning

confidence: 99%

Development of risk models for the prediction of new or worsening acute kidney injury on or during hospital admission: a cohort and nested study

Bedford

Stevens

Coulton

et al. 2016

Health Serv Deliv Res

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BackgroundAcute kidney injury (AKI) is a common clinical problem with significant morbidity and mortality. All hospitalised patients are at risk. AKI is often preventable and reversible; however, the 2009 National Confidential Enquiry into Patient Outcome and Death highlighted systematic failings of identification and management, and recommended risk assessment of all emergency admissions.ObjectivesTo develop three predictive models to stratify the risk of (1) AKI on arrival in hospital; (2) developing AKI during admission; and (3) worsening AKI if already present; and also to (4) develop a clinical algorithm for patients admitted to hospital and explore effective methods of delivery of this information at the point of care.Study designQuantitative methodology (1) to formulate predictive risk models and (2) to validate the models in both our population and a second population. Qualitative methodology to plan clinical decision support system (CDSS) development and effective integration into clinical care.Settings and participantsQuantitative analysis – the study population comprised hospital admissions to three acute hospitals of East Kent Hospitals University NHS Foundation Trust in 2011, excluding maternity and elective admissions. For validation in a second population the study included hospital admissions to Medway NHS Foundation Trust. Qualitative analysis – the sample consisted of six renal consultants (interviews) and six outreach nurses (focus group), with representation from all sites.Data collectionData (comprising age, sex, comorbidities, hospital admission and outpatient history, relevant pathology tests, drug history, baseline creatinine and chronic kidney disease stage, proteinuria, operative procedures and microbiology) were collected from the hospital data warehouse and the pathology and surgical procedure databases.Data analysisQuantitative – both traditional and Bayesian regression methods were used. Traditional methods were performed using ordinal logistic regression with univariable analyses to inform the development of multivariable analyses. Backwards selection was used to retain only statistically significant variables in the final models. The models were validated using actual and predicted probabilities, an area under the receiver operating characteristic (AUROC) curve analysis and the Hosmer–Lemeshow test. Qualitative – content analysis was employed.Main outcome measures(1) A clinical pratice algorithm to guide clinical alerting and risk modeling for AKI in emergency hospital admissions; (2) identification of the key variables that are associated with the risk of AKI; (3) validated risk models for AKI in acute hospital admissions; and (4) a qualitative analysis providing guidance as to the best approach to the implementation of clinical alerting to highlight patients at risk of AKI in hospitals.FindingsQuantitative – we have defined a clinical practice algorithm for risk assessment within the first 24 hours of hospital admission. Bayesian methodology enabled prediction of low risk but could not reliably identify high-risk patients. Traditional methods identified key variables, which predict AKI both on admission and at 72 hours post admission. Validation demonstrated an AUROC curve of 0.75 and 0.68, respectively. Predicting worsening AKI during admission was unsuccessful. Qualitative – analysis of AKI alerting gave valuable insights in terms of user friendliness, information availability, clinical communication and clinical responsibility, and has informed CDSS development.ConclusionsThis study provides valuable evidence of relationships between key variables and AKI. We have developed a clinical algorithm and risk models for risk assessment within the first 24 hours of hospital admission. However, the study has its limitations, and further analysis and testing, including continuous modelling, non-linear modelling and interaction exploration, may further refine the models. The qualitative study has highlighted the complexity regarding the implementation and delivery of alerting systems in clinical practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Renal function after acute tubular necrosis.

Cited by 72 publications

References 18 publications

Outcomes After Transplantation of Deceased-Donor Kidneys with Rising Serum Creatinine

Outcomes After Transplantation of Deceased-Donor Kidneys with Rising Serum Creatinine

Effects of Large Doses of Colistin Sulphomethate Sodium on Renal Function

Development of risk models for the prediction of new or worsening acute kidney injury on or during hospital admission: a cohort and nested study

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