The Relationship of Renal Blood Flow to Cardiac Output in Normal Individuals as Determined by Concomitant Radioisotopic Measurements

Botti, Robert E.; Razzak, Muhammad Abdel; MacIntyre, William J.; Pritchard, Walter H.

doi:10.1093/cvr/2.3.243

Cited by 13 publications

(9 citation statements)

References 6 publications

(7 reference statements)

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“…This association is biologically plausible by two possible mechanisms. First, the kidneys receive approximately 20 % of cardiac output [ 17 ] and are sensitive to ischemic injury. Ischemia in the kidney, reflected by an increase of UBs, may therefore be indicative of global ischemia.…”

Section: Discussionmentioning

confidence: 99%

The potential utility of urinary biomarkers for risk prediction in combat casualties: a prospective observational cohort study

et al. 2015

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IntroductionTraditional risk scoring prediction models for trauma use either anatomically based estimations of injury or presenting vital signs. Markers of organ dysfunction may provide additional prognostic capability to these models. The objective of this study was to evaluate if urinary biomarkers are associated with poor outcomes, including death and the need for renal replacement therapy.MethodsWe conducted a prospective, observational study in United States Military personnel with traumatic injury admitted to the intensive care unit at a combat support hospital in Afghanistan.ResultsEighty nine patients with urine samples drawn at admission to the intensive care unit were studied. Twelve patients subsequently died or needed renal replacement therapy. Median admission levels of urinary cystatin C (CyC), interleukin 18 (IL-18), L-type fatty acid binding protein (LFABP) and neutrophil gelatinase-associated lipocalin (NGAL) were significantly higher in patients that developed the combined outcome of death or need for renal replacement therapy. Median admission levels of kidney injury molecule-1 were not associated with the combined outcome. The area under the receiver operating characteristic curves for the combined outcome were 0.815, 0.682, 0.842 and 0.820 for CyC, IL-18, LFABP and NGAL, respectively. Multivariable regression adjusted for injury severity score, revealed CyC (OR 1.97, 95 % confidence interval 1.26-3.10, p = 0.003), LFABP (OR 1.92, 95 % confidence interval 1.24-2.99, p = 0.004) and NGAL (OR 1.80, 95 % confidence interval 1.21-2.66, p = 0.004) to be significantly associated with the composite outcome.ConclusionsUrinary biomarker levels at the time of admission are associated with death or need for renal replacement therapy. Larger multicenter studies will be required to determine how urinary biomarkers can best be used in future prediction models.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0965-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The potential utility of urinary biomarkers for risk prediction in combat casualties: a prospective observational cohort study

et al. 2015

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“…Renal blood flow, and thus renal function, are largely dependent on cardiac output, which, in turn, is directly related to systemic blood pressure (BP) and heart rate (HR) . Although high BP (hypertension) and low BP (hypotension) are established risk factors for renal dysfunction, the effect of HR levels as well as the isolated and cumulative effect of BP and HR variability on kidney function has not been well clarified.…”

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confidence: 99%

Correlation of 24‐Hour Blood Pressure and Heart Rate Variability to Renal Function Parameters in Hypertensive Patients. The Effect of Smoking

Liakos

Karpanou

Markou

et al. 2015

J of Clinical Hypertension

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Intrarenal hemodynamics depend on blood pressure (BP), heart rate (HR), and smoking. Although BP levels have been associated with kidney function, the effect of HR levels, BP, and HR variability on renal function are less well clarified. This cross-sectional study sought to determine the association of 24-hour BP and HR variability with kidney function in hypertensive patients, stratified by smoking. The study comprised 9600 nondiabetic, never-treated hypertensive individuals without evident renal impairment examined from 1985 to 2014 (aged 53.3AE13.4 years, 55.3% males). The 24-hour systolic BP (SBP) and HR variability were estimated via their coefficient of variation (C V =standard deviation9100/ mean value) derived from ambulatory recording. The C V SBPto-C V HR ratio (C V R) was used as a marker of the interplay between 24-hour SBP and HR variability. Renal function was estimated via 24-hour urine creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), and 24-hour urine a 1 -microglobulin. After adjustment for age, sex, and smoking, C V SBP was found to be weakly correlated to eGFR (r=À0.017, P=.1) and somewhat more strongly to CrCl, ACR, and a 1 -microglobulin (r=À0.032, 0.072, and 0.065; P=.002, <.001 and <.001, respectively). C V HR was much better related to renal function, with stronger adjusted correlations to CrCl, eGFR, ACR, and a 1 -microglobulin (r=0.185, 0.134, À0.306, À0.247; all P<.001, respectively). C V R also showed equally good adjusted correlations (r=À0.175, À0.125, 0.336, 0.262; all P<.001, respectively). Most adjusted correlations for C V HR and C V R were even better in smokers (r=0.213, 0.158, À0.332, À0.272 and À0.183, À0.118, 0.351, 0.275, respectively; all P<.001). C V HR and C V R emerge as better related to kidney function than C V SBP, especially in smokers. The correlation of C V HR and C V SBP to renal function is inverse to each other. ACR and a 1 -microglobulin are better related to variability indices than CrCl and eGFR. However, causal relations cannot be proved. J Clin Hypertens (Greenwich). 2015;17:938-943. ª 2015 Wiley Periodicals, Inc.

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“…While urinary biomarkers (UBs) have generally been thought to be renal specific, they may reflect the overall injury severity in the setting of trauma. The kidneys receive a large portion of cardiac output (3) and are exquisitely sensitive to ischemic injury, making them promising markers for global hypo-perfusion. Indeed, UBs have been demonstrated to correlate with poor outcomes in combat casualties (4).…”

Section: Introductionmentioning

confidence: 99%

Urinary Biomarkers are Associated with Severity and Mechanism of Injury

Janak

Stewart

Sosnov

et al. 2017

Shock

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Combat-related blast trauma results in massive tissue injury and tends to involve multiple systems. Further, an acute measure of injury severity based on underlying biological mechanisms may be important for the triage and treatment of these types of patients. We hypothesized that urinary biomarkers (UBs) would reflect severity of injury and that they would be elevated for blast injuries compared to gunshot wounds (GSW) in a cohort of combat casualties. We also postulated that UBs would be higher in patients with burns compared to patients with non-burn trauma in a civilian cohort. Among 80 service members who sustained combat-related injuries, we performed generalized estimating equations to compare differences in log-transformed concentrations of the UBs by both (1) injury severity and (2) injury mechanism. Among 22 civilian patients, we performed Kruskal-Wallis tests to compare differences for the UBs stratified by burn and non-burn trauma. In the military cohort, with the exception of IL-18, all UBs were significantly (p<0.05) higher for patients with a severe combat-related injury (Injury Severity Score≥25). In addition, all crude UBs concentrations were significantly higher for blast vs. GSW patients (p<0.05). After adjusting for injury severity score and time of UB draw, KIM-1 (2.80 vs. 2.31; p=0.03) and LFABP (−1.11 vs. −1.92; p=0.02) were significantly higher for patients with a blast mechanism of injury. There were no significant differences in UBs between burn and non-burn civilian trauma patients. Future studies are needed to understand the physiologic response to trauma and the extent that UBs reflect these underlying processes.

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The Relationship of Renal Blood Flow to Cardiac Output in Normal Individuals as Determined by Concomitant Radioisotopic Measurements

Cited by 13 publications

References 6 publications

The potential utility of urinary biomarkers for risk prediction in combat casualties: a prospective observational cohort study

The potential utility of urinary biomarkers for risk prediction in combat casualties: a prospective observational cohort study

Correlation of 24‐Hour Blood Pressure and Heart Rate Variability to Renal Function Parameters in Hypertensive Patients. The Effect of Smoking

Urinary Biomarkers are Associated with Severity and Mechanism of Injury

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