Urine electrolyte measurement as a “window” into renal microcirculatory stress assessment in critically ill patients

Maciel, Alexandre Toledo

doi:10.1016/j.jcrc.2018.08.011

Cited by 4 publications

(2 citation statements)

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“…Alterations in glomerular hemodynamics not yet clearly elucidated ( 43 , 44 ) lead to a reduced glomerular filtration pressure, RAA system activation and, consequently, Na + retention and low NaU levels. In summary, all situations that activate Na + retention may be indicative of conditions causing “renal microcirculatory stress” (RMS) ( 45 ) which seems to be a more accurate concept than “pre-renal” AKI ( Table 1 ). Hypovolemia is only one of the wide ranges of etiological factors in the differential diagnosis of RMS.…”

Section: The Concept Of “Renal Microcirculatory Stress”: Anticipating...mentioning

confidence: 99%

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Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box

2022

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Urine biochemistry (UB) remains a controversial tool in acute kidney injury (AKI) monitoring, being considered to be of limited value both in terms of AKI diagnosis and prognosis. However, many criticisms can be made to the studies that have established the so called “pre-renal paradigm” (used for decades as the essential physiological basis for UB assessment in AKI) as well as to more recent studies suggesting that UB has no utility in daily clinical practice. The aim of this article is to describe our hypothesis on how to interpret simple and widely recognized urine biochemical parameters from a novel perspective, propose the rationale for their sequential assessment and demonstrate their usefulness in AKI monitoring, especially in the critical care setting.

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Section: The Concept Of “Renal Microcirculatory Stress”: Anticipating...mentioning

confidence: 99%

“…Since FeK is the “future index” of sCr ( 45 ), a high FeK (normal value < 10–12%) points toward a subsequent rise in sCr. In fact, FeK normally does increase before sCr in AKI development ( 33 , 38 , 52 ).…”

Section: Urine Biochemistry As a Tool For An Earlier Detection Of Ren...mentioning

confidence: 99%

Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box

2022

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Prediction of acute kidney injury using a combined model of inflammatory vascular endothelium biomarkers and ultrasound indices

Abdelwahed

Aboulhoda

Awadallah

et al. 2023

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BACKGROUND: Acute kidney injury (AKI) is a common complication of sepsis, with the burden of long hospital admission. Early prediction of AKI is the most effective strategy for intervention and improvement of the outcomes. OBJECTIVE: In our study, we aimed to investigate the predictive performance of the combined model using ultrasound indices (grayscale and Doppler indieces), endothelium injury (E-selectin, VCAM-1, ICAM1, Angiopoietin 2, syndecan, and eNOS) as well as inflammatory biomarkers (TNF-α, and IL-1β) to identify AKI. METHODS: Sixty albino rats were divided into control and lipopolysaccharide (LPS) groups. Renal ultrasound, biochemical and immunohistological variables were recorded 6 hrs, 24 hrs, and 48 hrs after AKI. RESULTS: Endothelium injury and inflammatory markers were found to be significantly increased early after AKI, and correlated significantly with kidney size reduction and renal resistance indices elevation. CONCLUSIONS: Using area under the curve (AUC), the combined model was analyzed based on ultrasound and biochemical variables and provided the highest predictive value for renal injury.

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Optimizing Postoperative Acute Kidney Injury Monitoring Using a Urine Biochemical Approach—Time to Bring More Dynamism to Serum Creatinine Evaluation!

Maciel

2024

Indian Journal of Critical Care Medicine

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A bstract Glomerular filtration rate (GFR) impairment is common both intraoperatively and in the early postoperative period of major surgeries, even elective ones. In some patients, such impairment is subtle and short-lasting, not even detected by increases in serum creatinine (sCr) and, consequently, not of sufficient magnitude to fulfill acute kidney injury (AKI) sCr-based criteria. In patients with a GFR decrease of greater magnitude, significant increases in sCr will occur but, unfortunately, usually at a late time in its progression. Both urinary and serum biomarkers have been proposed to be capable of anticipating AKI development but they are not widely available nor cost-effective in most centers. In this context, a urine biochemical approach using urinary sodium concentration (NaU) and the fractional excretion of potassium (FeK) has been proposed, anticipating the level of renal microcirculatory stress and decreases in GFR. An educational postoperative case example is presented highlighting the relevance that this approach can have in the correct interpretation of sCr values, bringing more dynamism to renal function monitoring. How to cite this article Maciel AT. Optimizing Postoperative Acute Kidney Injury Monitoring Using a Urine Biochemical Approach—Time to Bring More Dynamism to Serum Creatinine Evaluation! Indian J Crit Care Med 2024;28(8):729–733.

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Urine electrolyte measurement as a “window” into renal microcirculatory stress assessment in critically ill patients

Cited by 4 publications

References 30 publications

Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box

Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box

Prediction of acute kidney injury using a combined model of inflammatory vascular endothelium biomarkers and ultrasound indices

Optimizing Postoperative Acute Kidney Injury Monitoring Using a Urine Biochemical Approach—Time to Bring More Dynamism to Serum Creatinine Evaluation!

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