A novel approach to ultrasound-guided percutaneous native renal biopsy: a better tissue sampling technique

Chancharoenthana, Wiwat; Kanjanabuch, Talerngsak; Kittikowit, Wipawee; Srisawat, Nattachai; Tiranathanagula, Khajohn; Praditpornsilpa, Kearkiat; Tungsanga, Kriang

doi:10.5372/1905-7415.0802.280

Cited by 2 publications

(1 citation statement)

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“…This approach could be one of the strategies for "sepsis-individualized therapy." As such, numerous renal biopsy techniques have high yields, safe and effortless [67,68]. The studies of renal biopsy in the selected case of patients with AKI will be very interesting.…”

Section: Clinical Approach To Sa-akimentioning

confidence: 99%

Sepsis-associated Acute Kidney Injury

Chancharoenthana¹,

Leelahavanichkul²,

SomchaiEiam-Ong³

2017

Sepsis

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Sepsis is a life-threatening condition caused by a dysregulated immune response to infection. Interestingly, sepsis mortality increases with acute kidney injury (AKI) and patients with AKI worsen with sepsis. It is interesting to note that most of the clinical trials on sepsis treatment that derived from the results of translational researches are a failure. This is, in part, because of the complexity of human sepsis in comparison with animal models. Another reason for the failure-translation might be the improper matching of the animal models to the individual patient. It is possible that the main mechanism of sepsis induction in each patient with the variety causes of sepsis might be different. Indeed, immune response to sepsis depends on genetic background, route of immune activation, and organisms. Thus, sepsis treatment classified by "mechanistic approach" to individual patient might be more proper than the classification with "sepsis severity". Specific treatment of sepsis in individual patient according to the specific immune response characteristic might be a more proper translational strategy. Indeed, the understanding in immune response pattern of sepsis and sepsis pathophysiology is necessary for "sepsis mechanistic approach". Then, we conclude most of the topics and our hypothesis regarding SA-AKI in this review.outcomes are not in consideration of AKIN system [8]. And AKIN does not synergize with RIFLE criteria in predicting in-hospital mortality of patients with critical illness. Recently, the kidney disease improving global outcomes (KDIGO) work group merges the RIFLE and AKIN classifications in order to establish one AKI classification [9]. KDIGO system defines AKI as an increase in SCr ≥0.3 mg/dL within 48 h or an increase in SCr to ≥1.5 times of baseline SCr or a urine volume of <0.5 mL/kg/h for 6 h. Baseline SCr is the known or presumed value that has occurred within the previous 7 days. In addition, AKI staging of KDIGO follows the AKIN classification with a simplification. KDIGO system shows some advantages over the RIFLE and AKIN classifications in AKI identification and AKI-outcomes prediction. Moreover, KDIGO introduces a new term of "acute kidney disease, AKD" which means the slower increase in SCr or GFR, >7 days but <3 months. This is because renal injury in some Sepsis 64 conditions progresses slowly and does not match with AKI definition where significant renal function declines within 7 days after the insults.Regarding SA-AKI classification, Pereira et al. [10] demonstrate that SA-AKI with all of these three classifications-RIFLE, AKIN, and KDIGO-shows similar prediction ability (assessed by the area under the receiver operating characteristic (AUROC) curve) for in-hospital mortality (RIFLE 0.652, p < 0.001; AKIN 0.686, p < 0.001; KDIGO 0.658, p < 0.001). However, the study shows that RIFLE and KDIGO classifications identify AKI more than AKIN criteria. Thus, SA-AKI is AKI induced or enhanced by sepsis which could be classified with any of these three classification systems. It is al...

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Section: Clinical Approach To Sa-akimentioning

confidence: 99%