Association of Postoperative Proteinuria with AKI after Cardiac Surgery among Patients at High Risk

Molnar, Amber O.; Parikh, Chirag R.; Sint, Kyaw; Coca, Steven G.; Koyner, Jay L.; Patel, Uptal D.; Butrymowicz, Isabel; Shlipak, Michael G.; Garg, Amit X.

doi:10.2215/cjn.13421211

Cited by 43 publications

(40 citation statements)

References 47 publications

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“…The predictive performance of uAGT was also better than UACR (0.84 versus 0.71), a marker that is associated with postoperative AKI in patients undergoing cardiac surgery. 29 Although uAGT level was reported to be correlated with proteinuria in patients with renal impairment, 30 elevation of uAGT was an independent predictor of CRS even after adjusting UACR. The risk reclassification, as measured by NRI and IDI, was significantly improved through the addition of uAGT to the clinical model and to the combination of urinary NGAL and the clinical model, supporting the concept that a single biomarker is not sufficient for the evaluation of a complex clinical setting such as acute CRS.…”

Section: Discussionmentioning

confidence: 91%

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

Yang

Chen²,

Tian

et al. 2015

Journal of the American Society of Nephrology

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A major challenge in prevention and early treatment of acute cardiorenal syndrome (CRS) is the lack of highperformance predictors. To test the hypothesis that urinary angiotensinogen (uAGT) is an early predictor for acute CRS and 1-year prognosis in patients with acute decompensated heart failure (ADHF), we performed a prospective, two-stage, multicenter cohort study in patients with ADHF. In stage I (test set), 317 patients were recruited from four centers. In stage II (validation set), 119 patients were enrolled from two other centers. Daily uAGT levels were analyzed consecutively. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines. In stage I, 104 (32.8%) patients developed AKI during hospitalization. Daily uAGT peaked on the first hospital day in patients who subsequently developed AKI. After multivariable adjustment, the highest quartile of uAGT on admission was associated with a 50-fold increased risk of AKI compared with the lowest quartile. For predicting AKI, uAGT (area under the receiveroperating characteristic curve [AUC]=0.84) outperformed urinary neutrophil gelatinase-associated lipocalin (AUC=0.78), the urinary albumin/creatinine ratio (AUC=0.71), and the clinical model (AUC=0.77). Survivors in stage I were followed prospectively for 1 year after hospital discharge. The uAGT level independently predicted the risk of 1-year mortality (adjusted odds ratio, 4.5; 95% confidence interval, 2.1 to 9.5) and rehospitalization (adjusted odds ratio, 3.6; 95% confidence interval, 1.6 to 5.7). The ability of uAGT in predicting AKI was validated in stage II (AUC=0.79). In conclusion, uAGT is a strong predictor for acute CRS and 1-year prognosis in ADHF.

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Section: Discussionmentioning

confidence: 91%

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

Yang

Chen²,

Tian

et al. 2015

Journal of the American Society of Nephrology

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“…Newonset urinary dipstick proteinuria was associated with severe AKI in critically ill septic patients [60] and increased risk of developing AKI in patients with severe burns [61] . In cardiac surgery patients, high amount of postoperative dipstick proteinuria was associated with the risk of AKI [62] . In our study, glomerular proteinuria correlated with the severity of upcoming AKI, but tubular proteinuria did not.…”

Section: Discussionmentioning

confidence: 99%

Glomerular Proteinuria Predicts the Severity of Acute Kidney Injury in Puumala Hantavirus-Induced Tubulointerstitial Nephritis

Mantula

Outinen

Clément

et al. 2017

Nephron

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Background:Puumala virus (PUUV)-induced hemorrhagic fever with renal syndrome is common in many European countries. The typical renal histologic lesion is acute tubulointerstitial nephritis. We examined the type and kinetics of urine protein excretion and prognostic significance of proteinuria for the severity of acute kidney injury (AKI) in acute PUUV infection. Methods: The amount of dipstick albuminuria at hospital admission was analyzed in 205 patients with acute PUUV infection. Dipstick albuminuria at admission was graded into 3 categories: 0-1+, 2+, and 3+. In 70 patients, 24-h urinary excretion of protein, overnight urinary excretion of albumin, immunoglobulin (Ig) G, and α1-microglobulin also were measured over 3 consecutive days during the hospital stay. Results: Maximum median daily proteinuria, overnight albuminuria, and IgG excretion were observed over 5 days, while that of creatinine values was observed 9 days after the onset of the disease. The medians of maximum plasma creatinine levels during hospital stay were different in the 3 categories of dipstick albuminuria: 0-1+: 98 µmol/L (58-1,499), 2+: 139 µmol/L (71-829), and 3+: 363 µmol/L (51-1,285; p < 0.001). Dipstick albuminuria ≥2+ at admission could be detected in 89% of the patients who subsequently developed severe AKI. Glomerular proteinuria, but not tubular proteinuria (α1-microglobulin), correlated with the severity of the emerging AKI. Conclusion: In acute PUUV infection, maximum median proteinuria values preceded the most severe phase of AKI by a few days. A highly useful finding for clinical work was that a quick and simple albuminuria dipstick test at hospital admission predicted the severity of the upcoming AKI.

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“…This cohort is fully described elsewhere (25, 26). In brief, we prospectively enrolled adults undergoing cardiac surgery (CABG or valve surgery) who were at high risk for AKI at 6 academic medical centers in North America between July 2007 and December 2009.…”

Section: Methodsmentioning

confidence: 99%

Association Between Preoperative Statin Use and Acute Kidney Injury Biomarkers in Cardiac Surgical Procedures

Molnar¹,

Parikh²,

Coca³

et al. 2014

The Annals of Thoracic Surgery

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Background Acute kidney injury is a serious complication of cardiac surgery for which there remains no specific therapy. Animal data and several observational studies suggest that statins prevent acute kidney injury, but the results are not conclusive, and many studies are retrospective in nature. Methods We conducted a multi-center prospective cohort study of 625 adult patients undergoing elective cardiac surgery. All patients were on statins and were grouped on whether statins were continued or held in the 24 hours prior to surgery. The primary outcome was acute kidney injury defined by a doubling of serum creatinine or dialysis. The secondary outcome was the peak level of several kidney injury biomarkers. Results were adjusted for demographic and clinical factors. Results Continuing (vs. holding) a statin prior to surgery was not associated with a lower risk of acute kidney injury defined by a doubling of serum creatinine or dialysis, [adjusted relative risk (RR) 1.09 (95% confidence interval (CI) 0.44, 2.70)]. However, continuing a statin was associated with a lower risk of elevation of the following AKI biomarkers: urine interleukin-18, urine neutrophil gelatinase-associated lipocalin, urine kidney injury molecule-1, and plasma neutrophil gelatinase-associated lipocalin [adjusted RR 0.34 (95% CI 0.18, 0.62), adjusted RR 0.41 (95% CI 0.22, 0.76), adjusted RR 0.37 (95% CI 0.20, 0.76), adjusted RR 0.62 (95% CI 0.39, 0.98), respectively]. Conclusions Statins may prevent kidney injury after cardiac surgery as evidenced by lower levels of kidney injury biomarkers.

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Association of Postoperative Proteinuria with AKI after Cardiac Surgery among Patients at High Risk

Cited by 43 publications

References 47 publications

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

Glomerular Proteinuria Predicts the Severity of Acute Kidney Injury in Puumala Hantavirus-Induced Tubulointerstitial Nephritis

Association Between Preoperative Statin Use and Acute Kidney Injury Biomarkers in Cardiac Surgical Procedures

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