Evaluation of estimated creatinine clearance before steady state in acute kidney injury by creatinine kinetics

Yashiro, Masatomo; Ochiai, Miyuki; Fujisawa, Nao; Kadoya, Yuko; Kamata, Tadashi

doi:10.1007/s10157-012-0602-x

Cited by 24 publications

(27 citation statements)

References 12 publications

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“…All non-survivors had an increase in absolute creatinine greater than 2 mg/dl within 24 hours. This is much greater than the maximum possible predicted by creatinine kinetic studies, which suggests an absolute increase of greater than 1.5 mg/dl could only be seen after approximately 48 hours of an acute decrease in GFR assuming a normal baseline [ 26 , 27 ]. Thus these results suggest that an elevated creatinine is a useful prognostic marker of death, but a poor biomarker of renal function in the setting of acute paraquat ingestion.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms Underlying Early Rapid Increases in Creatinine in Paraquat Poisoning

et al. 2015

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BackgroundAcute kidney injury (AKI) is common after severe paraquat poisoning and usually heralds a fatal outcome. The rapid large increases in serum creatinine (Cr) exceed that which can be explained by creatinine kinetics based on loss of glomerular filtration rate (GFR).Methods and FindingsThis prospective multi-centre study compared the kinetics of two surrogate markers of GFR, serum creatinine and serum cystatin C (CysC), following paraquat poisoning to understand and assess renal functional loss after paraquat poisoning. Sixty-six acute paraquat poisoning patients admitted to medical units of five hospitals were included. Relative changes in creatinine and CysC were monitored in serial blood and urine samples, and influences of non-renal factors were also studied.ResultsForty-eight of 66 patients developed AKI (AKIN criteria), with 37 (56%) developing moderate to severe AKI (AKIN stage 2 or 3). The 37 patients showed rapid increases in creatinine of >100% within 24 hours, >200% within 48 hours and >300% by 72 hours and 17 of the 37 died. CysC concentration increased by 50% at 24 hours in the same 37 patients and then remained constant. The creatinine/CysC ratio increased 8 fold over 72 hours. There was a modest fall in urinary creatinine and serum/urine creatinine ratios and a moderate increase in urinary paraquat during first three days.ConclusionLoss of renal function contributes modestly to the large increases in creatinine following paraquat poisoning. The rapid rise in serum creatinine most probably represents increased production of creatine and creatinine to meet the energy demand following severe oxidative stress. Minor contributions include increased cyclisation of creatine to creatinine because of acidosis and competitive or non-competitive inhibition of creatinine secretion. Creatinine is not a good marker of renal functional loss after paraquat poisoning and renal injury should be evaluated using more specific biomarkers of renal injury.

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Section: Discussionmentioning

confidence: 99%

Mechanisms Underlying Early Rapid Increases in Creatinine in Paraquat Poisoning

et al. 2015

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“…Several publications have attempted to create a "kinetic" estimated GFR (keGFR) equation to estimate CrCl or GFR in the non-steady-state using 2 creatinine measurements and fluid balance; others have used 2 compartment models to accurately estimate CrCl in the setting of fluctuating renal function, thereby facilitating earlier classification of AKI than by a creatinine-based approach, or the principles of mass balance [14][15][16]. These mass balance equations have the potential to provide clinically relevant real-time values of GFR without the need for timed urine collections.…”

Section: Introductionmentioning

confidence: 99%

Kinetic estimated glomerular filtration rate and acute kidney injury in cardiac surgery patients

Seelhammer

Maile

Heung

et al. 2016

Journal of Critical Care

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“…8 Each may differ in their mathematical approach, algebraic or calculus based, but they are all essentially rooted in first principles of creatinine mass balance that solves for the requisite creatinine excretion from a creatinine production rate and observed rate of change in the plasma creatinine. The creatinine excretion is then converted into a clearance rate.…”

mentioning

confidence: 99%

Retooling the Creatinine Clearance Equation to Estimate Kinetic GFR when the Plasma Creatinine Is Changing Acutely

Chen

2013

Journal of the American Society of Nephrology

172

224

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It is often desirable to estimate the GFR (eGFR) at the bedside to assess AKI or renal recovery. Current eGFR equations estimate kidney function when the plasma creatinine is stable, but do not work if the plasma creatinine is changing rapidly. To analyze kidney function in the acute setting, a simple formula is proposed that requires only a modest number of inputs that are readily obtainable from clinical laboratory data. The so-called kinetic eGFR (KeGFR) formula is derived from the initial creatinine content, volume of distribution, creatinine production rate, and the quantitative difference between consecutive plasma creatinines over a given time. For that period, the deciphered creatinine excretion then yields the creatinine clearance rate. The additional formula variables needed are any steady-state plasma creatinine, the corresponding eGFR by an empirical formula, and the maximum increase in creatinine per day if anuric. The kinetic formula complements clinical intuition but also adds a quantitative and visual dimension to the assessment of kidney function, demonstrated by its analysis of GFRs underlying the plasma creatinine fluctuations in several scenarios of AKI or renal recovery. Deduced from first principles regarding the physiology of creatinine balance, the KeGFR formula enhances the fundamental clearance equation with the power and versatility to estimate the kidney function when the plasma creatinine is varying acutely.

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Evaluation of estimated creatinine clearance before steady state in acute kidney injury by creatinine kinetics

Cited by 24 publications

References 12 publications

Mechanisms Underlying Early Rapid Increases in Creatinine in Paraquat Poisoning

Mechanisms Underlying Early Rapid Increases in Creatinine in Paraquat Poisoning

Kinetic estimated glomerular filtration rate and acute kidney injury in cardiac surgery patients

Retooling the Creatinine Clearance Equation to Estimate Kinetic GFR when the Plasma Creatinine Is Changing Acutely

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