The bio-sonographic index. A novel modality for early detection of acute kidney injury after complex vascular surgery. A protocol for an exploratory prospective study

Abstract

Objective Acute kidney injury (AKI) is a common complication of complex aortic surgery with high mortality, morbidity and health care expense. The current definition of AKI does not allow for structural characterization of the kidneys and utilizes functional indices with substantial limitations leading to delayed diagnosis and ineffective interventions. The aim of this study is to develop a method of early detection of structural renal abnormalities that can precede and predict the occurrence of AKI in this population. We propose a novel combined index of ultrasonography (shear wave elastography), biomarkers of renal stress (urinary insulin growth factor binding protein-7, IGFBP-7 and inhibitor of tissue metalloproteinase-2, TIMP-2) and renal injury markers (urinary neutrophil gelatinase-associated lipocalin -NGAL)- the bio-sonographic index (BSI). Methods A prospective observational study at a tertiary referral center will be performed enrolling 80 patients undergoing elective open and endovascular repair of the visceral aorta. The BSI will be evaluated at baseline, and at 6 and 24 hours after the procedure. The primary outcome is the occurrence of AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Each patient will be his/her own control. A reference group of 15 healthy volunteers who are not undergoing interventions will be enrolled to test the feasibility of and to refine the novel SWE protocol. The BSI will be tested for its predictability of the occurrence of AKI. Comparisons will be made between individual and combined components of the BSI and traditional markers used in the KDIGO definition; serum creatinine and urine output in terms of baseline status of the kidney. Correlations will be made between the BSI and conventional indices of AKI and exploratory analyses will be conducted to identify individual disease patterns using the BSI. Discussion We hypothesize that the BSI will be a sensitive index of early structural abnormalities that precede and predict the occurrence of AKI as defined by KDIGO in complex vascular surgery. Trial registration ClinicalTrials.gov NCT04144894. Registered 1/6/2020.

Value of shear wave elastography in predicting hepatorenal syndrome in patients with liver cirrhosis and ascites

“…In a clinical study, SWE improved the diagnostic value of current biomarkers, suggesting its clinical application in HRS. 28 In this study, we observed an increase in renal RI and a decrease in YM in patients with liver cirrhosis and ascites when AKI occurs, indicating that the changes in the values of RI and YM were related to the decline of the patient's renal function. Subsequently, in patients who developed HRS, we found that their renal RI was significantly higher, while YM was significantly lower than that of patients with non-HRS AKI.…”

“…Other studies also found that both SWE and renal stiffness tend to decrease with decreasing perfusion pressure. In a clinical study, SWE improved the diagnostic value of current biomarkers, suggesting its clinical application in HRS 28 . In this study, we observed an increase in renal RI and a decrease in YM in patients with liver cirrhosis and ascites when AKI occurs, indicating that the changes in the values of RI and YM were related to the decline of the patient's renal function.…”