Urinary biomarker incorporation into the renal angina index early in intensive care unit admission optimizes acute kidney injury prediction in critically ill children: a prospective cohort study

Menon, Shina; Goldstein, Stuart L.; Mottes, Theresa; Lin, Fei; Kaddourah, Ahmad; Terrell, Tara; Arnold, P; Bennett, Michael; Basu, Rajit K.

doi:10.1093/ndt/gfv457

Cited by 106 publications

(69 citation statements)

References 49 publications

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“…Our results were agreed with study Shina Menon et al 2016 [10], which state that approximately one in three patients (32.6%) was RA+ within the irst 12h of PICU admission. These patients had a higher prevalence of sepsis.…”

Section: Discussionsupporting

confidence: 93%

“…Our results was agreed with study of Shina Menon et al 2016 [10], which stated that there was statistically signi icant increase in serum creatinine and renal angina ful illment (RAI+) (P-value < 0.001).…”

Section: Discussionsupporting

confidence: 93%

“…Also our results was agreed with study of Shina Menon et al 2016 [10], which stated that addition of NGAL to RAI enhance the predictive ability of RAI (AUC of RAI is 0.80 and AUC of both RAI and NGAL 0.97).…”

Section: Discussionsupporting

confidence: 93%

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Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

Zeid¹,

Mohammed²,

AbdAlazeem³

et al. 2019

J Clini Nephrol

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Background and objectives: New AKI biomarkers (on the top of it NGAL biomarker) have demonstrated better performance for prediction of AKI in critically ill patients with heterogeneous illness. Renal angina index was recently reported to enhance prediction of severe AKI at the time of intensive care unit admission. This study tested the hypothesis that incorporation of uNGAL in patients with renal angina improves the prediction of severe AKI. Design, setting, participants & measurements:In our study 53critically ill children admitted to the pediatric intensive care unit in Zagazig university hospital, Measurement of urine neutrophil gelatinaseassociated lipocalin (uNGAL) was determined individually by ELISA kit and in combination with the RAI which is calculated in each critically ill child for severe AKI. Statistical analysis was done for these data.Results: Individual uNGAL demonstrated marginal discrimination for severe AKI (area under curve [AUC]: NGAL, 0.877), little higher than prediction by RAI (AUC=0.847). Incorporation of uNGAL signifi cantly added to the renal angina index AKI prediction (AUC=0.847, increased to 0.893). Conclusion:This study shows that incorporation of uNGAL into the RAI improves detection ability of severe AKI in critically ill children.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

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Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

Zeid¹,

Mohammed²,

AbdAlazeem³

et al. 2019

J Clini Nephrol

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“…The renal angina index (RAI) is used for pediatric cohorts instead of RA to evaluate the risk for developing AKI by establishing point values [47, 48]. Clinical studies confirmed that a combined use of AKI biomarkers with RAI could improve the predictive value of the biomarkers for AKI [49]. Therefore, to a certain extent, this approach may be considerably potent for early prediction of AKI.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 for acute kidney injury: a meta-analysis

et al. 2017

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BackgroundTissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7), inducers of G1 cell cycle arrest, are two recently discovered good biomarkers for early diagnosis of acute kidney injury (AKI). To obtain a more robust performance measurement, the present meta-analysis was performed, pooling existing studies.MethodsLiterature in the MEDLINE (via PubMed), Ovid, Embase, and Cochrane Library databases was systematically searched from inception to 12 October 2016. Studies that met the set inclusion and exclusion criteria were identified by two independent investigators. The diagnostic value of urinary [TIMP-2] × [IGFBP7] for AKI was evaluated by pooled sensitivity, specificity, likelihood ratio (LR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve analyses. The causes of heterogeneity were explored by sensitivity and subgroup analyses.ResultsA total of nine published and eligible studies assessing 1886 cases were included in this meta-analysis. Early diagnostic value of urinary [TIMP-2] × [IGFBP7] for AKI was assessed using a random-effects model. Pooled sensitivity and specificity with corresponding 95% CIs were 0.83 (95% CI 0.79–0.87, heterogeneity I 2 = 68.8%) and 0.55 (95% CI 0.52–0.57, I 2 = 92.9%), respectively. Pooled positive LR, negative LR, and DOR were 2.37 (95% CI 1.87–2.99, I 2 = 82.6%), 0.30 (95% CI 0.21–0.41, I 2 = 43.4%), and 9.92 (95% CI 6.09–16.18, I 2 = 38.5%), respectively. The AUC estimated by SROC was 0.846 (SE 0.027) with a Q* value of 0.777 (SE 0.026). Sensitivity analysis indicated that one study significantly affected the stability of pooled results. Subgroup analysis showed that population setting and AKI threshold were the key factors causing heterogeneity in pooled sensitivity and specificity.ConclusionsOn the basis of recent evidence, urinary [TIMP-2] × [IGFBP7] is an effective predictive factor of AKI.Trial registrationPROSPERO registration number: CRD42016051186. Registered on 10 November 2016.

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“…The RAI combines validated clinical risk factors (ICU admission, solid organ or stem cell transplant, mechanical ventilation, and vasopressor need) with evidence for decreased kidney function (increases in serum creatinine or degrees of fluid accumulation) to stratify patients at risk for subsequent severe AKI. Importantly, the incorporation of urinary biomarkers further improves the predictive ability of the RAI (26). In a prospective study of 184 children admitted to the pediatric ICU, a positive RAI (score ≥8) was present in 33% of patients at day 0 and predicted day 3 AKI with an AUC of 0.80.…”

Section: Identify Patients Who Are At Risk For Aki Post-injury Earlymentioning

confidence: 99%

The Current State of the Art in Acute Kidney Injury

Devarajan

2020

Front. Pediatr.

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Decades of pre-clinical research have revealed biologic pathways that have suggested potential therapies for acute kidney injury (AKI) in experimental models. However, translating these to human AKI has largely yielded disappointing results. Fortunately, recent discoveries in AKI molecular mechanisms are providing new opportunities for early detection and novel interventions. This review identifies technologies that are revealing the exceptionally complex nature of the normal kidney, the remarkable heterogeneity of the AKI syndrome, and the myriad responses of the kidney to AKI. Based on the current state of the art, novel approaches to improve the bench-to-bedside translation of novel discoveries are proposed. These strategies include the use of unbiased approaches to improve our understanding of human AKI, establishment of irrefutable biologic plausibility for proposed biomarkers and therapies, identification of patients at risk for AKI pre-injury using clinical scores and non-invasive biomarkers, initiation of safe, and effective preventive interventions of pre-injury in susceptible patients, identification of patients who may develop AKI post-injury using electronic triggers, clinical scores, and novel biomarkers, employment of sequential biomarkers to initiate appropriate therapies based on knowledge of the underlying pathophysiology, use of new biomarkers as criteria for enrollment in randomized clinical trials, assessing efficacy, and empowering the drug development process, and early initiation of anti-fibrotic therapies. These strategies are immediately actionable and hold tremendous promise for effective bench-to-bedside translation of novel discoveries that will change the current dismal prognosis of human AKI.

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Urinary biomarker incorporation into the renal angina index early in intensive care unit admission optimizes acute kidney injury prediction in critically ill children: a prospective cohort study

Abstract: We have now prospectively validated the RAI as a functional risk stratification methodology in a heterogeneous group of critically ill patients, providing context to direct measurement of novel urinary biomarkers and improving the prediction of severe persistent AKI.

Cited by 106 publications

References 49 publications

Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

Diagnostic value of urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 for acute kidney injury: a meta-analysis

The Current State of the Art in Acute Kidney Injury

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