Urinary Biomarkers and Renal Recovery in Critically Ill Patients with Renal Support

Srisawat, Nattachai; Wen, Xiang; Lee, Minjae; Kong, Lan; Elder, Michele; Carter, Melinda; Unruh, Mark; Finkel, Kevin W.; Vijayan, Anitha; Mohan, Ramkumar; Paganini, Emil P.; Singbartl, Kai; Palevsky, Paul M.; Kellum, John A.

doi:10.2215/cjn.11261210

Cited by 152 publications

(158 citation statements)

References 34 publications

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“…Modest increases in urinary NGAL have also been detected in patients with prerenal AKI, suggesting that mild renal tubular injury could be recognized (31). Decreasing urinary NGAL was associated with greater odds for renal recovery (32). However, sCr and GFR achieved similar performance levels, and both plasma and urinary NGAL had only a minor role in predicting hospital mortality (31).…”

Section: Discussionmentioning

confidence: 99%

Kinetic eGFR and Novel AKI Biomarkers to Predict Renal Recovery

Dewitte

Joannès-Boyau

Sidobre

et al. 2015

Clinical Journal of the American Society of Nephrology

108

109

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Background and objectives Prompt recognition of severe renal impairment could improve the early management of critically ill patients. We compared the value of kinetic eGFR, plasma neutrophil gelatinase-associated lipocalin (NGAL), and urine tissue inhibitor of metalloproteinase-2 and urine insulin-like growth factor-binding protein 7 ([TIMP-2]*[IGFBP7]) in predicting short-term recovery from AKI and major adverse kidney events.Design, setting, participants, & measurements During the 6-month study period, 245 patients were admitted to our intensive care unit. This study included 57 consecutive patients presenting with AKI within the first 24 hours after admission. AKI markers were evaluated at inclusion (day 0) and 24 hours later (day 1). Kinetic eGFR was calculated on day 1 according to serum creatinine evolution. Renal recovery was defined as normalization of serum creatinine with reversal of oliguria within 48 hours. Major adverse kidney events included death, need for RRT, or persistence of renal dysfunction at hospital discharge.Results Plasma NGAL and [TIMP-2]*[IGFBP7] predicted renal recovery, with area under the receiver-operating characteristic curve (AUC-ROC) values between 0.70 and 0.79 at inclusion. Although plasma NGAL values frequently reached the maximal measurement range, their decrease on day 1 predicted recovery. The kinetic eGFR calculation after initial resuscitation provided the best AUC-ROC value for renal recovery, at 0.87. The best predictions for major adverse kidney events were provided by [TIMP-2]*[IGFBP7] and kinetic eGFR (equal AUCROCs of 0.81). Combining AKI markers in addition to clinical prediction models improved the discrimination and reclassification of patients who will recover from AKI or suffer from major adverse kidney events.Conclusions Biomarkers of kidney damage predicted short-term renal recovery and major adverse kidney events for an unselected cohort of critically ill patients. Calculating the kinetic eGFR imposed a delay after initial resuscitation but provided a good diagnostic and prognostic approach. The utility of functional and damage AKI marker combinations in addition to clinical information requires validation in larger prospective studies.

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Section: Discussionmentioning

confidence: 99%

Kinetic eGFR and Novel AKI Biomarkers to Predict Renal Recovery

Dewitte

Joannès-Boyau

Sidobre

et al. 2015

Clinical Journal of the American Society of Nephrology

108

109

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“…First, we selected candidate biomarkers on the basis of biologic plausibility within inflammation and apoptosis. We did not include more recent novel urinary biomarkers, such as neutrophil gelatinase-associated lipocalin (14), kidney injury molecule-1 (15), or cell-cycle arrest markers (16,17) because the ATN trial did not collect urine samples (3). In a small subset of the BioMaRK study cohort, we previously examined a panel of urinary markers and found that day 1 results were of similar predictive value (AUROC, 0.51-0.66) to the markers examined in this study (15).…”

Section: Discussionmentioning

confidence: 99%

Biomarker Enhanced Risk Prediction for Adverse Outcomes in Critically Ill Patients Receiving RRT

Pike

Murugan

Keener

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Higher plasma concentrations of inflammatory and apoptosis markers in critically ill patients receiving RRT are associated with RRT dependence and death. This study objective was to examine whether plasma inflammatory ; macrophage migration inhibitory factor) and apoptosis (death receptor-5, tumor necrosis factor receptor I and II) biomarkers augment risk prediction of renal recovery and mortality compared with clinical models.Design, setting, participants, & measurements The Biologic Markers of Recovery for the Kidney study (n=817) was a prospective, nested, observational cohort study conducted as an ancillary to the Veterans Affairs/ National Institutes of Health Acute renal failure Trial Network study, a randomized trial of intensive versus less intensive RRT in critically ill patients with AKI conducted between November 2003 and July 2007 at 27 Veterans Affairs-and university-affiliated centers. Primary outcomes of interest were renal recovery and mortality at day 60. Conclusions This study suggests that a simple four-variable clinical model with plasma IL-8 had predictive value for renal recovery and mortality. These findings require external validation but could easily be used by clinicians.

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“…La utilización de biomarcadores asociados a IRA, como son la Lipocalina Asociada a Gelatinasa de Neutrófilos (NGAL), cistatina C, IL-18 y KIM-1, para diagnóstico precoz, podría ayudar a mejorar el pronóstico que no ha cambiado en los últimos años. Hasta el día de hoy no se ha logrado que los biomarcadores constituyan una herramienta útil en la práctica clínica [42][43][44][45][46] , estableciéndose así un desafío a futuras investigaciones.…”

Section: Discussionunclassified