Use of stress tests in evaluating kidney disease

Koyner, Jay L.; Chawla, Lakhmir S.

doi:10.1097/mnh.0000000000000292

Cited by 10 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…26 This test measures the urine output response to furosemide, an inhibitor of sodium potassium chloride cotransporter in the Loop of Henle, and provides an indirect measure of functioning nephrons. 27…”

Section: Traditional and Novel Biomarkers For Aki Phenotypingmentioning

confidence: 99%

Phenotyping of Acute Kidney Injury: Beyond Serum Creatinine

Moledina

Parikh

2018

Seminars in Nephrology

136

117

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a common complication in hospitalized patients and is associated with adverse short- and long-term outcomes. AKI is diagnosed by serum creatinine (SCr)-based consensus definitions that capture an abrupt decrease in glomerular filtration rate associated with AKI. However, SCr-based AKI definitions lack sensitivity and specificity for diagnosing structural kidney injury. Moreover, AKI is a heterogeneous condition consisting of distinct phenotypes based on its etiology, prognosis, and molecular pathways, and that may potentially require different therapies. SCr-based AKI definitions provide no information on these AKI phenotypes. This review highlights traditional and novel tools that overcome the limitations of SCr-based AKI definitions to improve AKI phenotyping.

show abstract

Section: Traditional and Novel Biomarkers For Aki Phenotypingmentioning

confidence: 99%

Phenotyping of Acute Kidney Injury: Beyond Serum Creatinine

Moledina

Parikh

2018

Seminars in Nephrology

136

117

View full text Add to dashboard Cite

show abstract

“…The functions of the thick ascending limb, luminal patency, and collecting duct must all be intact. A decrement in the response to furosemide below a predefined threshold, which suggests the evolution of progressive renal dysfunction 6 7 8 as demonstrated by 11 of the patients with no AKI at furosemide and severe AKI within the 7 day observation period after furosemide. Thus, it can be used as a functional capacitance marker identifying the amount of reserve left in the renal tubular system.…”

Section: Discussionmentioning

confidence: 99%

“…Quantification of urine output following administration of a medication that is not filtered by the glomerulus (i.e., furosemide), also known as the furosemide stress test (FST) may yield informative and actionable information on the evolution of AKI even in the absence of serum creatinine elevation. [6][7][8] This concept of stress testing is used to assess the reserve of an organ, and it has the potential to provide excellent diagnostic information in assessing progression of disease. Organ reserve is defined as the difference between maximal functional capacity and baseline functional capacity.…”

Section: Introductionmentioning

confidence: 99%

Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children

Gist

Penk

Wald

et al. 2021

J Pediatr Intensive Care

View full text Add to dashboard Cite

A standardized, quantified assessment of furosemide responsiveness predicts acute kidney injury (AKI) in children after cardiac surgery and AKI progression in critically ill adults. The purpose of this study was to determine if response to furosemide is predictive of severe AKI in critically ill children outside of cardiac surgery. We performed a multicenter retrospective study of critically ill children. Quantification of furosemide response was based on urine flow rate (normalized for weight) measurement 0 to 6 hours after the dose. The primary outcome was presence of creatinine defined severe AKI (Kidney Disease Improving Global Outcomes stage 2 or greater) within 7 days of furosemide administration. Secondary outcomes included mortality, duration of mechanical ventilation and length of stay. A total of 110 patients were analyzed. Severe AKI occurred in 20% (n = 22). Both 2- and 6-hour urine flow rate were significantly lower in those with severe AKI compared with no AKI (p = 0.002 and p < 0.001). Cutoffs for 2- and 6-hour urine flow rate for prediction of severe AKI were <4 and <3 mL/kg/hour, respectively. The adjusted odds of developing severe AKI for 2-hour urine flow rate of <4 mL/kg/hour was 4.3 (95% confidence interval [CI]: 1.33–14.15; p = 0.02). The adjusted odds of developing severe AKI for 6-hour urine flow rate of <3 mL/kg/hour was 6.19 (95% CI: 1.85–20.70; p = 0.003). Urine flow rate in response to furosemide is predictive of severe AKI in critically ill children. A prospective assessment of urine flow rate in response to furosemide for predicting subsequent severe AKI is warranted.

show abstract

“…As accumulation of fluid can be a proxy for reduced UOP, and evidence indicates excessive positive fluid balance (FO) is associated with poor outcome (44), attention to how UOP and FO change over time may offer a point of intervention earlier than changes in SCr. To this end, the furosemide stress test (FST), a standardized metric to gauge urine flow after a single diuretic dose, may be valuable to phenotype renal reserve and tubular function (36,45,46).…”

Section: Precision In Aki: Combinations and Sequential Biomarkersmentioning

confidence: 99%

Dynamic Biomarker Assessment: A Diagnostic Paradigm to Match the AKI Syndrome

Basu

2020

Front. Pediatr.

View full text Add to dashboard Cite

Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of injury as well as to reconsider the existing diagnostic framework. Novel urinary and serum biomarkers of injury have, however, not been readily integrated into practice-partially because of the limited scope to current testing. The predominant focus to date has been the adjudication of a single biomarker measured at a single point of time for the prediction of either AKI progression or disease-related mortality. This approach is pragmatically problematic. The imprecise, umbrella classification of AKI diagnosis coupled with the absence of a consistently effective set of therapies creates a difficult rubric for biomarkers to demonstrate value in the scope of practice. AKI is, however, not a binary process but more an ICU syndrome-with complex biology underpinning injury, interacting and disrupting other organ function, multidimensional in manifestation, and varying in severity over time. As such, a more appropriate diagnostic paradigm is needed. In this minireview, the status quo for AKI diagnosis and associated limitations will be discussed, and a novel, dynamic, and multidimensional paradigm will be presented. Appreciation of AKI as an ICU syndrome and creation of an appropriately matching and sophisticated diagnostic platform of injury assessment are possible and represent the next step in AKI management.

show abstract

Use of stress tests in evaluating kidney disease

Abstract: Although various methods to interrogate the reserve capacity of the several nephron segments (glomerulus and tubules) have been investigated, none of these techniques have had wide-spread clinical implementation. Further research into acute kidney injury stress testing is warranted.

Cited by 10 publications

References 35 publications

Phenotyping of Acute Kidney Injury: Beyond Serum Creatinine

Phenotyping of Acute Kidney Injury: Beyond Serum Creatinine

Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children

Dynamic Biomarker Assessment: A Diagnostic Paradigm to Match the AKI Syndrome

Contact Info

Product

Resources

About