-
Heart Failure Clinics Oct 2019Patients with acute or chronic decompensated heart failure (ADHF) present with various degrees of heart and kidney dysfunction characterizing cardiorenal syndrome (CRS).... (Review)
Review
Patients with acute or chronic decompensated heart failure (ADHF) present with various degrees of heart and kidney dysfunction characterizing cardiorenal syndrome (CRS). CRS can be generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of 1 organ may induce acute or chronic dysfunction of the other. ADHF is a challenge in the management of heart failure. This review provides an overview the pathophysiology of type 1 CRS together with new approaches to treatment in patients with heart failure with worsening renal function or acute kidney disease.
Topics: Acute Kidney Injury; Cardio-Renal Syndrome; Disease Management; Disease Progression; Heart Failure; Humans
PubMed: 31472882
DOI: 10.1016/j.hfc.2019.05.002 -
American Journal of Kidney Diseases :... Nov 2020Acute kidney injury (AKI) is one of the most common and morbid complications of decompensated cirrhosis. Management of AKI is dictated by cause: prerenal AKI is treated... (Review)
Review
Acute kidney injury (AKI) is one of the most common and morbid complications of decompensated cirrhosis. Management of AKI is dictated by cause: prerenal AKI is treated with volume resuscitation; hepatorenal syndrome (HRS), with intravenous albumin and vasoconstrictors; and acute tubular necrosis, with supportive care. However, differentiating between causes is difficult using creatinine-based definitions of AKI alone. The use of novel kidney biomarkers in AKI and cirrhosis provides an opportunity to improve both the diagnosis and prognosis of this vulnerable population. This review examines the challenges of AKI in cirrhosis and the research experience around novel kidney biomarkers in cirrhosis. Specific focus is paid to the tubular injury marker neutrophil gelatinase-associated lipocalin (NGAL), which has been the most studied in liver disease and has demonstrated the strongest performance in differentiating the cause of AKI (acute tubular necrosis vs functional injury such as prerenal AKI or HRS), as well as improving the prognostic performance of mortality prediction models such as the model for end stage liver disease (MELD) score. We advocate for the discussion of incorporating markers such as NGAL in the next iteration of HRS guidelines and identify areas for future research in this clinical condition.
Topics: Acute Kidney Injury; Biomarkers; Disease Progression; Glomerular Filtration Rate; Humans; Liver Cirrhosis; Prognosis
PubMed: 32622560
DOI: 10.1053/j.ajkd.2020.03.016 -
Nephron 2019Delayed allograft function (DGF) is defined as dialysis treatment in the kidney transplant recipient in the first week following transplantation. With the demand for... (Review)
Review
Delayed allograft function (DGF) is defined as dialysis treatment in the kidney transplant recipient in the first week following transplantation. With the demand for kidney transplants growing and the supply limited, as well as implementation of a national allocation scheme for deceased donor kidneys, rates of DGF remain high, on average, 30% for recipients of deceased donor kidneys. DGF is associated with inferior allograft outcomes, and there are no FDA-approved therapies to mitigate this disorder. There is renewed interest in this therapeutic arena, and there are several recent clinical trials that have considered interventions within the recipient to reduce injury. A critical issue is that of trial design and end points as well as translating from acute kidney injury (AKI) trials in cardiac bypass to the more complicated kidney transplant scenario. DGF is a significant clinical outcome after kidney transplantation without known approved therapy beyond clinical support. This mini-review highlights our presentation at the 24th International Conference on Advances in Critical Care Nephrology and UAB/UCSD O'Brien Center AKI Pre-Meeting.
Topics: Acute Kidney Injury; Animals; Delayed Graft Function; Graft Rejection; Humans; Kidney Transplantation; Postoperative Complications
PubMed: 31096218
DOI: 10.1159/000500550 -
Nephron 2017Adjudication, which comes from the Latin term "adjudicare" (to act as a judge), uses expert opinion to define and classify disease entities. The use of clinical... (Review)
Review
Adjudication, which comes from the Latin term "adjudicare" (to act as a judge), uses expert opinion to define and classify disease entities. The use of clinical adjudication may help to define more homogeneous disease subsets but comes at the expense of effort needed and generalizability. Here, we will describe the pros and cons of acute kidney injury (AKI) adjudication under varied circumstances. We will use heart failure as a paradigm and provide comparable examples from the current AKI literature.
Topics: Acute Kidney Injury; Biomarkers; Heart Failure; Humans
PubMed: 28614829
DOI: 10.1159/000477831 -
Cardiovascular Journal of Africa 2020Acute kidney injury is a disease spectrum that can present with from mild renal dysfunction to complete renal failure that would require renal replacement therapy.... (Review)
Review
Acute kidney injury is a disease spectrum that can present with from mild renal dysfunction to complete renal failure that would require renal replacement therapy. Cardiac surgery-associated acute kidney injury is a complication that carries a grave disease burden. Risk factors are identified as being either modifiable or non-modifiable. This literature review aims to define the pathophysiology of cardiac surgery-associated acute kidney injury, the current definition and classification of acute kidney injury and the available diagnostic modalities, especially the use of biomarkers.
Topics: Acute Kidney Injury; Biomarkers; Cardiac Surgical Procedures; Glomerular Filtration Rate; Humans; Kidney; Kidney Function Tests; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 32555928
DOI: 10.5830/CVJA-2019-069 -
Nephron 2018Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and... (Review)
Review
BACKGROUND
Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients' outcome.
SUMMARY
According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrease, that are not renal-specific and have important limitations. However, preoperative risk stratification for postoperative AKI and/or early diagnosis after surgery could be the best way to apply preventive or timely supportive therapeutic measures. Clinical prediction scores, renal functional reserve assessment, and new biomarkers of kidney stress (suppression of tumorigenicity-2, insulin-like growth factor binding protein-7, tissue inhibitor metalloproteinase-2) may help the clinicians to identify patients at risk of AKI and that could benefit from the application of nephroprotective bundles suggested by the KDIGO guidelines. In severe AKI patients with oligoanuria and fluid accumulation, renal replacement therapy is the only supportive measure even if mode and timing remain open to investigation. Key messages: Perioperative AKI is an important and underdiagnosed complication. Identifying patients at high risk of AKI and diagnosing AKI early are major goals. Preventive interventions are mainly based on the KDIGO guidelines and bundles. Furthermore, a personalized multidisciplinary approach should always be considered to minimize the progression of disease and the complications related to kidney damage.
Topics: Acute Kidney Injury; Biomarkers; Humans; Intraoperative Complications; Perioperative Care; Postoperative Complications; Renal Replacement Therapy
PubMed: 29945154
DOI: 10.1159/000490500 -
Nephron 2017Acute kidney injury (AKI) continues to be a major therapeutic challenge. Despite significant advances made in cellular and molecular pathophysiology of AKI, major gaps... (Review)
Review
Acute kidney injury (AKI) continues to be a major therapeutic challenge. Despite significant advances made in cellular and molecular pathophysiology of AKI, major gaps in knowledge exist regarding the changes in renal hemodynamics and oxygenation in the early stages and through the continuum of AKI. Particular features of renal hemodynamics and oxygenation increase the susceptibility of the kidney to sustain injury due to oxygen demand-supply mismatch and also play an important role in the recovery and repair from AKI as well as the transition of AKI to chronic kidney disease. However, lack of well-established physiological biomarkers and noninvasive imaging techniques limit our understanding of the interactions between renal macro and microcirculation and tissue oxygenation in AKI. Advances in our ability to assess these parameters in preclinical and clinical AKI will enable the development of targeted therapeutics to improve clinical outcomes.
Topics: Acute Kidney Injury; Hemodynamics; Humans; Kidney; Oxygen Consumption; Renal Circulation
PubMed: 28614837
DOI: 10.1159/000477830 -
International Journal of Molecular... Jan 2017Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and... (Review)
Review
Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and chronic kidney injury. Both the direct and indirect effects of the drug, and the context which leads to the development of renal failure, are explored. While commonly used safely for pain control and anesthesia in those with kidney disease, the concerns with respect to side effects and toxicity of opioids are addressed. This is especially relevant with the worldwide increase in the use of opioids for medical and recreational use.
Topics: Acute Kidney Injury; Analgesics, Opioid; Humans; Incidence; Kidney; Renal Insufficiency
PubMed: 28117754
DOI: 10.3390/ijms18010223 -
FP Essentials Oct 2021Acute kidney injury (AKI) is characterized by an abrupt decrease in renal function or the onset of frank renal failure. Kidney Disease: Improving Global Outcomes (KDIGO)...
Acute kidney injury (AKI) is characterized by an abrupt decrease in renal function or the onset of frank renal failure. Kidney Disease: Improving Global Outcomes (KDIGO) defines AKI as an increase in the serum creatinine (SCr) level of 0.3 mg/dL or more within 48 hours, an SCr level increase of 1.5 times or more of the baseline level within 7 days, or a decrease in urine output to less than 0.5 mL/kg/hour for 6 hours. AKI severity is determined by the degree of SCr increase or decrease in urine output. AKI typically is caused by systemic illness or toxic exposure. Thus, determining the cause is critical when possible. The history should focus on risk factors, including nephrotoxic drugs. The physical examination should include determination of fluid volume status. Urinalysis with microscopy can narrow the differential diagnosis. AKI management includes control of the underlying cause, achievement and maintenance of euvolemia, nutritional optimization, blood glucose control, and pharmacotherapy. Treatment with fluid resuscitation or diuresis is guided by the volume status. Emergent referral to a nephrology subspecialist is recommended for patients with stage 2 or 3 AKI; patients with stage 1 AKI and a concomitant, decompensated condition; or if the etiology of the AKI is unclear. Urgent referral should be considered if the injury does not improve with treatment or if glomerulonephritis is suspected.
Topics: Acute Kidney Injury; Creatinine; Humans; Risk Factors
PubMed: 34643360
DOI: No ID Found -
Contributions To Nephrology 2016Acute kidney injury (AKI), also known in the past as acute renal failure, is a syndrome characterized by the rapid loss of kidney excretory function. It is usually... (Review)
Review
Acute kidney injury (AKI), also known in the past as acute renal failure, is a syndrome characterized by the rapid loss of kidney excretory function. It is usually diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output or both. AKI is the clinical consequence of several disorders that acutely affect the kidney, causing electrolytes and acid-base imbalance, hyperhydration and loss of depurative function. AKI is common in critical care patients in whom it is often secondary to extrarenal events. No specific therapies can attenuate AKI or accelerate renal function recovery; thus, the only treatment is supportive. New diagnostic techniques such as renal biomarkers might improve early diagnosis. Also ultrasonography helps nephrologists in AKI diagnosis, in order to describe and follow kidney alterations and find possible causes of AKI. Renal replacement therapy is a life-saving treatment if AKI is severe. If patients survive to AKI, and did not have previous chronic kidney disease (CKD), they typically recover to dialysis independence. However, evidence suggests that patients who have had AKI are at increased risk of subsequent CKD.
Topics: Acute Kidney Injury; Biomarkers; Early Diagnosis; Humans; Renal Replacement Therapy; Ultrasonography
PubMed: 27169469
DOI: 10.1159/000445460