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American Family Physician Dec 2019Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. Acute...
Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. Acute kidney injury is associated with an increased risk of mortality, cardiovascular events, and progression to chronic kidney disease. Severity of acute kidney injury is classified according to urine output and elevations in creatinine level. Etiologies of acute kidney injury are categorized as prerenal, intrinsic renal, and postrenal. Accurate diagnosis of the underlying cause is key to successful management and includes a focused history and physical examination, serum and urine electrolyte measurements, and renal ultrasonography when risk factors for a postrenal cause are present (e.g., older male with prostatic hypertrophy). General management principles for acute kidney injury include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function. Additional supportive care measures may include optimizing nutritional status and glycemic control. Pharmacist-led quality-improvement programs reduce nephrotoxic exposures and rates of acute kidney injury in the hospital setting. Acute kidney injury care bundles are associated with improved in-hospital mortality rates and reduced risk of progression. Nephrology consultation should be considered when there is inadequate response to supportive treatment and for acute kidney injury without a clear cause, stage 3 or higher acute kidney injury, preexisting stage 4 or higher chronic kidney disease, renal replacement therapy, and other situations requiring subspecialist expertise.
Topics: Acute Kidney Injury; Creatinine; Fluid Therapy; Glomerular Filtration Rate; Humans; Nephrology; Prognosis; Referral and Consultation; Risk Factors
PubMed: 31790176
DOI: No ID Found -
Expert Review of Molecular Diagnostics Oct 2020Chronic kidney disease (CKD) is common, occurring in over 10% of individuals globally, and is increasing in prevalence. The limitations of traditional biomarkers of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Chronic kidney disease (CKD) is common, occurring in over 10% of individuals globally, and is increasing in prevalence. The limitations of traditional biomarkers of renal dysfunction, such as serum creatinine, have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as serum cystatin C, has the potential to improve disease monitoring and patient care.
AREAS COVERED
The present paper assesses the utility and limitations of serum cystatin C as a biomarker for CKD in light of the current literature.
EXPERT OPINION
Serum cystatin C has been well established as an early and accurate biomarker of CKD that is particularly helpful in patients for whom creatinine is an inadequate marker or for whom more cumbersome methods of glomerular filtration rate (GFR) measurement are impractical. Current research questions are no longer focused on if, but rather when and how often cystatin C should be used in the evaluation of CKD patients. However, transition of all reagents and estimated GFR equations to the newly established International Standard is critical for developing generalizable data.
Topics: Biomarkers; Creatinine; Cystatin C; Glomerular Filtration Rate; Humans; Liquid Biopsy; Prognosis; Renal Insufficiency, Chronic; Reproducibility of Results
PubMed: 32450046
DOI: 10.1080/14737159.2020.1768849 -
Annals of Internal Medicine Feb 2021The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are...
BACKGROUND
The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are recommended serum creatinine (SCr)-based calculations for estimating glomerular filtration rate (GFR). However, these equations, as well as their combination, have limitations, notably the problem of implausible changes in GFR during the transition from adolescence to adulthood and overestimation of GFR in young adults. The full age spectrum (FAS) equation addresses these issues but overestimates GFR when SCr levels are low.
OBJECTIVE
To develop and validate a modified FAS SCr-based equation combining design features of the FAS and CKD-EPI equations.
DESIGN
Cross-sectional analysis with separate pooled data sets for development and validation.
SETTING
Research and clinical studies ( = 13) with measured GFR available.
PATIENTS
11 251 participants in 7 studies (development and internal validation data sets) and 8378 participants in 6 studies (external validation data set).
MEASUREMENTS
Clearance of an exogenous marker (reference method), SCr level, age, sex, and height were used to develop a new equation to estimate GFR.
RESULTS
The new European Kidney Function Consortium (EKFC) equation is a FAS equation with low bias (-1.2 mL/min/1.73 m [95% CI, -2.7 to 0.0 mL/min/1.73 m] in children and -0.9 mL/min/1.73 m [CI, -1.2 to -0.5 mL/min/1.73 m] in adults) across the FAS (2 to 90 years) and SCr range (40 to 490 µmol/L [0.45 to 5.54 mg/dL]) and with fewer estimation errors exceeding 30% (6.5% [CI, 3.8% to 9.1%] in children and 3.1% [CI, 2.5% to 3.6%] in adults) compared with the CKiD and CKD-EPI equations.
LIMITATION
No Black patients were included.
CONCLUSION
The new EKFC equation shows improved accuracy and precision compared with commonly used equations for estimating GFR from SCr levels.
PRIMARY FUNDING SOURCE
Swedish Research Council (Vetenskapsrådet).
Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Creatinine; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Reproducibility of Results; Sex Factors; Young Adult
PubMed: 33166224
DOI: 10.7326/M20-4366 -
Journal of Veterinary Internal Medicine Mar 2022Basal serum cortisol (BSC) ≥2 μg/dL (>55 nmol/L) has high sensitivity but low specificity for hypoadrenocorticism (HA).
BACKGROUND
Basal serum cortisol (BSC) ≥2 μg/dL (>55 nmol/L) has high sensitivity but low specificity for hypoadrenocorticism (HA).
OBJECTIVE
To determine whether the urinary corticoid:creatinine ratio (UCCR) can be used to differentiate dogs with HA from healthy dogs and those with diseases mimicking HA (DMHA).
ANIMALS
Nineteen healthy dogs, 18 dogs with DMHA, and 10 dogs with HA.
METHODS
Retrospective study. The UCCR was determined on urine samples from healthy dogs, dogs with DMHA, and dogs with HA. The diagnostic performance of the UCCR was assessed based on receiver operating characteristics (ROC) curves, calculating the area under the ROC curve.
RESULTS
The UCCR was significantly lower in dogs with HA (0.65 × 10 ; range, 0.33-1.22 × 10 ) as compared to healthy dogs (3.38 × 10 ; range, 1.11-17.32 × 10 ) and those with DMHA (10.28 × 10 ; range, 2.46-78.65 × 10 ) (P < .0001). There was no overlap between dogs with HA and dogs with DMHA. In contrast, 1 healthy dog had a UCCR value in the range of dogs with HA. The area under the ROC curve was 0.99. A UCCR cut-off value of <1.4 yielded 100% sensitivity and 97.3% specificity in diagnosing HA.
CONCLUSIONS AND CLINICAL IMPORTANCE
The UCCR seems to be a valuable and reliable screening test for HA in dogs. The greatest advantage of this test is the need for only a single urine sample.
Topics: Adrenal Insufficiency; Animals; Creatinine; Dog Diseases; Dogs; Hydrocortisone; Retrospective Studies
PubMed: 35150029
DOI: 10.1111/jvim.16358 -
Nutrients May 2020Diabetic nephropathy is a diabetic complication caused by chronic inflammation. As the primary polyphenol in pomegranate, punicalagin is believed to have significant...
Diabetic nephropathy is a diabetic complication caused by chronic inflammation. As the primary polyphenol in pomegranate, punicalagin is believed to have significant anti-inflammatory properties. In this study, we established a mice model for diabetes induced by high-fat diet (HFD)/ streptozotocin (STZ) to verify the protective effect of punicalagin in vivo. The results show that the blood urea nitrogen (BUN), serum creatinine (CREA), and the urine albumin to creatinine ratio (UACR) were significantly decreased in diabetic mice after punicalagin intervention, and the symptoms of glomerular interstitial hyperplasia and glomerular hypertrophy were alleviated. Pyroptosis is an essential manner of programmed cell death in the inflammatory response; the expression of pyroptosis-related proteins such as interleukin-1 (IL-1β), cysteinyl aspartate-specific protease-1 (caspase-1), gasdermin D (GSDMD), and nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain containing protein 3 (NLRP3) was decreased in our study, which proved that the administration of punicalagin for eight weeks can significantly inhibit pyroptosis in mice. In addition, punicalagin reduced high glucose-mediated protein expressions of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4) and alleviated mitochondria damage. Low expression of NOX4 inhibits the dissociation of thioredoxin (Trx) and thioredoxin-interacting protein (TXNIP) and the suppression of NLRP3 inflammasome activation. To summarize, our study provided evidence that punicalagin can alleviate diabetic nephropathy, and the effect is associated with downregulating the expression of NOX4, inhibiting TXNIP/NLRP3 pathway-mediated pyroptosis, suggesting its therapeutic implications for complications of diabetes.
Topics: Albumins; Albuminuria; Animals; Apoptosis; Carrier Proteins; Creatinine; Diabetes Mellitus, Experimental; Diabetic Nephropathies; Diet, High-Fat; Hydrolyzable Tannins; Inflammasomes; Kidney; Male; Mice; Mice, Inbred C57BL; NADPH Oxidase 4; NLR Family, Pyrin Domain-Containing 3 Protein; Protective Agents; Pyroptosis; Serum Albumin; Streptozocin; Thioredoxins
PubMed: 32456088
DOI: 10.3390/nu12051516 -
Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality.JAMA Network Open Dec 2023Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of...
IMPORTANCE
Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR.
OBJECTIVE
To investigate associations of traditionally normal UACR and CVH with all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria.
EXPOSURES
The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points).
MAIN OUTCOMES AND MEASURES
Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups.
RESULTS
The study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001).
CONCLUSIONS AND RELEVANCE
The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.
Topics: Adult; Male; Humans; Female; Middle Aged; Cardiovascular Diseases; Creatinine; Cohort Studies; Nutrition Surveys; Reference Values; Follow-Up Studies; Albumins
PubMed: 38113044
DOI: 10.1001/jamanetworkopen.2023.48333 -
Advances in Therapy Nov 2023The EAGLE-DH study assessed the efficacy and safety of esaxerenone in hypertensive patients with diabetes mellitus receiving sodium-glucose cotransporter 2 (SGLT2)...
INTRODUCTION
The EAGLE-DH study assessed the efficacy and safety of esaxerenone in hypertensive patients with diabetes mellitus receiving sodium-glucose cotransporter 2 (SGLT2) inhibitors.
METHODS
In this multicenter, open-label, prospective, interventional study, esaxerenone was started at 1.25 or 2.5 mg/day and could be gradually increased to 5 mg/day on the basis of blood pressure (BP) and serum potassium levels. Oral hypoglycemic or antihypertensive medications prior to obtaining consent was continued. Data were evaluated in the total population and creatinine-based estimated glomerular filtration rate (eGFR) subcohorts (eGFR ≥ 60 mL/min/1.73 m [G1-G2 subcohort] and 30 to < 60 mL/min/1.73 m [G3 subcohort]).
RESULTS
In total, 93 patients were evaluated (G1-G2, n = 49; G3, n = 44). Morning home systolic/diastolic BP values (SBP/DBP) were significantly reduced from baseline to week 12 (- 11.8 ± 10.8/- 5.1 ± 6.3 mmHg, both P < 0.001) and week 24 (- 12.9 ± 10.5/- 5.7 ± 6.3 mmHg, both P < 0.001). Similar results were observed in both eGFR subcohorts. The urinary albumin-to-creatinine ratio significantly decreased from baseline to week 24 in the total population (geometric percentage change, - 49.1%, P < 0.001) and in both eGFR subcohorts. The incidences of treatment-emergent adverse events (TEAEs) and drug-related TEAEs were 45.2% and 12.9%, respectively; most were mild or moderate. Serum potassium levels increased over the first 2 weeks of esaxerenone treatment, gradually decreased by week 12, and remained constant to week 24. One patient in the G1-G2 subcohort had serum potassium levels ≥ 5.5 mEq/L. No patients had serum potassium ≥ 6.0 mEq/L.
CONCLUSION
Esaxerenone effectively lowered BP, was safe, and showed renoprotective effects in hypertensive patients with diabetes mellitus receiving treatment with SGLT2 inhibitors. Esaxerenone and SGLT2 inhibitors did not interfere with either drug's efficacy and may reduce the frequency of serum potassium elevations, suggesting they are a compatible combination.
CLINICAL TRIAL REGISTRATION
jRCTs031200273.
Topics: Humans; Sodium-Glucose Transporter 2 Inhibitors; Creatinine; Prospective Studies; Hypertension; Blood Pressure; Diabetes Mellitus, Type 2; Potassium; Glucose; Sodium
PubMed: 37733211
DOI: 10.1007/s12325-023-02633-8 -
Brain and Behavior May 2022Hypernatremia often occurs in patients with brain death. This study summarizes its characteristics.
OBJECTIVES
Hypernatremia often occurs in patients with brain death. This study summarizes its characteristics.
METHODS
We recorded 57 patient's highest blood sodium value, as well as daily NT-proBNP, blood creatinine, and urine output. Further, we analyzed the time of the first rise in blood sodium, and the relationship between NT-proBNP, serum creatinine, urine output, and serum sodium.
RESULTS
There was no hyponatremia in these patients, and only seven of the 53 patients registered blood sodium between 137 and 150 mmol/L. We found that blood sodium started to rise at 36.0 (28.5-52.3) h, reaching the highest value in 79.0 (54.0-126.0) h. Urine volume and creatinine have no correlation with serum sodium level, while NT-proBNP has a significant correlation with serum sodium level.
CONCLUSION
It is necessary to conduct volume assessments and urine electrolyte testing on patients with brain death. BNP has a protective effect on water and electrolytes to prevent hypernatremia.
Topics: Brain; Brain Death; Creatinine; Humans; Hypernatremia; Sodium
PubMed: 35452564
DOI: 10.1002/brb3.2574 -
Peritoneal Dialysis International :... May 2020
Topics: Creatinine; Glomerular Filtration Rate; Goals; Humans; Patient Selection; Peritoneal Dialysis; Renal Insufficiency
PubMed: 32063219
DOI: 10.1177/0896860819895364 -
Journal of the American Society of... Jul 2022
Topics: Biomarkers; Creatinine; Cystatin C; Glomerular Filtration Rate; Humans; Infant, Newborn
PubMed: 35728882
DOI: 10.1681/ASN.2022040470