A08 Using Kidney Biomarkers for AKI 2: Differential Diagnosis, Interventions and Prognosis

Size: px
Start display at page:

Download "A08 Using Kidney Biomarkers for AKI 2: Differential Diagnosis, Interventions and Prognosis"

Transcription

1 A08 Using Kidney Biomarkers for AKI 2: Differential Diagnosis, Interventions and Prognosis Kent Doi, MD, PhD Emergency and Critical Care Medicine, The Univ of Tokyo, Japan

2 Using kidney biomarkers: Key questions for differential diagnosis 1. Can biomarkers distinguish a pre-renal state' from AKI? 2. Can biomarkers differentiate etiology of AKI? 3. Can biomarkers identify the mechanism and time course of AKI? 4. Can biomarkers distinguish AKI from CKD? 5. Can biomarkers distinguish de novo AKI from AKI superimposed on CKD? 6. What is role of biomarkers from other organs in the context of determining etiology of AKI?

3 Using kidney biomarkers: Key questions for differential diagnosis 1. Can biomarkers distinguish a pre-renal state' from AKI? 2. Can biomarkers differentiate etiology of AKI? 3. Can biomarkers identify the mechanism and time course of AKI? 4. Can biomarkers distinguish AKI from CKD? 5. Can biomarkers distinguish de novo AKI from AKI superimposed on CKD? 6. What is role of biomarkers from other organs in the context of determining etiology of AKI?

4 Pre-renal AKI acute renal success?? The renal tubules conserve salt and water in the face of sensed renal hypoperfusion. Because this is undoubtedly a good response (a means of organ protection), prerenal syndrome could be called acute renal success.

5 Pre-renal vs Renal AKI Concept Rapid recovery Na reabsorption Pre-renal Physiological reaction against hypoperfusion Yes (Reversible) Increased (low FENa) Renal Structural damage in renal tissue No (Irreversible) Decreased (high FENa) Location Outpatient Inpatient

6 Pre-renal vs Renal AKI 1. Pre-renal AKI Reversible, volume-responsive retrospective diagnosis 2. Ischemic renal AKI As a result of prolonged ischemia, the tubular epithelial cells undergo injury and, if it is severe, cell death by apoptosis and necrosis (=acute tubular necrosis [ATN]), will be observed with organ functional impairment. 3. When pre-renal transforms into renal AKI??

7 Ischemic renal AKI not transient but persistent Sutton TA/Molitoris BA, Kidney Int 2002

8 Ischemic renal AKI Extension phase occurs even after RBF completely recovered. Case: AKI after left ventricular assist device (LVAD) implantation 24 y.o. Male of dilated cardiomyopathy (DCM), no CKD For Decompensated heart failure, IABP+MV+CRRT were used Emergent LVAD implantation

9 2012/6/ /6/ /6/ /6/ /6/ /6/ /6/ /7/2 2012/7/4 2012/7/6 2012/7/8 2012/7/ /7/ /7/ /7/ /7/ /7/ /7/ /7/ /7/ /7/ /7/30 (ml) (mg/dl) AKI after LVAD implantation extension phase of ischemic AKI 2500 LVAD CHDF/IHD plasma NGAL Serum Cre NGAL Urine RRT Cre Urine volume Tsukamoto M/Doi K, Circ J 2015

10 Ischemic renal AKI and Biomarker monitor tubular injury in AKI New AKI biomarkers NGAL, IL-18, KIM-1, L-FABP, TIMP-2/IGFBP-7, etc Ischemia Vaidya VS. Annu Rev Pharmacol Toxicol 2008

11 Function Glomerular (scre) New spectrum of AKI combo of function and damage Damage Tubular biomarkers Pre-renal Renal McCullough PA/Ronco C, Contrib Nephrol 2013

12 New spectrum of AKI combo of function and damage

13 Urinary L-FABP FABPs (Fatty acid-binding proteins) 1. L-FABP : Liver, Kidney (proximal tubule) 2. H-FABP: Heart, Kidney (distal tubule) 3. A-FABP (ap2) : Adipocyte, Macrophage 4. I-FABP : Intestine, Liver fatty acids mitochondrion fatty acids transporter FABP Normal Ischemic (1h Bx) peroxisome ER PPAR RXR PPAR FABP gene expression Yamamoto T/Doi K/Noiri E. JASN 2007 Wolfrum C. PNAS 2001

14 Urinary L-FABP in Pre-renal AKI Volume depletion model shows 1. transient BUN elevation 2. no pathological finding in PAS 3. pimonidazole incorporation BUN (mg/dl) # Hypoxia induced by dehydration (A) (B) 0 0h 24h 48h 72h 7d 14d (C) (D) Pimonidazole Doi K, Kidney Int 2012

15 Urinary L-FABP in Pre-renal AKI Urinary L-FABP discriminates pre-renal from renal AKI. (A) (B) Urinary L-FABP (ng/ml) * * * * * 100~1000x Acute tubular necrosis (C) CDDP (D) I/R ~10x h 24h 48h 72h 0h 72h 0h 24h Dehydration CDDP I/R Doi K, Kidney Int 2012

16 Urinary NGAL Neutrophil gelatinase-associated lipocalin The normal kidney had little staining for NGAL in distal tubules and collecting ducts (<10%). Ischemic ATN produced intense but heterogeneous staining of the cortical tubules (>50%). Mori K and Barash J. JCI 2005

17 Urinary NGAL in pre-renal AKI No expression of NGAL in the dehydrated kidney Renal ischemia reperfusion Dehydration Paragas N and Barash J. Nat Med 2011

18 Urinary NGAL in pre-renal AKI Patients (>18 y.o.) who visited ED of Columbia University Medical Center at 6am~12am from March to August Nickolas TL, Ann Intern Med. 2008

19 Urinary NGAL in pre-renal AKI Higher urinary NGAL level in AKI vs pre-renal or CKD U-NGAL Serum Cre Nickolas TL, Ann Intern Med. 2008

20 Urinary NGAL in pre-renal AKI Urinary NGAL level >130 μg/gcre identified more nephrology consult, dialysis, or ICU admission. Nickolas TL, Ann Intern Med. 2008

21 Combo of U-NGAL and Cystatin C 345 pediatric pts after CPB, 62 (18%) severe AKI (= stage 2, 3) ungal, pcysc at 2h after CPB ΔScre >50% from pre-opp JACC 64 ; , 2014

22 ΔScre, pcysc Combo of U-NGAL and Cystatin C Double-positive biomarker showed significantly better prediction for severe AKI (stage 2,3). U-NGAL Sens Spec + LR - LR ΔScre ungal+ pcysc ( ) 34.2 (13-94) 0.8 ( ) 0.5 ( ) JACC 64 ; , 2014

23 Combo of U-NGAL and Cystatin C Identifying transient AKI (<48h) by U-NGAL+/pCysCi.e., Loss of function without damage JACC 64 ; , 2014

24 Summary Biomarkers can distinguish a pre-renal state' from AKI in animal AKI model and human AKI. Two-dimension approach with functional change' and kidney damage' will help to understand pathophysiology of AKI better than the old classification using the terms prerenal, renal and post-renal AKI.

Novel Biomarkers in Critically Ill Patients and the Emergency Room

Novel Biomarkers in Critically Ill Patients and the Emergency Room Novel Biomarkers in Critically Ill Patients and the Emergency Room Jay L. Koyner MD Section of Nephrology University of Chicago Research Funding: NIDDK, Abbvie, Astute, Argutus Outline Background / Pitfalls

More information

Case - Acute Renal Failure

Case - Acute Renal Failure Case - Acute Renal Failure 73 yo diabetic F w hx of mild HBP but normal renal function develops infection of R foot. Over 1 week fever, chills, inflammation swelling of her R foot and leg. She takes Motrin

More information

NGAL, a new markers for acute kidney injury

NGAL, a new markers for acute kidney injury NGAL, a new markers for acute kidney injury Prof. J. Delanghe, MD, PhD Dept. Clinical Chemistry Ghent University Lecture Feb 8, 2011 Serum creatinine is an inadequate marker for AKI. > 50% of renal

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION Supplementary information S1 Studies of the effect of AKI duration on outcomes Study Study group (n) Criteria for AKI Definition of RR Outcomes Uchino et al. All patients admitted to (2010) 1 a university-affiliated

More information

Acute Kidney Injury for the General Surgeon

Acute Kidney Injury for the General Surgeon Acute Kidney Injury for the General Surgeon UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Epidemiology & Definition Pathophysiology Clinical Studies Management Summary Hobart W. Harris,

More information

Heart Failure and Cardio-Renal Syndrome 1: Pathophysiology. Biomarkers of Renal Injury and Dysfunction

Heart Failure and Cardio-Renal Syndrome 1: Pathophysiology. Biomarkers of Renal Injury and Dysfunction CRRT 2011 San Diego, CA 22-25 February 2011 Heart Failure and Cardio-Renal Syndrome 1: Pathophysiology Biomarkers of Renal Injury and Dysfunction Dinna Cruz, M.D., M.P.H. Department of Nephrology San Bortolo

More information

Doppler ultrasound, see Ultrasonography. Magnetic resonance imaging (MRI), kidney oxygenation assessment 75

Doppler ultrasound, see Ultrasonography. Magnetic resonance imaging (MRI), kidney oxygenation assessment 75 Subject Index Acidemia, cardiorenal syndrome type 3 146 Acute Dialysis Quality Initiative (ADQI) acute kidney injury biomarkers, see Acute kidney injury; specific biomarkers cardiorenal syndrome, see specific

More information

Biomarkers for optimal management of heart failure. Cardiorenal syndrome. Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland

Biomarkers for optimal management of heart failure. Cardiorenal syndrome. Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland Biomarkers for optimal management of heart failure Cardiorenal syndrome Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland Presenter Disclosure Information V-P Harjola The following

More information

Urinary biomarkers in acute kidney injury. Max Bell MD, PhD Karolinska University Hospital Solna/Karolinska Institutet

Urinary biomarkers in acute kidney injury. Max Bell MD, PhD Karolinska University Hospital Solna/Karolinska Institutet Urinary biomarkers in acute kidney injury Max Bell MD, PhD Karolinska University Hospital Solna/Karolinska Institutet Development of AKI-biomarkers Early markers of AKI, do we need them? GFR drop Normal

More information

ENDPOINTS FOR AKI STUDIES

ENDPOINTS FOR AKI STUDIES ENDPOINTS FOR AKI STUDIES Raymond Vanholder, University Hospital, Ghent, Belgium SUMMARY! AKI as an endpoint! Endpoints for studies in AKI 2 AKI AS AN ENDPOINT BEFORE RIFLE THE LIST OF DEFINITIONS WAS

More information

Discovery & Validation of Kidney Injury Biomarkers

Discovery & Validation of Kidney Injury Biomarkers Dublin Academic Medical Centre Discovery & Validation of Kidney Injury Biomarkers Patrick Murray, MD, FASN, FRCPI, FJFICMI Professor, University College Dublin, Mater Misericordiae University Hospital,

More information

Biomarkers of renal diseases. By Dr. Gouse Mohiddin Shaik

Biomarkers of renal diseases. By Dr. Gouse Mohiddin Shaik By Dr. Gouse Mohiddin Shaik Introduction Renal system performs several functions Excretory Waste products like urea, creatinine, drug, toxins clearance Regulatory Water, electrolyte and acid base balance

More information

changing the diagnosis and management of acute kidney injury

changing the diagnosis and management of acute kidney injury changing the diagnosis and management of acute kidney injury NGAL NGAL is a novel biomarker for diagnosing acute kidney injury (AKI). The key advantage of NGAL is that it responds earlier than other renal

More information

Cardiorenal Biomarkers and Heart Failure. Nicholas Wettersten, MD April 7 th, 2017

Cardiorenal Biomarkers and Heart Failure. Nicholas Wettersten, MD April 7 th, 2017 Cardiorenal Biomarkers and Heart Failure Nicholas Wettersten, MD April 7 th, 2017 Disclosures Still none, but looking for some Acute Kidney Injury Biomarkers 547 in 2015 4112 as of March 2017 Case 1 60

More information

AKI Risk Assessment, Prevention & Early Detection. Dr Lui G Forni Worthing Hospital, Brighton & Sussex Medical School

AKI Risk Assessment, Prevention & Early Detection. Dr Lui G Forni Worthing Hospital, Brighton & Sussex Medical School AKI Risk Assessment, Prevention & Early Detection Dr Lui G Forni Worthing Hospital, Brighton & Sussex Medical School Risk Assessment Prevention Early Detection I won t tell you how many In slides 25 I

More information

Renal Klotho expression in patients with acute kidney injury is associated with the severity of the injury

Renal Klotho expression in patients with acute kidney injury is associated with the severity of the injury ORIGINAL ARTICLE Korean J Intern Med 2015;30:489-495 Renal Klotho expression in patients with acute kidney injury is associated with the severity of the injury Min Young Seo 1, Jihyun Yang 1, Jun Yong

More information

Outline. Overview of Current Biomarkers in Kidney Disease

Outline. Overview of Current Biomarkers in Kidney Disease Overview of Current Biomarkers in Kidney Disease Joseph V. Bonventre MD PhD Chief, Renal Division Chief, Biomedical Engineering Division Brigham and Women s Hospital Harvard Medical School Disclosure:

More information

Interest of NGAL as early marker of Acute Kidney Injury CLINIQUES UNIVERSITAIRES SAINT-LUC

Interest of NGAL as early marker of Acute Kidney Injury CLINIQUES UNIVERSITAIRES SAINT-LUC Interest of NGAL as early marker of Acute Kidney Injury P Wallemacq, Clinical Chemistry Department, M Mourad, Surgery and Abdominal Transplantation Cliniques universitaires St Luc, Université Catholique

More information

Update in. Acute Kidney Injury. Mark Devonald Consultant Nephrologist. Nottingham AKI Research Group

Update in. Acute Kidney Injury. Mark Devonald Consultant Nephrologist. Nottingham AKI Research Group Update in Acute Kidney Injury Mark Devonald Consultant Nephrologist If you stay awake you might hear about Why AKI is important Some cases to illustrate some specific points A couple of updates on AKI

More information

NGAL Connect to the kidneys

NGAL Connect to the kidneys NGAL Connect to the kidneys Acute kidney injury (AKI) An imposing medical and diagnostic challenge >13 million AKI patients each year ~ 30% with fatal outcome Cardiac surgery > 1 million patients/year

More information

Biomarkers for the Prevention of Drug Induced AKI (D-AKI)

Biomarkers for the Prevention of Drug Induced AKI (D-AKI) Biomarkers for the Prevention of Drug Induced AKI (D-AKI) Sandra Kane-Gill, PharmD, MSc, FCCM, FCCP Associate Professor, University of Pittsburgh Critical Care Medication Safety Pharmacist, UPMC OBJECTIVE

More information

The 2012 KDIGO guidelines on Acute Kidney Injury-

The 2012 KDIGO guidelines on Acute Kidney Injury- The 2012 KDIGO guidelines on Acute Kidney Injury- Is there a need for an update and have the guidelines improved AKI prognosis? Norbert Lameire, MD,PhD Em prof of Medicine and Nephrology University Hospital

More information

NGAL. Changing the diagnosis of acute kidney injury. Key abstracts

NGAL. Changing the diagnosis of acute kidney injury. Key abstracts NGAL Changing the diagnosis of acute kidney injury Key abstracts Review Neutrophil gelatinase-associated lipocalin: a troponin-like biomarker for human acute kidney injury. Devarajan P. Nephrology (Carlton).

More information

Research Article. KIM-1 as a biomarker to predict and diagnose Acute Kidney Injury (AKI)

Research Article. KIM-1 as a biomarker to predict and diagnose Acute Kidney Injury (AKI) Available online wwwjocprcom Journal of Chemical and Pharmaceutical Research, 216, 8(4):56-61 Research Article ISSN : 975-7384 CODEN(USA) : JCPRC5 KIM-1 as a biomarker to predict and diagnose Acute Kidney

More information

Biomarkers in Acute Kidney Injury

Biomarkers in Acute Kidney Injury Biomarkers in Acute Kidney Injury Mark D. Okusa, M.D. Chief, Division of Nephrology Center for Immunity, Inflammation and Regenerative Medicine University of Virginia Health System Population incidence

More information

The role of microcirculatory and mitochondrial dysfunction in sepsisinduced acute kidney injury (AKI): a. model of sepsis-induced organ dysfunction

The role of microcirculatory and mitochondrial dysfunction in sepsisinduced acute kidney injury (AKI): a. model of sepsis-induced organ dysfunction The role of microcirculatory and mitochondrial dysfunction in sepsisinduced acute kidney injury (AKI): a model of sepsis-induced organ dysfunction Hernando Gomez, MD Mentors: Michael R. Pinsky, MD John

More information

PRE-RENAL AKI: DOES IT LEAD TO ATN. Sushma Bhusal

PRE-RENAL AKI: DOES IT LEAD TO ATN. Sushma Bhusal PRE-RENAL AKI: DOES IT LEAD TO ATN Sushma Bhusal 9.9.14 CASE PRESENTATION CC : 31 AAM presented with Fatigue, malaise and body aches x 10 days HPI: STD testing done 2 weeks prior, all results negative

More information

Acute kidney injury it personal! Spring 2018

Acute kidney injury it personal! Spring 2018 Objectives Acute kidney injury it personal! Spring 2018 Mitzi Glover, PhD, MT(ASCP) mglov1@lsuhsc.edu Differentiate between acute kidney injury and chronic kidney disease Describe RIFLE, AKIN, and KDIGO

More information

The incidence of acute kidney injury (AKI)

The incidence of acute kidney injury (AKI) NGAL in Acute Kidney Injury: From Serendipity to Utility Related Articles, p. 425 and p. 595 The incidence of acute kidney injury (AKI) has reached epidemic proportions, affecting an estimated 7% of hospitalized

More information

RENAL FUNCTION BIOMARKERS

RENAL FUNCTION BIOMARKERS HERNÁN TRIMARCHI HOSPITAL BRITÁNICO DE BUENOS AIRES ARGENTINA 2015 1 DISCLOSURES Served as a consultant and/or has received lecture honoraria from: ALEXION BRISTOL MYERS SQUIBB GENZYME NOVARTIS PFIZER

More information

Acute renal failure Definition and detection

Acute renal failure Definition and detection Acute renal failure Definition and detection Pierre Delanaye, MD, PhD Nephrology, Dialysis, Transplantation CHU Sart Tilman University of Liège BELGIUM Definition Acute Renal Failure Acute Kidney Injury

More information

Disclosures. Acute Kidney Injury. Outline. Do electronic alerts improve the care of patients with AKI? 5/9/2015

Disclosures. Acute Kidney Injury. Outline. Do electronic alerts improve the care of patients with AKI? 5/9/2015 Disclosures Acute Kidney Injury Kathleen D. Liu, MD, PhD May 2015 Consultant: Achaogen, Chemocentryx, Durect, Z Pharma Clinical trials adjudication: Astute Funding: NIH Stockholder: Amgen Outline patients

More information

Biomarcadores de lesión renal aguda AKI Biomarkers

Biomarcadores de lesión renal aguda AKI Biomarkers Biomarcadores de lesión renal aguda AKI Biomarkers ASOCIACION COSTARRICENSE DE MEDICINA INTERNA San José, Costa Rica June 2017 Kianoush B. Kashani, MD, MSc, FASN, FCCP 2013 MFMER 3322132-1 Disclosure I

More information

HYDRATION & EXERCISE : IMPLICATIONS FOR KIDNEY HEALTH

HYDRATION & EXERCISE : IMPLICATIONS FOR KIDNEY HEALTH 64 TH AMERICAN COLLEGE OF SPORTS MEDICINE ANNUAL MEETING HYDRATION & EXERCISE : IMPLICATIONS FOR KIDNEY HEALTH May 31 st 5.30pm-7.00pm Room 103 Colorado Convention Center Denver AGENDA Session chaired

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Zarbock A, Schmidt C, Van Aken H, et al; for the RenalRIPC Investigators. Effect of remote ischemic preconditioning on kidney injury among high-risk patients undergoing cardiac

More information

Urinary Neutrophil Gelatinase-Associated Lipocalin in Cirrhotic Patients with Acute Kidney Injury

Urinary Neutrophil Gelatinase-Associated Lipocalin in Cirrhotic Patients with Acute Kidney Injury 624 ORIGINAL ARTICLE July-August, Vol. 17 No. 4, 2018: 624-630 The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for Study of the Liver and the Canadian Association

More information

Renal Disease and PK/PD. Anjay Rastogi MD PhD Division of Nephrology

Renal Disease and PK/PD. Anjay Rastogi MD PhD Division of Nephrology Renal Disease and PK/PD Anjay Rastogi MD PhD Division of Nephrology Drugs and Kidneys Kidney is one of the major organ of drug elimination from the human body Renal disease and dialysis alters the pharmacokinetics

More information

Soto K, Coelho S, et al. Hospital Fernando Fonseca

Soto K, Coelho S, et al. Hospital Fernando Fonseca SEPTIC INDUCED ACUTE KIDNEY INJURY Soto K, Coelho S, et al. Hospital Fernando Fonseca Introduction- Epidemiology RIFLE/AKIN Classification Scheme for AKI diagnosis 4.2 23 53 % Absence of other clear and

More information

Acute Kidney Injury. Amandeep Khurana, MD Southwest Kidney Institute

Acute Kidney Injury. Amandeep Khurana, MD Southwest Kidney Institute Acute Kidney Injury Amandeep Khurana, MD Southwest Kidney Institute 66 yr white male w/ DM, HTN, CAD admitted to an OSH w/ E Coli UTI on 7/24/16, developed E Coli bacteremia and Shock (on vaso + levo)

More information

Acute Kidney Injury. APSN JSN CME for Nephrology Trainees May Professor Robert Walker

Acute Kidney Injury. APSN JSN CME for Nephrology Trainees May Professor Robert Walker Acute Kidney Injury APSN JSN CME for Nephrology Trainees May 2017 Professor Robert Walker Kidney International (2017) 91, 1033 1046; http://dx.doi.org/10.1016/ j.kint.2016.09.051 Case for discussion 55year

More information

Prof. Michael Joannidis Medical Intensive Care and Emergency Unit Department of Internal Medicine Medical University Innsbruck Innsbruck, Austria

Prof. Michael Joannidis Medical Intensive Care and Emergency Unit Department of Internal Medicine Medical University Innsbruck Innsbruck, Austria 1 di 27 Prevention of AKI: experimental promises and clinical realities Michael Joannidis, Innsbruck, Austria Chairs:Norbert Lameire, Ghent, Belgium Gert Mayer, Innsbruck, Austria Prof. Michael Joannidis

More information

Biomarkers, the Kidney and the Heart: Acute Kidney Injury

Biomarkers, the Kidney and the Heart: Acute Kidney Injury Biomarkers, the Kidney and the Heart: Acute Kidney Injury 12th Annual Conference on Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices San Diego May 13, 2016 Ravindra

More information

Professor and Director. Children s Hospital of Richmond

Professor and Director. Children s Hospital of Richmond Evaluation of AKI in term and premature infants Timothy E. Bunchman Professor and Director Pediatric Nephrology & Transplantation Children s Hospital of Richmond Virginia Commonwealth Univ. School of Medicine

More information

Biological markers for kidney injury and renal function in the intensive care unit Royakkers, A.A.N.M.

Biological markers for kidney injury and renal function in the intensive care unit Royakkers, A.A.N.M. UvA-DARE (Digital Academic Repository) Biological markers for kidney injury and renal function in the intensive care unit Royakkers, A.A.N.M. Link to publication Citation for published version (APA): Royakkers,

More information

ΒΙΟΔΕΙΚΤΕΣ ΣΤΗΝ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ. ΔΗΜΗΤΡΙΟΣ ΤΟΥΣΟΥΛΗΣ Καθηγητής Καρδιολογίας

ΒΙΟΔΕΙΚΤΕΣ ΣΤΗΝ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ. ΔΗΜΗΤΡΙΟΣ ΤΟΥΣΟΥΛΗΣ Καθηγητής Καρδιολογίας ΕΘΝΙΚΟ ΚΑΙ ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ ΙΑΤΡΙΚΗ ΣΧΟΛΗ Ά ΚΑΡΔΙΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ Διευθυντής: Καθηγητής Δημήτριος Τούσουλης ΒΙΟΔΕΙΚΤΕΣ ΣΤΗΝ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ ΔΗΜΗΤΡΙΟΣ ΤΟΥΣΟΥΛΗΣ Καθηγητής Καρδιολογίας

More information

Clinical Significance of ARF. Hospital Acquired Renal Insufficiency. Case - Acute Renal Failure. Hospital Acquired Renal Insufficiency

Clinical Significance of ARF. Hospital Acquired Renal Insufficiency. Case - Acute Renal Failure. Hospital Acquired Renal Insufficiency Case - Acute Renal Failure 73 yo diabetic F w hx of mild HBP but normal renal function develops infection of R foot. Over 1 week fever, chills, inflammation swelling of her R foot and leg. She takes Motrin

More information

Acute Kidney Injury. I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS

Acute Kidney Injury. I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS Acute Kidney Injury I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS 374-6102 David.Weiner@medicine.ufl.edu www.renallectures.com Concentration

More information

Use of NGAL in intensive care unit

Use of NGAL in intensive care unit Use of NGAL in intensive care unit Magdaléna Mokrejšová MD 3rd Medical School Charles University Prague A/ Our faculty hospital provides healthcare for 170.000 inhabitants B/ Our ICU is specialized in

More information

Acute kidney injury it personal! Spring 2018

Acute kidney injury it personal! Spring 2018 Objectives Acute kidney injury it personal! Spring 2018 Mitzi Glover, PhD, MT(ASCP) mglov1@lsuhsc.edu Differentiate between acute kidney injury and chronic kidney disease Describe RIFLE, AKIN, and KDIGO

More information

Acute kidney injury definition, causes and pathophysiology. Financial Disclosure. Some History Trivia. Key Points. What is AKI

Acute kidney injury definition, causes and pathophysiology. Financial Disclosure. Some History Trivia. Key Points. What is AKI Acute kidney injury definition, causes and pathophysiology Financial Disclosure Current support: Center for Sepsis and Critical Illness Award P50 GM-111152 from the National Institute of General Medical

More information

Adding Insult to Injury. Marlies Ostermann Consultant in Nephrology & Critical Care Guy s & St Thomas Hospital, London

Adding Insult to Injury. Marlies Ostermann Consultant in Nephrology & Critical Care Guy s & St Thomas Hospital, London Acute Kidney Injury Adding Insult to Injury Marlies Ostermann Consultant in Nephrology & Critical Care Guy s & St Thomas Hospital, London Content 1. Brief review of AKI and its impact 2. Comments on the

More information

Use of Acute Kidney Injury Biomarkers in Clinical Trials

Use of Acute Kidney Injury Biomarkers in Clinical Trials Use of Acute Kidney Injury Biomarkers in Clinical Trials Design Considerations Amit X. Garg MD, MA (Education), FRCPC, PhD Nephrologist, London Health Sciences Centre Professor, Medicine and Epidemiology

More information

Use of Acute Kidney Injury Biomarkers in Clinical Trials

Use of Acute Kidney Injury Biomarkers in Clinical Trials Use of Acute Kidney Injury Biomarkers in Clinical Trials Design Considerations Amit X. Garg MD, MA (Education), FRCPC, PhD Nephrologist, London Health Sciences Centre Professor, Medicine and Epidemiology

More information

Its 2:45 am, and Angela Johnson,

Its 2:45 am, and Angela Johnson, SCIENTIFIC REVIEWS Acute kidney injury John A. Kellum, MD, FCCM Diagnosis and classification of acute pathology in the kidney are major clinical problems. Azotemia and oliguria represent not only disease

More information

JMSCR Vol 06 Issue 12 Page December 2018

JMSCR Vol 06 Issue 12 Page December 2018 www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.02 Original Research Article Fractional

More information

Lithium toxicity. Dr Aude Servais Service de Néphrologie adulte Hôpital Necker, Paris

Lithium toxicity. Dr Aude Servais Service de Néphrologie adulte Hôpital Necker, Paris Lithium toxicity Dr Aude Servais Service de Néphrologie adulte Hôpital Necker, Paris Lithium Use of lithium salts as salt substitutes but recall from the marketplace in 1949 Efficient in the treatment

More information

Acute Kidney Injury Care in the Chronic Unit

Acute Kidney Injury Care in the Chronic Unit Acute Kidney Injury Care in the Chronic Unit BONNIE B GREENSPAN WITH ASSIST FROM: DENISE MURCEK, JINA BOGLE, MARY SCHIRA, OCTOBER 5, 2017 Objectives At the completion of the session, engaged participants

More information

Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial)

Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial) http://www.kidney-international.org & 20 International Society of Nephrology see commentary on page 947 Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF

More information

Research Article. NGAL as a biomarker to predict and diagnose Acute Kidney Injury (AKI)

Research Article. NGAL as a biomarker to predict and diagnose Acute Kidney Injury (AKI) Available online wwwjocprcom Journal of Chemical and Pharmaceutical Research, 215, 7(5):224-232 Research Article ISSN : 975-7384 CODEN(USA) : JCPRC5 NGAL as a biomarker to predict and diagnose Acute Kidney

More information

High urinary excretion of kidney injury molecule-1 predicts adverse outcomes in acute kidney injury: a case control study

High urinary excretion of kidney injury molecule-1 predicts adverse outcomes in acute kidney injury: a case control study Xie et al. Critical Care (2016) 20:286 DOI 10.1186/s13054-016-1455-6 RESEARCH High urinary excretion of kidney injury molecule-1 predicts adverse outcomes in acute kidney injury: a case control study Yuanyuan

More information

Worldwide, 2,000,000 people. will die this year with. Acute Kidney Injury: Raising Awareness. Epidemiology. AKI Outline. AKI Impact.

Worldwide, 2,000,000 people. will die this year with. Acute Kidney Injury: Raising Awareness. Epidemiology. AKI Outline. AKI Impact. AKI Outline Acute Kidney Injury: Raising Awareness Ashita Tolwani, M.D., M.S. Professor of Medicine University of Alabama at Birmingham 2018 Epidemiology Definitions and Classification of AKI Diagnosis

More information

Acute kidney injury (AKI) is considered an important

Acute kidney injury (AKI) is considered an important Emergency. 2018; 6 (1): e2 ORIGINAL RESEARCH Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C in Early Detection of Pediatric Acute Kidney Injury; a Diagnostic Accuracy Study Neamatollah

More information

DEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY

DEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY DEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY JOSÉ ANTÓNIO LOPES, MD, PhD Faculty of Medicine, University of Lisbon Department of Nephrology and Renal Transplantation Centro Hospitalar

More information

Acute kidney injury and outcomes in acute decompensated heart failure in Korea

Acute kidney injury and outcomes in acute decompensated heart failure in Korea Acute kidney injury and outcomes in acute decompensated heart failure in Korea Mi-Seung Shin 1, Seong Woo Han 2, Dong-Ju Choi 3, Eun Seok Jeon 4, Jae-Joong Kim 5, Myeong-Chan Cho 6, Shung Chull Chae 7,

More information

Neutrophil Gelatinase-Associated Lipocalin as a Biomarker of Acute Kidney Injury in Patients with Morbid Obesity Who Underwent Bariatric Surgery

Neutrophil Gelatinase-Associated Lipocalin as a Biomarker of Acute Kidney Injury in Patients with Morbid Obesity Who Underwent Bariatric Surgery Published online: October 31, 213 1664 5529/13/31 11$38./ This is an Open Access article licensed under the terms of the Creative Commons Attribution- NonCommercial 3. Unported license (CC BY-NC) (www.karger.com/oa-license),

More information

Some Biomarkers of Acute Kidney Injury Are Increased in Pre- Renal Acute Injury

Some Biomarkers of Acute Kidney Injury Are Increased in Pre- Renal Acute Injury Some Biomarkers of Acute Kidney Injury Are Increased in Pre- Renal Acute Injury The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.

More information

How and why to measure renal function in patients with liver disease?

How and why to measure renal function in patients with liver disease? ow and why to measure renal function in patients with liver disease? P. Angeli, Dept. of Medicine, Unit of Internal Medicine and epatology (), University of Padova (Italy) pangeli@unipd.it 10th Paris epatology

More information

Advances in the Pathogenesis and Management of Acute Kidney Injury (AKI)

Advances in the Pathogenesis and Management of Acute Kidney Injury (AKI) Advances in the Pathogenesis and Management of Acute Kidney Injury (AKI) Prasad Devarajan, MD Professor of Pediatrics and Developmental Biology Louise M. Williams Endowed Chair Director, Nephrology and

More information

IJBPAS, November, 2015, 4(11), Special Issue: ISSN:

IJBPAS, November, 2015, 4(11), Special Issue: ISSN: : 808-818 ISSN: 2277 4998 CORRELATION BETWEEN PLASMA NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN AND ACUTE KIDNEY INJURY IN ADULT TRAUMA PATIENTS FOLLOWING SEVERE TRAUMA ADMITTED IN INTEIVE CARE UNIT MAOOR

More information

Acute Kidney Injury in the ED

Acute Kidney Injury in the ED + Acute Kidney Injury in the ED + Dr Eric Clark, MD FRCPC University of Ottawa Canada Canadian Association of Emergency Physicians + Outline 1. Diagnostic challenges 2. ED treatment 3. Contrast induced

More information

Endothelial Nitric Oxide Function and Tubular Injury in Premature Infants

Endothelial Nitric Oxide Function and Tubular Injury in Premature Infants Endothelial Nitric Oxide Function and Tubular Injury in Premature Infants Huseynova Saadat, PhD Akhundova Afag Panakhova Nushaba, PhD Hasanov Safikhan, MD K. Farajova Pediatry Institute Bakikhanov 23.

More information

Journal of American Science 2016;12(9)

Journal of American Science 2016;12(9) Significance of Liver Fatty Acid Binding Protein after Coronary Angiography for Early detection of Acute Kidney Injury in Diabetics with normal Renal Angiography Yasser Abdelgaleel Omar Department of Cardiology,

More information

PAEDIATRIC MANAGEMENT KDIGO. Uma Ramaswami FRCPCH, MD Royal Free London NHS Foundation Trust

PAEDIATRIC MANAGEMENT KDIGO. Uma Ramaswami FRCPCH, MD Royal Free London NHS Foundation Trust PAEDIATRIC MANAGEMENT Uma Ramaswami FRCPCH, MD Royal Free London NHS Foundation Trust Disclosure of Interests UR has received travel grants and lecture fees from Shire HGT, Amicus and Genzyme; and advisory

More information

Chapter 5: Acute Kidney Injury

Chapter 5: Acute Kidney Injury Chapter 5: Acute Kidney Injury In 2015, 4.3% of Medicare fee-for-service beneficiaries experienced a hospitalization complicated by Acute Kidney Injury (AKI); this appears to have plateaued since 2011

More information

Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis

Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone

More information

CHAPTER-1 INTRODUCTION, AIMS & OBJECTIVES AND REVIEW OF LITERATURE

CHAPTER-1 INTRODUCTION, AIMS & OBJECTIVES AND REVIEW OF LITERATURE CHAPTER-1 INTRODUCTION, AIMS & OBJECTIVES AND REVIEW OF LITERATURE 1. INTRODUCTION AND REVIEW OF LITERATURE The state of a person's health is often directly related to that person's lifestyle. With more

More information

Review: Neutrophil gelatinase-associated lipocalin: A troponin-like biomarker for human acute kidney injurynep_

Review: Neutrophil gelatinase-associated lipocalin: A troponin-like biomarker for human acute kidney injurynep_ Nephrology 15 (2010) 419 428 Review Article Review: Neutrophil gelatinase-associated lipocalin: A troponin-like biomarker for human acute kidney injurynep_ 419..428 PRASAD DEVARAJAN Cincinnati Children

More information

AKI: definitions, detection & pitfalls. Jon Murray

AKI: definitions, detection & pitfalls. Jon Murray AKI: definitions, detection & pitfalls Jon Murray Previous conventional definition Acute renal failure (ARF) An abrupt and sustained decline in renal excretory function due to a reduction in glomerular

More information

REVIEW ARTICLE NEWER BIOMARKERS IN EARLY DIABETIC NEPHROPATHY

REVIEW ARTICLE NEWER BIOMARKERS IN EARLY DIABETIC NEPHROPATHY JCD REVIEW ARTICLE NEWER BIOMARKERS IN EARLY DIABETIC NEPHROPATHY SAPTARSHI MUKHOPADHYAY* *FACULTY (DEPARTMENT OF MEDICINE), B R SINGH HOSPITAL (EASTERN RAILWAY), KOLKATA. INTRODUCTION renal disease. It

More information

Reliability of FEUA in AKI and its Combination with Other Renal Failure Indices

Reliability of FEUA in AKI and its Combination with Other Renal Failure Indices Med. J. Cairo Univ., Vol. 80, No. 2, September: 181-189, 2012 www.medicaljournalofcairouniversity.com Reliability of FEUA in AKI and its Combination with Other Renal Failure Indices ADEL TAIE, MBBCh.;

More information

Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery

Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery http://www.kidney-international.org & 2008 International Society of Nephrology original article see commentary on page 379 Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac

More information

Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery

Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery http://www.kidney-international.org & 2008 International Society of Nephrology see commentary on page 987 Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic

More information

SPRINT: Consequences for CKD patients

SPRINT: Consequences for CKD patients SPRINT: Consequences for CKD patients 29 e Workshop Nierziekten Papendal 2018 December 12, 2018 MICHAEL ROCCO, MD, MSCE VARDAMAN M. BUCKALEW JR. PROFESSOR OF MEDICINE PROFESSOR OF PUBLIC HEALTH SCIENCES

More information

Adis Tasanarong 1*, Pisit Hutayanon 2 and Dilok Piyayotai 2

Adis Tasanarong 1*, Pisit Hutayanon 2 and Dilok Piyayotai 2 Tasanarong et al. BMC Nephrology 2013, 14:270 RESEARCH ARTICLE Open Access Urinary Neutrophil Gelatinase-Associated Lipocalin predicts the severity of contrast-induced acute kidney injury in chronic kidney

More information

Urinary Biomarkers for Early Detection of Recovery in Patients with Acute Kidney Injury

Urinary Biomarkers for Early Detection of Recovery in Patients with Acute Kidney Injury ORIGINAL ARTICLE Nephrology http://dx.doi.org/1.3346/jkms.213.28.8.1181 J Korean Med Sci 213; 28: 1181-1186 Urinary Biomarkers for Early Detection of Recovery in Patients with Acute Kidney Injury Sung

More information

Introduction to Clinical Diagnosis Nephrology

Introduction to Clinical Diagnosis Nephrology Introduction to Clinical Diagnosis Nephrology I. David Weiner, M.D. C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University of Florida College

More information

ACUTE KIDNEY INJURY. Stuart Linas U. Colorado SOM

ACUTE KIDNEY INJURY. Stuart Linas U. Colorado SOM ACUTE KIDNEY INJURY Stuart Linas U. Colorado SOM Marked increases in incidence of dialysis-requiring AKI in last decade JASN 24 37 2013 Question 1 Of patients who recover from an episode of AKI, what percentage

More information

Advanced Concept of Nursing- II UNIT-VI Advance Nursing Management of Genitourinary (GU) Diseases.

Advanced Concept of Nursing- II UNIT-VI Advance Nursing Management of Genitourinary (GU) Diseases. In The Name of God (A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI) Advanced Concept of Nursing- II UNIT-VI Advance Nursing Management of Genitourinary (GU) Diseases. Shahzad Bashir RN, BScN, DCHN,MScN

More information

Nephrotoxic Burden and Consequences Associated with Drug Induced AKI (D-AKI)

Nephrotoxic Burden and Consequences Associated with Drug Induced AKI (D-AKI) Nephrotoxic Burden and Consequences Associated with Drug Induced AKI (D-AKI) Sandra Kane-Gill, PharmD, MSc, FCCM, FCCP Associate Professor, University of Pittsburgh Critical Care Medication Safety Pharmacist,

More information

Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery

Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery http://www.kidney-international.org & 2013 International Society of Nephrology clinical investigation Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery

More information

Hepatorenal Syndrome

Hepatorenal Syndrome Necker Seminars in Nephrology Institut Pasteur Paris, April 22, 2013 Hepatorenal Syndrome Dr. Richard Moreau 1 INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, 2 Université Paris Diderot

More information

Update on Cardiorenal Syndrome: A Clinical Conundrum

Update on Cardiorenal Syndrome: A Clinical Conundrum Advances in Peritoneal Dialysis, Vol. 27, 2011 Eric J. Chan, 1 Kevin C. Dellsperger 1 3 Update on Cardiorenal Syndrome: A Clinical Conundrum Our understanding of the cardiorenal syndrome continues to progress.

More information

Acute Kidney Injury in the Hospitalized Patient

Acute Kidney Injury in the Hospitalized Patient Acute Kidney Injury in the Hospitalized Patient Biff F. Palmer, M.D. Professor of Internal Medicine University of Texas Southwestern Medical Center, Dallas Texas Classification of Acute Kidney Injury 1

More information

State-of-the-Art: Treatment of Renal Dysfunction in Heart Failure. W. H. Wilson Tang, MD Cleveland Clinic, U.S.A.

State-of-the-Art: Treatment of Renal Dysfunction in Heart Failure. W. H. Wilson Tang, MD Cleveland Clinic, U.S.A. State-of-the-Art: Treatment of Renal Dysfunction in Heart Failure W. H. Wilson Tang, MD Cleveland Clinic, U.S.A. Heart Failure Exacerbates Renal Insufficiency ADHERE Registry: Prevalence of CKD by egfr

More information

Acute Renal Failure aka Acute Kidney Injury. Dr H Bierman

Acute Renal Failure aka Acute Kidney Injury. Dr H Bierman Acute Renal Failure aka Acute Kidney Injury Dr H Bierman RIFLE criteria for diagnosis of AKI based on The Acute Dialysis Quality Initiative Increase in S Cr Urine output Risk of renal injury Injury to

More information

Renal failure in sepsis and septic shock

Renal failure in sepsis and septic shock Renal failure in sepsis and septic shock Dr. Venugopal Reddy. MD, EDIC, FCARCSI Associate Professor of Anesthesiology and Critical Care medicine Department of Anaesthesia and CCM Penn State College of

More information

Acute Kidney Injury Is there a Best Practice?

Acute Kidney Injury Is there a Best Practice? Acute Kidney Injury Is there a Best Practice? M I T C H E L L R O S N E R, M D C h a i r m a n, D e p a r t m e n t o f M e d i c i n e U n i v e r s i t y o f V i r g i n i a H e a l t h S y s t e m Disclosures

More information

THE KIDNEY IN HYPOTENSIVE STATES. Benita S. Padilla, M.D.

THE KIDNEY IN HYPOTENSIVE STATES. Benita S. Padilla, M.D. THE KIDNEY IN HYPOTENSIVE STATES Benita S. Padilla, M.D. Objectives To discuss what happens when the kidney encounters low perfusion To discuss new developments and clinical application points in two scenarios

More information

PREGNANCY ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND ACUTE KIDNEY INJURY

PREGNANCY ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND ACUTE KIDNEY INJURY VII, 2013, 2 33 A, PREGNANCY ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND ACUTE KIDNEY INJURY M. Lubomirova Clinic of Nephrology, University Hospital Aleksandrovska So a : ( ), /HELLP, (AFLP) (TTP)

More information

AKI in Hospitalized Patients ACOI 2017

AKI in Hospitalized Patients ACOI 2017 AKI in Hospitalized Patients ACOI 2017 Objectives 1. Define AKI KDIGO Classification 2. Incidence and consequences of AKI 3. Causes of AKI and workup 4. Prevention of AKI 5. Treatment of AKI AKI Case 67

More information