Novel Biomarkers in Critically Ill Patients and the Emergency Room
|
|
- Sharleen Jordan
- 5 years ago
- Views:
Transcription
1 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 about / ER patients Sources of Scoring Systems Biomarker Tour- Consumers Report Approach Blood and Urine Blood and Urine -ER Differential Diagnosis Limitations Renal Perfusion Drug Metabolism Nephrotoxin Contrast Surgery- Ischemia Comorbidities Immune Function ( or ER) Cardio- Renal Sepsis / Infection Acute Lung Injury Mech. Vent Chronic Kidney Disease 1
2 in the (Sapphire) N= Endre (Early ARF) KI N=528 Siew (CJASN 2010) N=391 Uchino (JAMA) 2005 N=1,738 Sepsis 19% 19% 41% 47.5% Respiratory 43% 12% 14.8% Surgery 34% 21% 41.1% Cardiovascular 33% 22% 3% 34.5% Neurological 10% 14% 2.7% Trauma 8% 8% % Cardiac Surgery 18% 23.2% Other 17% 13% Severity of Illness: Scoring Systems Simplified Acute Physiology Score (SAPS) Sequential Organ Failure Score (SOFA) Acute Physiology and Chronic Health Evaluation (APACHE) Include markers of renal function (SCr, BUN...) Designed to predict inpatient mortality Reactive to pre-existing Non-predictive of severity Warning Scores for the : Not Kidney-Centric Scores to predict who will transfer to the Focused on Vitals not labs / UOP based Churpek et al Chest 2
3 Renal Angina Goldstein Chawla CJASN 2010 Basu et al Kid Int Biomarkers in Relation to Site of Injury in Nephron Proximal Tubule Injury Urine IL-18 Urine KIM-1 Urine L-FABP Urine Cystatin C α1-microglobulin β2-microglobulin Urine α-gst Urine Netrin-1 Urine NAG Distal Tubule Urine NGAL Urine π-gst Glomerular Filtration Serum Creatinine Blood urine Nitrogen Serum Cystatin C Plasma NGAL Glomerular Injury Urine albumin excretion Loop of Henle Injury Uromodulin Other Mechanisms / Sites of Injury not specific to the Nephron Hepcidin Iron trafficking TIMP-2/ IGFBP7 G1 cell cycle arrest Excellent AUC Sens/ Spec Very Good Good Fair Poor < 0.50 P=NS > 90% > 80% >70% >60% >50% 3
4 Herget- Rosenthal KI 2004 Nejat NDT 2010 (Early ARF) Ahlstrohm Clin Neph 2004 Serum Cystatin C - n % of CKD (52%) >50% (77%) 50% (27%) Creat. Data Arrival 19% Arrival Arrival (early) 0.99 Injury RRT 0.84 Other Valid 9% 12 hour 12 hour Pickering Blood Pur Cruz 2009 Valid De Gues AJRCCM 2011 Plasma NGAL- n % of CKD mixed 28% 44% 27% Creat. Data arrival 6.6% w/in 48 hours 12 hour 9% 12 hour admission (early) Mortality / RRT Mortality RRT pngal assoc. w/ APACHE & SOFA F 0.63 Mort. Sepsis 4
5 Parikh JASN 2005 Doi Med 2011 Siew CJASN 2010 Valid Urine IL-18 n % of CKD 137 ARDS % SCr 28% 39% N 22% All w/ Cr<1.2 2% CKD4 Creat. Data 24 hours before arrival 12.7% arrival 9% 12 hour 12 hour (early) hr 0.62 N2/ Mortality / mortality Endre Kid Int 2011 EARLY 529 N 28% arrival RRT mortality Urinary Kidney Injury Molecule-1 (KIM-1)- n % of CKD Creat. Data (early) Mortality / Endre Kid Int 2011 EARLY Valid 529 N 28% arrival 9% 12 hour 12 hour RRT No data provided No data provided Urine L-FABP n % CKD Creat. Data AUC (time) Mortality / Siew et al Kid Int Crit Care Valid 380 N 34% 0% Arrive 9% 12 hour N Predicted RRT but not death Doi Med % 2% CKD4 arrival 0.80 Predicted Mortality 5
6 LFABP: Meta-analysis Susantitaphong et al AJKD Siew et al Kid Int Endre Kid Int 2011 EARLY Urine Cystatin C - n % CKD Creat. Data 380 N 34% 529 N 28% arrival AUC (time) Arrive AUC RRT Mortality / 0.66 De Gues AJRCCM 2011 Valid Siew et al JASN 2009 Doi Med 2011 Endre Kid Int 2011 EARLY Urine NGAL n CKD (Early) 632 mixed % N 22% 39% N 28% arrival 9% 12 hour 12 hour 12% within 24 2% CKD4 arrival arrival F Mortality/ 0.63 Mort. Sepsis Predicted Mortality RRT 0.66 mortal 6
7 Urine NGAL Haase - Meta-analysis and Pooled data Haase et al AJKD 2009 N Cutoff (95% CI) 123 of 602 (20.4%) 50% 7days ( ) Sens. (95% CI) 76.4% (60-88) Spec. (95% CI) 75.5 (52-90) Diag. Odds (95%CI) I (3-33) 17.5 * Not exclusively * Not exclusively Hasse JACC 2010 TIMP-2 IGFBP7 n % of CKD Creat. Data 9% (early) 0.77 Severity / No data provided Valid 12 hour 0.80 No data provided et al Koyner ASN Abstract oral presentation Friday Others Biomarkers in the Urinary Albumin Doi - Med 2010 N-acetyl-β-D-glucosamine (NAG) - Doi Med 2010 Urine π-gst - FGF-23 Leaf CJASN Koyner CJASN
8 Back to Basics: Acutally Looking at Urine Perazella et al CJASN 2010, Bagshaw et al NDT 2012 On to the ER Adding Urinalysis to the mix Schinstock et al NDT 8
9 Urine NGAL in the ER 635 admitted patients AUC ( R) Urine NGAL 0.95 FENA Serum Creat Nickolas et al Ann Int Med 2008 Hey, what about the physician 665 ER patients 7% (N) Combined Physician assessment w/ NGAL = 0.90 DiSomma et al The Lisbon ER: Cystatin & NGAL 616 patients 21% 26% Pre-renal 2.5% CKD AUC for N-1 Serum 0.88 Creatinine P-NGAL 0.77 S-CysC 0.87 U-CysC 0.61 Soto et al CJASN 2010 Soto et al CJASN 9
10 252 Children 12 with RISK 6 with Injury Don t forget the Kids!! AUC Severity Urine NGAL Urine IL Urine KIM-1 Beta-2- microglob Du, Zappitelli et al. Pediatr Neph 2011 Nickolas 2012: JACC Multicenter 1635 pts 96(6%) Intrinsic 254(15.5%)-Pre-Renal 154 (9%) - CKD AUC for INTRINSIC Urine NGAL 0.81 Urine KIM Urine IL Urine LFABP 0.70 Urine CysC 0.65 Serum Creat Doi et al. Kid Int 2012 Nejat et al Kid Int 2012 Back to the : Differentiating 10
11 Your FENA is low, you must be dehydrated Doi Nejat Nickolas Soto De Gues U- NGAL U-KIM1 U- LFABP U- IL-18 U-CysC P-NGAL P-CysC None &T- T & I None &T- T & I None &T- T & I None &T- T & I None &T- T & I None &T- T & I None &T- T & I Limitations Bronze Standard SCr Endre, Kellum et al Contrib Neph 11
12 Biomarker Positive - Creatinine Negative: A Under-utilized Paradigm!!! DiSomma Haase and Devarajan JACC 2010 Biomarker Quantitation: Impact on Results Normalization to urine creatinine improves prediction of incipient and outcomes No clear benefit for established of interest shapes the ideal method of quantitation. Ralib et al. JASN 2012 Combinations Siew et al Kid Int et al Combine for kinetics Increase the duration of diagnosis Combine for different functions Filtration and injury Functional and Structural Combine for improved accuracy Strategic combinations Diagnostic + Prognostic marker Sensitive +Specific marker 12
13 Publication Bias Other Limitations Exaggerating the importance of result Standardization of Biomarker Assays Du et al Pediatr Nephrol NGAL assay Frozen Bio-banked samples Unclear how fresh samples/poc assay will differ Limited number of hard endpoints Less focus on RRT / Severity Continued Scr Reliance -Bronze Standard Impact of CKD and other factors on biomarkers Summary remains extremely common in the and ER Hardly a pristine clinical phenotype specific prediction tools are needed (Renal Angina) Several viable biomarker candidates None are clinically available in the United States Factors that impact biomarkers remain poorly studied (CKD, sample handling) Combining the correct biomarkers should improve performance Thanks jkoyner@uchicago.edu 13
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 informationA08 Using Kidney Biomarkers for AKI 2: Differential Diagnosis, Interventions and Prognosis
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 Using kidney biomarkers: Key
More informationUrinary 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 informationWho should get a Biomarker Assessment? A focus on Biomarkers you may have at your hospital and risk scores
Who should get a Biomarker Assessment? A focus on Biomarkers you may have at your hospital and risk scores Jay L. Koyner MD Section of Nephrology Department of Medicine University of Chicago Disclosures
More informationBiomarkers 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 informationNovel biomarker panel approach to renal assessment
Novel biomarker panel approach to renal assessment Professor of Critical Care Medicine, Medicine, Bioengineering and Clinical & Translational Science Vice Chair for Research Director, Center for Critical
More informationSoto 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 informationHeart 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 informationNGAL, 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 informationAcute 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 informationDoppler 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 informationNGAL. 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 informationAcute 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 informationSUPPLEMENTARY 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 informationWorldwide, 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 informationBiomarkers 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 informationAKI 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 informationAdvances 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 informationInterest 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 informationUpdate 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 informationAGING KIDNEY IN HIV DISEASE
AGING KIDNEY IN HIV DISEASE Michael G. Shlipak, MD, MPH Professor of Medicine, Epidemiology and Biostatistics, UCSF Chief, General Internal Medicine, San Francisco VA Medical Center Kidney, Aging and HIV
More informationCase - 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 informationFluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
More informationBiomarcadores 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 informationDisclosures. 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 informationDiscovery & 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 informationSome 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 informationProfessor 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 informationThe 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 informationLas dos caras de la cretinina sérica The two sides of serum creatinine
Las dos caras de la cretinina sérica The two sides of serum creatinine ASOCIACION COSTARRICENSE DE MEDICINA INTERNA San José, Costa Rica June 2017 Kianoush B. Kashani, MD, MSc, FASN, FCCP 2013 MFMER 3322132-1
More informationAcute 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 informationAcute 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 informationUse 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 informationUse 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 informationAKI: 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 informationCystatin C: A New Approach to Improve Medication Dosing
Cystatin C: A New Approach to Improve Medication Dosing Erin Frazee Barreto, PharmD, MSc, FCCM Assistant Professor of Pharmacy and Medicine Kern Scholar, Center for the Science of Health Care Delivery
More informationOutline. 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 informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationCardiorenal 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 informationThe 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 informationCharacteristics of factor x so that its clearance = GFR. Such factors that meet these criteria. Renal Tests. Renal Tests
Renal Tests Holly Kramer MD MPH Associate Professor of Public Health Sciences and Medicine Division of Nephrology and Hypertension Loyola University of Chicago Stritch School of Medicine Renal Tests 1.
More informationPredictors of renal recovery in patients with severe acute kidney injury on renal replacement therapy
Predictors of renal recovery in patients with severe acute kidney injury on renal replacement therapy Protocol version 10 02/02/2018 1 BACKGROUND The incidence of acute kidney injury (AKI) is increasing
More informationBiomarkers 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 informationBiomarkers for AKI. Hilde R.H. De Geus
Biomarkers for AKI Hilde R.H. De Geus Biomarkers for AKI Hilde RH de Geus Publication of this thesis was financially supported by: Department of Intensive Care, Erasmus MC University Medical Center Rotterdam
More informationDEFINITION, 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 informationRecognizing and Treating Patients with the Cardio-Renal Syndrome
Recognizing and Treating Patients with the Cardio-Renal Syndrome Joachim H. Ix, MD, MAS, FASN Professor of Medicine Chief; Division of Nephrology-Hypertension University of California San Diego 1 Conflicts
More informationThe NGAL Turbidimetric Immunoassay Reagent Kit
Antibody and Immunoassay Services Li Ka Shing Faculty of Medicine, University of Hong Kong The NGAL Turbidimetric Immunoassay Reagent Kit Catalogue number: 51300 For the quantitative determination of NGAL
More informationWORSENING OF RENAL FUNCTION AFTER RAS INHIBITION IN DECOMPENSATED HEART FAILURE: CLINICAL IMPLICATIONS
WORSENING OF RENAL FUNCTION AFTER RAS INHIBITION IN DECOMPENSATED HEART FAILURE: CLINICAL IMPLICATIONS George Bakris, MD, FASH, FAHA, FASN Professor of Medicine Director, Comprehensive Hypertension Center
More informationEvidence-based practice in nephrology : Meta-analysis
Evidence-based practice in nephrology : Meta-analysis Paweena Susantitaphong, MD,Ph.D 1-3 1 Associate Professor, Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn
More informationThe cell cycle biomarkers: promising research, but do not oversell them
CKJ REVIEW Clinical Kidney Journal, 2016, vol. 9, no. 3, 353 358 doi: 10.1093/ckj/sfw033 Advance Access Publication Date: 24 May 2016 CKJ Review The cell cycle biomarkers: promising research, but do not
More informationFluid Management in Critically Ill AKI Patients
Fluid Management in Critically Ill AKI Patients Sang Kyung Jo, MD, PhD Department of Internal Medicine Korea University Medical College KO/MG31/15-0017 Outline Fluid balance in critically ill patients:
More informationResearch Article Assessment of Cell-Cycle Arrest Biomarkers to Predict Early and Delayed Acute Kidney Injury
Disease Markers Volume 215, Article ID 158658, 9 pages http://dx.doi.org/1.1155/215/158658 Research Article Assessment of Cell-Cycle Arrest Biomarkers to Predict Early and Delayed Acute Kidney Injury Max
More informationRCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem?
RCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem? Lui G Forni : Consultant Intensivist & Nephrologist Faculty of Health Sciences : University of Surrey Disclosures Research Funding
More informationNovel biomarkers of acute kidney injury and failure: clinical applicability
British Journal of Anaesthesia 109 (6): 843 50 (2012) Advance Access publication 9 October 2012. doi:10.1093/bja/aes357 REVIEW ARTICLES Novel biomarkers of acute kidney injury and failure: clinical applicability
More informationSPRINT: 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 informationRuolo della clinica e del laboratorio nella diagnosi di IRA
Ruolo della clinica e del laboratorio nella diagnosi di IRA Antonio Granata Ospedale San Giovanni di Dio - Agrigento Scuola Nazionale Specialistica di Ecografia Nefrologica SIUMB Centro di Riferimento
More informationInternational Journal of Advanced Research in Biological Sciences ISSN: Coden: IJARQG(USA) Research Article
International Journal of Advanced Research in Biological Sciences ISSN: 2348-8069 www.ijarbs.com Coden: IJARQG(USA) Research Article Serum Neutrophil gelatinase-associated lipocalin, a novel biomarker
More informationchanging 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 informationUne promenade dans l'épidémiologie de l'insuffisance rénale aiguë en quatre étapes
Une promenade dans l'épidémiologie de l'insuffisance rénale aiguë en quatre étapes Fernando Liaño Hospital Universitario Ramón y Cajal Madrid, España Genéve, 14-12-2012 Une promenade dans l'épidémiologie
More informationPRE-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 informationAcute Kidney Injury (AKI) Undergraduate nurse education
Acute Kidney Injury (AKI) Undergraduate nurse education Year One Developed Summer 2017 Overview Basic A & P of: Urinary system Kidneys Followed by: Introduction to Acute Kidney Injury Urinary System The
More informationAcute 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 informationSAFE-T consortium. DIKI BM Summary Data Package. Novel clinical biomarkers of Drug-Induced Kidney Injury
1 SAFE-T consortium Summary Data Package Novel clinical biomarkers of Drug-Induced Kidney Injury The Drug induced kidney injury work package of Innovative Medicines Initiative SAFE-T Consortium Document
More informationNutrition and Sepsis
Nutrition and Sepsis Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University 2017 DNS Symposium June 2, 2017 Case 55 y.o. male COPD, DM, HTN, presents with pneumonia and septic shock.
More informationSupplementary Online Content
Supplementary Online Content Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney
More informationThe 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 informationBiomarkers 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 informationReview: 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 informationOptimal Use of Iodinated Contrast Media In Oncology Patients. Focus on CI-AKI & cancer patient management
Optimal Use of Iodinated Contrast Media In Oncology Patients Focus on CI-AKI & cancer patient management Dr. Saritha Nair Manager-Medical Affairs-India & South Asia GE Healthcare Context Cancer patients
More informationNGAL 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 informationHigh 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 informationUsing Kidney Biomarkers for AKI: Risk Assessment, Diagnosis, and Staging. Rajit K. Basu Patrick Murray Jay L. Koyner
Using Kidney Biomarkers for AKI: Risk Assessment, Diagnosis, and Staging Rajit K. Basu Patrick Murray Jay L. Koyner Using Kidney Biomarkers for AKI: Risk Assessment, Diagnosis, and Staging Starting the
More informationHow 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 informationAdding 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 informationAcute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit
Original article Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit Cyriacus U Anaele MD, Gabriela Suarez MD, Sofia
More informationComparing RRT Modalities: Does It Matter What You Use If The Job Is Done?
Comparing RRT Modalities: Does It Matter What You Use If The Job Is Done? Sean M Bagshaw, MD, MSc Division of Critical Care Medicine University of Alberta Disclosure Consulting: Alere, Baxter, Gambro,
More informationPrédire la récupéra1on rénale. Michaël DARMON Réanima1on polyvalente CHU de Saint- E1enne
Prédire la récupéra1on rénale Michaël DARMON Réanima1on polyvalente CHU de Saint- E1enne Non- specific AKI in the ICU Lameire et al. Lancet 2005 The classical view Intense renal vasoconstric1on r= - 0.82;
More informationRENAL BIOMARKERS: TECHNOLOGIES AND GLOBAL MARKETS
RENAL BIOMARKERS: TECHNOLOGIES AND GLOBAL MARKETS BIO138A January 2015 Cheng-Yuk Lee Project Analyst ISBN: 1-62296-003-3 BCC Research 49 Walnut Park, Building 2 Wellesley, MA 024 USA 866-285-7215 (toll-free
More informationEvaluation 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 informationEarlier diagnosis of acute kidney injury in critically ill patients by novel biomarkers: Moving from supportive care to targeted renoprotection?
Anaesthesiology, Perioperative & Critical Care Medicine Page 1 of 6 Earlier diagnosis of acute kidney injury in critically ill patients by novel biomarkers: Moving from supportive care to targeted renoprotection?
More informationThe Outcome of Neutrophil Gelatinase-Associated Lipocalin-Positive Subclinical Acute Kidney Injury
Journal of the American College of Cardiology Vol. 57, No. 17, 2011 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.11.051
More informationNephrotoxic 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 informationPro-enkephalin and Renal Disease. Alan H. Wu, Ph.D. University of California, San Francisco 12 th Annual UCSD Biomarkers of Cardiac Disease
Pro-enkephalin and Renal Disease Alan H. Wu, Ph.D. University of California, San Francisco 12 th Annual UCSD Biomarkers of Cardiac Disease The presenter has received relevant grants and /or consulting
More informationACUTE 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 informationThe role of the Nephrologist in Acute Kidney Injury. Rebecca Brown Consultant Nephrologist Royal Liverpool University Hospital
The role of the Nephrologist in Acute Kidney Injury Rebecca Brown Consultant Nephrologist Royal Liverpool University Hospital Overview Impact of AKI Need for change Who needs a Nephrologist Are we making
More informationActual versus ideal body weight for acute kidney injury diagnosis and classification in critically Ill patients
Thongprayoon et al. BMC Nephrology 2014, 15:176 RESEARCH ARTICLE Open Access Actual versus ideal body weight for acute kidney injury diagnosis and classification in critically Ill patients Charat Thongprayoon
More informationWhat s new in kidneys a renal update for Anaesthetists
What s new in kidneys a renal update for Anaesthetists Thursday 11 th December 2014 Roslyn Simms Clinical Lecturer in Nephrology Renal update What s new/update AKI When to start RRT in AKI? Perioperative
More informationJournal 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 informationEarly 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 informationSepsis associated acute kidney injury
1 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA 2 Section of Nephrology, Department of Medicine, University of Chicago Correspondence
More informationAcute 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 informationAugmented Renal Clearance: Let s Get the Discussion Flowing
Augmented Renal Clearance: Let s Get the Discussion Flowing Terry Makhoul, PharmD PGY-2 Emergency Medicine Pharmacy Resident University of Rochester Medical Center Strong Memorial Hospital Disclosures
More information1. Introduction. Keywords: NGAL protein, human, Cystatin C, Acute kidney injury, biomarkers, sepsis, Intensive Care Units, predictive value of tests
Disease Markers 34 (2013) 237 246 237 DOI 10.3233/DMA-130966 IOS Press The use of plasma and urine neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C in early diagnosis of septic acute kidney
More informationAcute 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 informationSeveral investigations have demonstrated that acute
Association Between Progression and Improvement of Acute Kidney Injury and Mortality in Critically Ill Children* L. Nelson Sanchez-Pinto, MD 1 ; Stuart L. Goldstein, MD 2 ; James B. Schneider, MD 3 ; Robinder
More informationIts 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 informationAcute Kidney Injury. Arvind Bagga All India Institute of Medical Sciences New Delhi, India
Acute Kidney Injury Arvind Bagga All India Institute of Medical Sciences New Delhi, India What is AKI? Sudden loss of renal function, over hrdays, with derangement(s) in fluid balance, acid base & electrolytes
More informationWEEK. MPharm Programme. Acute Kidney Injury. Alan M. Green MPHM13: Acute Kidney Injury. Slide 1 of 47
MPharm Programme Acute Kidney Injury Alan M. Green 2017 Slide 1 of 47 Overview Renal Function What is it? Why does it matter? What causes it? Who is at risk? What can we (Pharmacists) do? How do you recognise
More informationIJBPAS, 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 informationRenal 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