Nephron. Physiology
-
Nephron. Physiology · Jan 2010
Clinical usefulness of novel biomarkers for the detection of acute kidney injury following elective cardiac surgery.
Acute kidney injury (AKI) is common following cardiac surgery and predicts a poor outcome. However, the early detection of AKI has proved elusive and most cases are diagnosed only following a significant rise in serum creatinine (SCr). We compared a panel of early biomarkers of AKI for the detection of AKI in patients undergoing heart surgery. This study included serum cystatin C (CyC) and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), retinol-binding protein (RBP) and N-acetyl-beta-D-glucosaminidase (NAG). ⋯ The use of serum and urinary biomarkers for the prediction of AKI in patients undergoing cardiac surgery is highly dependent on the sampling time. Of the evaluated markers urinary NGAL had the best predictive profile. The previously unstudied marker of urinary RBP showed similar predictive power as more established markers. By combining all 5 studied biomarkers we were able to predict significantly more cases, suggesting that the use of more than one marker may be beneficial clinically.
-
Nephron. Physiology · Jan 2010
Comparative StudyA comparison of nonoliguric and oliguric severe acute kidney injury according to the risk injury failure loss end-stage (RIFLE) criteria.
Risk, Injury, Failure, Loss, and End-Stage (RIFLE) criteria have been proposed as a standard definition of acute kidney injury (AKI). The most severe form of AKI, class F AKI, can be defined by either severe oliguria or a 3-fold increase in serum creatinine concentrations. We hypothesized that the outcomes of patients with these 2 alternative criteria of severe AKI were different. ⋯ Oliguric RIFLE class F AKI is a more severe form of AKI than nonoliguric class F AKI. These 2 forms of AKI should be considered separately when AKI is evaluated in a clinical trial.
-
Nephron. Physiology · Jan 2010
Evaluation of sepsis/systemic inflammatory response syndrome, acute kidney injury, and RIFLE criteria in two tertiary hospital intensive care units in Turkey.
Sepsis is a common cause of acute renal failure in intensive care units (ICU) with mortality rates as high as 60%. In this study, the clinical and laboratory predictors of acute kidney injury (AKI) in critically ill Turkish patients with sepsis/systemic inflammatory response syndrome were identified. We studied 139 (67 females/72 males) patients admitted to our ICUs with sepsis/systemic inflammatory response syndrome without renal failure. ⋯ In this population, the incidence of AKI was higher and contrary to previous knowledge. A positive fluid balance also carries a risk for AKI and mortality in septic ICU patients. The RIFLE criteria were found to be applicable to our ICU population.
-
Nephron. Physiology · Jan 2010
Improving the management of chronic kidney disease in Uruguay: a National Renal Healthcare Program.
Uruguay has implemented a chronic kidney disease (CKD) prevention program. ⋯ Our results highlight the best management of CKD patients in both groups and the impact of the NC and renin-angiotensin-aldosterone system blockers.
-
In nephrology research, both observational studies and randomized controlled trials (RCTs) are commonly applied. Clinicians using the evidence from epidemiological studies should be aware of the specific qualities and limitations of each study design. ⋯ Conversely, observational study designs, including case reports, case series, cross-sectional studies, case-control studies and cohort studies, are usually more useful than RCTs for non-therapeutic research questions. In conclusion, both observational studies and RCTs fulfill a complementary and valuable role in nephrology.