Kidney international
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Kidney international · Feb 2008
Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery.
Acute kidney injury (AKI) is a major complication of cardiac bypass surgery. We examined whether levels of liver fatty acid-binding protein (L-FABP) can be an early biomarker for ischemic injury by measuring this protein in the urine of 40 pediatric patients prior to and following cardiopulmonary bypass surgery. AKI was defined as a 50% increase in the serum creatinine from baseline, which was normally not seen until 24-72 h after surgery. ⋯ Univariate logistic regression analyses showed that both bypass time and urinary L-FABP were significant independent risk indicators for AKI. After excluding bypass time from the model and using a stepwise multivariate logistic regression analysis, urinary L-FABP levels at 4 h after surgery were an independent risk indicator with the area under the receiver-operating characteristic curve 0.810, sensitivity 0.714, and specificity 0.684 for a 24-fold increase in urinary L-FABP. Our study shows that urinary L-FABP levels represent a sensitive and predictive early biomarker of AKI after cardiac surgery.
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Kidney international · Dec 2007
Clinical TrialBeta-blockers improve outcomes in kidney disease patients having noncardiac vascular surgery.
Beta-blockers are known to improve postoperative outcome after major vascular surgery. We studied the effects of beta-blockers in 2126 vascular surgery patients with and without kidney disease followed for 14 years. Creatinine clearance was calculated using the Cockcroft-Gault equation, and kidney function was categorized as Stage 1 for a reference group of 550 patients, Stage 2 with 808 patients, Stage 3 with 627 patients, and combined Stages 4 and 5 with 141 patients. ⋯ Mortality rates were three- and two-fold higher, respectively, for patients at Stages 3-5 compared to the reference group for the two outcomes. beta-Blocker use was significantly associated with a lower risk of mortality after surgery. The overall adjusted hazard ratio was 0.35 and 0.62, respectively, for individuals at Stages 3-5 compared to the reference group for 30-day and long-term mortality. This study shows that kidney function is a predictor of all-cause mortality and beta-blocker use is associated with a lower risk of death in kidney disease patients undergoing elective vascular surgery.
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Kidney international · Oct 2007
ReviewLeptospirosis renal disease: understanding the initiation by Toll-like receptors.
Leptospirosis is a prevalent infectious disease affecting both humans and animals worldwide. This infection is associated with occupational or recreational exposure to animals as well as contact with leptospires, particularly in flood-prone areas. Multiple organ dysfunctions may be associated with acute severe leptospirosis. ⋯ Leptospira OMP may also induce activation of the transforming growth factor-beta/Smad-associated fibrosis pathway leading to accumulation of extracellular matrix. Thus, leptospirosis renal disease is a model for understanding the pathogenesis and initiation of pathogen-induced tubulo-interstitial nephritis and fibrosis. In particular, TLRs may be important mediators.