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1.
Lancet ; 394(10197): 488-496, 2019 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-31202596

RESUMO

BACKGROUND: Cardiac surgery is associated with a high risk of postoperative acute kidney injury (AKI) and subsequent loss of kidney function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a renal tubular stress marker, for preoperative identification of patients at risk for AKI and subsequent kidney function loss. METHODS: This observational cohort study included patients who had cardiac surgery in a derivation cohort and those who had cardiac surgery in a validation cohort (RenalRIP trial). The study comprised consecutive patients who had elective cardiac surgery at the Saarland University Medical Centre (Homburg, Germany; derivation cohort) and those undergoing elective cardiac surgery (selected on the basis of a Cleveland Clinical Foundation score of 6 or higher) who were enrolled in the prospective RenalRIP multicentre trial (validation cohort) and who were randomly assigned to remote ischaemic preconditioning or a sham procedure. The association between the ratio of preoperative urinary concentrations of DKK3 to creatinine (DKK3:creatinine) and postoperative AKI, defined according to the Kidney Disease Improving Global Outcomes criteria, and subsequent kidney function loss, as determined by estimated glomerular filtration rate, was assessed. FINDINGS: In the 733 patient in the derivation cohort, urinary concentrations of DKK3 to creatinine that were higher than 471 pg/mg were associated with significantly increased risk for AKI (odds ratio [OR] 1·65, 95% CI 1·10-2·47, p=0·015), independent of baseline kidney function. Compared with clinical and other laboratory measurements, urinary concentrations of DKK3:creatinine significantly improved AKI prediction (net reclassification improvement 0·32, 95% CI 0·23-0·42, p<0·0001). High urinary DKK3:creatinine concentrations were independently associated with significantly lower kidney function at hospital discharge and after a median follow-up of 820 days (IQR 733-910). In the RenalRIP trial, preoperative urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with a significantly higher risk for AKI (OR 1·94, 95% CI 1·08-3·47, p=0·026), persistent renal dysfunction (OR 6·67, 1·67-26·61, p=0·0072), and dialysis dependency (OR 13·57, 1·50-122·77, p=0·020) after 90 days compared with DKK3:creatinine concentrations of 471 pg/mg or less. Urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with significantly higher risk for AKI (OR 2·79, 95% CI 1·45-5·37) and persistent renal dysfunction (OR 3·82, 1·32-11·05) only in patients having a sham procedure, but not remote ischaemic preconditioning (AKI OR 1·35, 0·76-2·39 and persistent renal dysfunction OR 1·05, 0·12-9·45). INTERPRETATION: Preoperative urinary DKK3 is an independent predictor for postoperative AKI and for subsequent loss of kidney function. Urinary DKK3 might aid in the identification of patients in whom preventive treatment strategies are effective. FUNDING: No study funding.


Assuntos
Lesão Renal Aguda/fisiopatologia , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Peptídeos e Proteínas de Sinalização Intercelular/urina , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Idoso , Idoso de 80 Anos ou mais , Quimiocinas , Creatinina/urina , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/urina , Estudos Prospectivos
2.
Ann Transplant ; 24: 291-297, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31110167

RESUMO

Acute kidney injury (AKI) is a frequent and serious complication of orthotopic liver transplantation (OLT), with a significant impact on mortality, graft survival, and chronic kidney disease. Currently, the diagnosis of AKI is based on changes in serum creatinine, which is a late marker, usually rising when there is already significant damage to the renal parenchyma. During the last 2 decades, various biomarkers have been studied in many clinical situations, mostly after cardiac surgery, in drug-induced AKI, or in sepsis. The present article summarizes the data on those biomarkers that have been evaluated for the prediction of AKI in patients undergoing OLT.


Assuntos
Lesão Renal Aguda/diagnóstico , Proteínas de Ligação a Ácido Graxo/metabolismo , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Interleucina-18/metabolismo , Lipocalina-2/metabolismo , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Biomarcadores/sangue , Biomarcadores/urina , Proteínas de Ligação a Ácido Graxo/sangue , Proteínas de Ligação a Ácido Graxo/urina , Humanos , Interleucina-18/sangue , Interleucina-18/urina , Lipocalina-2/sangue , Lipocalina-2/urina , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina , Fatores de Risco
3.
Prog Urol ; 29(5): 253-262, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30962140

RESUMO

INTRODUCTION: The aim was to assess the risk of postoperative infections in patients with preoperative polymicrobial urine culture and to provide the urologist with practices to minimise the risk of infection in these clinical situations. METHODS: A systematic literature review was carried. All national and international recommendations have been reviewed. Data collection has been performed from the Cochrane, LILACS and the Medline database. 31 publications were selected for inclusion. RESULTS: Risk of infection in patients without ureteral stents or urinary catheters with previous polymicrobial urine culture is low. In the absence of leukocyturia, the urine sample can be considered as sterile. With ureteral stents or urinary catheters, the colonisation by biofilm ranges from 4 to 100% depending on the duration and ureteral stents or urinary catheters type. Urine culture is positive 24 to 45% of the time when ureteral stents or urinary catheters are known to be colonised. The post-operative risk of infection in endo-urological surgery in a patient with ureteral stents or urinary catheters is estimated around 8 to 11% depending on the type of surgery. A retrospective study reports a postoperative infections rate of 18.5% in photo selective vaporization of the prostate with preoperative polymicrobial urine culture. CONCLUSIONS: Scientific data are limited but for patients without ureteral stents or urinary catheters, in the absence of leukocyturia, the polymicrobial urine culture can be considered as negative. Considering a preoperative polymicrobial urine culture as sterile in patients with colonised ureteral stents or urinary catheters is at risk of neglecting a high risk of postoperative infections or sepsis even in case of perioperative antibiotic prophylaxis. It should not always be considered sterile and therefore, a perioperative antibiotic therapy could be an acceptable option.


Assuntos
Bacteriúria/terapia , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto/normas , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Antibioticoprofilaxia , Técnicas Bacteriológicas , Bacteriúria/epidemiologia , Bacteriúria/urina , Feminino , França/epidemiologia , Humanos , Masculino , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/urina , Fatores de Risco , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Urinálise , Procedimentos Cirúrgicos Urológicos/normas , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/métodos , Urologia/normas
4.
Ann Thorac Surg ; 107(6): 1699-1705, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30880140

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a common complication of cardiac surgery. Postprocedural AKI is a risk factor for 30-day readmission. We sought to examine the association of AKI and kidney injury biomarkers with readmission after cardiac surgery. METHODS: Patients alive at discharge who underwent cardiac surgery from the Translational Research Investigating Biomarker Endpoints-AKI cohort were enrolled from six medical centers in the United States and Canada. AKI duration was defined as the total number of days AKI was present during index admission (no AKI, 1-2, 3-6, and 7+ days). Preoperative and postoperative urinary levels were collected for interleukin-18, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio. Readmission and death events were identified through US (Medicare) and Canadian administrative databases at 30 days and 365 days after discharge. RESULTS: Of 968 patients 15.9% were readmitted or died within 30 days of discharge and 35.9% were readmitted or died within 365 days. AKI duration of 3 to 6 days was significantly associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08-3.05). Patients with AKI duration ≥ 7 days had increased odds of readmission or death at both 30 days (adjusted odds ratio, 2.49%; 95% confidence interval, 1.15-5.43) and 365 days (adjusted odds ratio, 3.67%; 95% confidence interval, 1.73-7.79). Urinary biomarkers had no association with readmission and death. CONCLUSIONS: AKI duration ≥ 3 days, and not kidney biomarkers, was strongly associated with readmission or death. These clinical outcomes are potentially due to cardiovascular or hemodynamic causes rather than intrinsic injury to the kidney parenchyma.


Assuntos
Lesão Renal Aguda/urina , Procedimentos Cirúrgicos Cardíacos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/urina , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo
5.
J Infect Chemother ; 25(5): 337-340, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30718193

RESUMO

PURPOSE: To assess the efficacy of a combined regimen of levofloxacin (LVFX) plus isepamicin (ISP) as prophylaxis for transrectal ultrasound-guided needle biopsy of the prostate (TRUSP-Bx). MATERIALS AND METHODS: Overall, 562 patients undergoing TRUSP-Bx were included in the present study. All patients were administered a single-dose of oral LVFX (500 mg) in the morning and intravenous ISP (400 mg) 60 min before biopsy. All biopsies were performed via TRUSP-Bx with an 18-gauge needle, and 12-core specimens were routinely obtained. Before initiating antibiotic treatment, urine and blood bacterial cultures were tested to determine the causative microorganisms in the patients with acute bacterial prostatitis. RESULTS: Acute bacterial prostatitis developed in three (0.53%) participants. The incidence rates of acute bacterial prostatitis in the low- and high-risk groups were 0.79% and 0.46%, respectively. These patients showed clinical symptoms of acute bacterial prostatitis 12-24 h after their biopsy. Escherichia coli (E. coli) was isolated in the urine or bladder cultures of all of patients. All three isolates were determined to be LVFX-resistant E. coli, although they had good sensitivity to aminoglycosides, cephalosporins, and carbapenems. All patients were administered antibiotic treatment (cephalosporin or carbapenem) immediately and were treated successfully with no evidence of further disease progression. CONCLUSION: Antibiotic prophylaxis with LVFX plus ISP was effective, resulting in a lower incidence of acute bacterial prostatitis after TRUSP-Bx in both low- and high-risk patients.


Assuntos
Antibioticoprofilaxia/métodos , Levofloxacino/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Prostatite/prevenção & controle , Doença Aguda/epidemiologia , Administração Intravenosa , Administração Oral , Idoso , Bactérias/isolamento & purificação , Biópsia com Agulha de Grande Calibre/efeitos adversos , Quimioterapia Combinada/métodos , Gentamicinas/uso terapêutico , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina , Próstata/diagnóstico por imagem , Próstata/microbiologia , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Prostatite/epidemiologia , Prostatite/etiologia , Prostatite/urina , Reto/microbiologia , Reto/cirurgia , Estudos Retrospectivos , Ultrassonografia de Intervenção
6.
Urology ; 124: 310.e9-310.e14, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30412704

RESUMO

OBJECTIVE: To test the effect of calcium and vitamin B6 therapies on urinary oxalate excretion in a rodent model of enteric hyperoxaluria after Roux-en Y gastric bypass (RYGB) surgery. METHODS: Obese male Sprague-Dawley rats underwent sham (n = 7) or RYGB (n = 10). Animals were maintained on low oxalate (1.5%) and fat (10%; LOF), normal calcium (0.6 %) diet for 8 weeks and then completed a 2-phase crossover metabolic study. In the first 2-week phase, animals were fed a Low oxalate and fat (LOF), high calcium (2.4%; HC) diet. After a 2-week washout, rats were fed a LOF/normal calcium diet highly enriched with vitamin B6. Urine was collected before and after each intervention. Plasma pyridoxal 5'-phosphate (PLP) and metabolites were measured baseline and 11 weeks after sham or RYGB. RESULTS: Compared to baseline, sham animals on LOF/HC diet doubled their urinary calcium excretion but not oxalate. RYGB animals on LOF/HC diet decreased urinary oxalate excretion 28% (P = .001) without a significant rise in urinary calcium. Vitamin B6 supplementation decreased RYGB urinary oxalate by approximately 15% (P = .06), and serum PLP explained 63% of urinary oxalate variability. CONCLUSION: Based on the findings in this model, calcium supplementation appears to be a reasonable therapy to decrease urinary oxalate in RYGB patients who maintain a low fat and oxalate diet. Serum PLP had a fair correlation to urinary oxalate excretion and may be a useful screening tool in hyperoxaluric RYGB patients. Further experimental human studies after RYGB are necessary to determine whether these commonly employed supplements truly provide a benefit in enteric hyperoxaluria.


Assuntos
Cálcio/uso terapêutico , Suplementos Nutricionais , Derivação Gástrica , Hiperoxalúria/tratamento farmacológico , Hiperoxalúria/urina , Oxalatos/urina , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/urina , Vitamina B 6/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Animais , Modelos Animais de Doenças , Derivação Gástrica/efeitos adversos , Hiperoxalúria/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Ratos , Ratos Sprague-Dawley
7.
Nutrition ; 58: 110-119, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30391689

RESUMO

OBJECTIVES: Perioperative nutritional management is essential for early recovery after liver surgery. The aim of this study was to assess changes in amino acid levels in serum and urine after hepatectomy. METHODS: Serum samples were collected from 16 patients with hepatocellular carcinoma before and 1, 3, and 14 d after hepatectomy (S0, S1, S3, and S14, respectively). Spot urine samples were collected before and 3 d after the hepatectomy (U0 and U3). Metabolites in the serum and urine were analyzed. RESULTS: Compared with S0, insulin levels significantly increased in the S1 and S3 samples. Valine levels significantly decreased in S1 and S14, and leucine levels significantly decreased in S14. Phenylalanine levels significantly increased in S1 and S3, and tyrosine levels significantly increased in S1. The Fischer ratio (branched-chain/aromatic amino acids) significantly decreased in S1 and S3. In multiple regression analysis, changes in serum taurine levels were related to the white blood cell count in S1 and S3, and inversely related to alanine aminotransferase levels in S14. Changes in serum glutamine levels were negatively related to C-reactive protein levels in S3. Serum glutamine levels decreased in S3 and S14, and tended to increase in U3, suggesting a deficiency of glutamate resulting from the invasive surgical procedure. CONCLUSIONS: These findings highlight the usefulness of metabolome analysis for characterizing perioperative patterns after liver resection. The observed amino acid pattern, including the reduction in Fischer ratio, underscores the need for specialized nutritional support.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Metaboloma , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/urina , Idoso , Feminino , Humanos , Fígado/cirurgia , Masculino , Assistência Perioperatória/métodos
8.
Am J Kidney Dis ; 73(1): 51-61, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30037726

RESUMO

RATIONALE & OBJECTIVE: Cardiovascular disease (CVD) is common and overall graft survival is suboptimal among kidney transplant recipients. Although albuminuria is a known risk factor for adverse outcomes among persons with native chronic kidney disease, the relationship of albuminuria with cardiovascular and kidney outcomes in transplant recipients is uncertain. STUDY DESIGN: Post hoc longitudinal cohort analysis of the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) Trial. SETTING & PARTICIPANTS: Stable kidney transplant recipients with elevated homocysteine levels from 30 sites in the United States, Canada, and Brazil. PREDICTOR: Urine albumin-creatinine ratio (ACR) at randomization. OUTCOMES: Allograft failure, CVD, and all-cause death. ANALYTICAL APPROACH: Multivariable Cox models adjusted for age; sex; race; randomized treatment allocation; country; systolic and diastolic blood pressure; history of CVD, diabetes, and hypertension; smoking; cholesterol; body mass index; estimated glomerular filtration rate (eGFR); donor type; transplant vintage; medications; and immunosuppression. RESULTS: Among 3,511 participants with complete data, median ACR was 24 (Q1-Q3, 9-98) mg/g, mean eGFR was 49±18 (standard deviation) mL/min/1.73m2, mean age was 52±9 years, and median graft vintage was 4.1 (Q1-Q3, 1.7-7.4) years. There were 1,017 (29%) with ACR < 10mg/g, 912 (26%) with ACR of 10 to 29mg/g, 1,134 (32%) with ACR of 30 to 299mg/g, and 448 (13%) with ACR ≥ 300mg/g. During approximately 4 years, 282 allograft failure events, 497 CVD events, and 407 deaths occurred. Event rates were higher at both lower eGFRs and higher ACR. ACR of 30 to 299 and ≥300mg/g relative to ACR < 10mg/g were independently associated with graft failure (HRs of 3.40 [95% CI, 2.19-5.30] and 9.96 [95% CI, 6.35-15.62], respectively), CVD events (HRs of 1.25 [95% CI, 0.96-1.61] and 1.55 [95% CI, 1.13-2.11], respectively), and all-cause death (HRs of 1.65 [95% CI, 1.23-2.21] and 2.07 [95% CI, 1.46-2.94], respectively). LIMITATIONS: No data for rejection; single ACR assessment. CONCLUSIONS: In a large population of stable kidney transplant recipients, elevated baseline ACR is independently associated with allograft failure, CVD, and death. Future studies are needed to evaluate whether reducing albuminuria improves these outcomes.


Assuntos
Albuminúria/epidemiologia , Albuminúria/urina , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/urina , Creatinina/urina , Transplante de Rim , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/urina , Causas de Morte , Estudos de Coortes , Método Duplo-Cego , Feminino , Sobrevivência de Enxerto , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento
9.
J Cardiothorac Vasc Anesth ; 33(2): 348-356, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30181085

RESUMO

OBJECTIVE: Administration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. DESIGN: Prospective, randomized, and single-blinded trial. SETTING: Single university medical center. PARTICIPANTS: Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. INTERVENTIONS: Subjects were randomized to receive either NS or Isolyte during the intraoperative period. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). CONCLUSION: The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.


Assuntos
Lesão Renal Aguda/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Taxa de Filtração Glomerular/fisiologia , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/urina , Lactato de Ringer/administração & dosagem , Solução Salina/administração & dosagem , Inibidor Tecidual de Metaloproteinase-2/urina , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Idoso , Biomarcadores/urina , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/urina , Estudos Prospectivos , Curva ROC , Método Simples-Cego
10.
Eur J Pediatr Surg ; 29(2): 215-222, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29727865

RESUMO

PURPOSE: The aim of the study was to investigate urinary levels of monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), ß-2-microglobulin (ß2M), and FAS-ligand (FAS-L) in children with congenital anomalies of kidney and urinary tract (CAKUT) disease at risk of developing glomerular hyperfiltration syndrome. For this reason, we selected patients with multicystic kidney, renal agenesia and renal hypodysplasia, or underwent single nephrectomy. MATERIALS AND METHODS: This prospective, multicentric study was conducted in collaboration between the Pediatric Surgery Unit in Foggia and the Pediatric Nephrology Unit in Bari, Italy. We enrolled 80 children with CAKUT (40 hypodysplasia, 22 agenetic; 10 multicystic; 8 nephrectomy) who underwent extensive urological and nephrological workup. Exclusion criteria were recent urinary tract infections or pyelonephritis, age > 14 years, presence of systemic disease, or hypertension. A single urine sample was collected in a noninvasive way and processed for measuring by enzyme-linked immunosorbent assay urine levels of MCP-1, EGF, ß2M, and FAS-L. As control, urine samples were taken from 30 healthy children.Furthermore, we evaluated the urinary ratios uEGF/uMCP-1 (indicator of regenerative vs inflammatory response) and uEGF/uß2M (indicator of regenerative response vs. tubular damage). RESULTS: These results suggest that urinary levels of MCP-1 are overexpressed in CAKUT patients. Furthermore, our findings clearly demonstrated that both uEGF/uMCP-1 and uEGF/uß2M ratios were significantly downregulated in all patient groups when compared with the control group. CONCLUSION: These findings further support that CAKUT patients may, eventually, experience progressive renal damage and poor regenerative response. The increased urinary levels of MCP-1 in all groups of CAKUT patients suggested that the main factor responsible for the above effects is chronic renal inflammation mediated by local monocytes.


Assuntos
Biomarcadores/urina , Nefropatias/congênito , Rim/anormalidades , Rim Displásico Multicístico/complicações , Insuficiência Renal/diagnóstico , Anormalidades Urogenitais/complicações , Criança , Pré-Escolar , Anormalidades Congênitas/urina , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Nefropatias/complicações , Nefropatias/urina , Masculino , Rim Displásico Multicístico/urina , Nefrectomia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/urina , Estudos Prospectivos , Insuficiência Renal/etiologia , Insuficiência Renal/urina , Anormalidades Urogenitais/urina
11.
BMJ Open ; 8(8): e021219, 2018 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-30166295

RESUMO

OBJECTIVE: As a marker of in vivo thromboxane generation, high-level urinary thromboxane metabolites (TXA-M) increase the occurrence of cardiovascular events in high-risk patients. To investigate whether perioperative urinary TXA-M level is associated with major adverse cardiac and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) surgery, we designed a nested case-control study. DESIGN: Observational, nested case-control study. SETTING: Single-centre outcomes research in Fuwai Hospital, Beijing, China. PARTICIPANTS: One thousand six hundred and seventy Chinese patients undergoing CABG surgery from September 2011 to October 2013. METHODS: We obtained urinary samples from 1670 Chinese patients undergoing CABG 1 hour before surgery (pre-CABG), and 6 hours (post-CABG 6 hours) and 24 hours after surgery (post-CABG 24 hours). Patients were followed up for 1 year, and we observed 56 patients had MACCE. For each patient with MACCE, we matched three control subjects. Perioperative urinary TXA-M of the three time spots was detected in these 224 patients. RESULTS: Post-CABG 24 hours TXA-M is significantly higher than that of patients without MACCE (11 101vs8849 pg/mg creatine, P=0.007). In addition, patients in the intermediate tertile and upper tertile of post-CABG 24 hours urinary TXA-M have a 2.2 times higher (HR 2.22, 95% CI 1.04 to 4.71, P=0.038) and a 2.8 times higher (HR 2.81, 95% CI 1.35 to 5.85, P=0.006) risk of 1 year MACCE than those in the lower tertile, respectively. CONCLUSIONS: In conclusion, post-CABG 24 hours urinary TXA-M elevation is associated with an increase of 1 year adverse events after CABG, indicating that the induction of cyclo-oxygenase-2 by surgery-related inflammatory stimuli or platelet turnover may be responsible for the high levels of post-CABG urinary TXA-M. TRIAL REGISTRATION NUMBER: NCT01573143.


Assuntos
Ponte de Artéria Coronária , Período Perioperatório , Tromboxanos/urina , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Transtornos Cerebrovasculares/etiologia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina , Fatores de Risco , Tromboxanos/metabolismo
12.
Can J Surg ; 61(5): E11-E16, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247865

RESUMO

Background: Acute kidney injury (AKI) is associated with increased morbidity and mortality after liver resection. Patients with hepatocellular carcinoma (HCC) have a higher risk of AKI owing to the underlying association between hepatic and renal dysfunction. Use of the Acute Kidney Injury Network (AKIN) diagnostic criteria is recommended for patients with cirrhosis, but remains poorly studied following liver resection. We compared the prognostic value of the AKIN creatinine and urine output criteria in terms of postoperative outcomes following liver resection for HCC. Methods: All patients who underwent a liver resection for HCC from January 2010 to June 2016 were included. We used AKIN urine output and creatinine criteria to assess for AKI within 48 hours of surgery. Results: Eighty liver resections were performed during the study period. Cirrhosis was confirmed in 80%. Median hospital stay was 9 (interquartile range 7­12) days, and 30-day mortality was 2.5%. The incidence of AKI was higher based on the urine output than on the creatinine criterion (53.8% v. 20%), and was associated with prolonged hospitalization and 30-day postoperative mortality when defined by serum creatinine (hospital stay: 11.2 v. 20.1 d, p = 0.01; mortality: 12.5% v. 0%, p < 0.01), but not urine output (hospital stay: 15.6 v. 10 d, p = 0.05; mortality: 2.3% v. 2.7%, p > 0.99). Conclusion: The urine output criterion resulted in an overestimation of AKI and compromised the prognostic value of AKIN criteria. Revision may be required to account for the exacerbated physiologic postoperative reduction in urine output in patients with HCC.


Assuntos
Lesão Renal Aguda/diagnóstico , Carcinoma Hepatocelular/cirurgia , Fibrose/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Guias de Prática Clínica como Assunto/normas , Lesão Renal Aguda/urina , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/urina , Valor Preditivo dos Testes
13.
PLoS One ; 13(9): e0203447, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30180211

RESUMO

BACKGROUND: Although urinary neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising biomarker for the early detection of kidney injury, previous studies of adult patients who underwent cardiac surgery have reported only moderate discrimination. The age, creatinine, and ejection fraction (ACEF) score is a preoperative validated risk model with satisfactory accuracy for predicting AKI following cardiac surgery. It remains unknown whether combining preoperative risk assessment through ACEF scores followed by urinary NGAL test in a population of high-risk individuals is an optimal approach with improved predictive performance. MATERIAL AND METHODS: A total of 177 consecutive patients who underwent cardiac surgery were enrolled. Clinical characteristics, prognostic model scores, and outcomes were assessed. Urinary NGAL were examined within 6 hours after cardiac surgery. Patients were stratified according to preoperative ACEF scores, and comparisons were made using the area under the receiver operator characteristic curve (AUROC) for the prediction of AKI. RESULTS: A total of 45.8% (81/177) of the patients had AKI. As expected, patients with ACEF scores ≥ 1.1 were older and more likely to have class III or IV heart failure. They were also more likely to have diabetes mellitus, myocardial infarction, and peripheral arterial disease. Urinary NGAL alone moderately predicted AKI, with an AUROC of 0.732. Risk stratification by ACEF scores ≥ 1.1 substantially improved the AUROC of urinary NGAL to 0.873 (95% confidence interval, 0.784-0.961; P < .001). CONCLUSIONS: Risk stratification by preoperative ACEF scores ≥ 1.1, followed by postoperative urinary NGAL, provides more satisfactory risk discrimination than does urinary NGAL alone for the early detection of AKI after cardiac surgery. Future studies should investigate whether this strategy could improve the outcomes and cost-effectiveness of care in patients undergoing cardiac surgery.


Assuntos
Lesão Renal Aguda , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Modelos Cardiovasculares , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/efeitos adversos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/urina , Adulto , Idoso , Biomarcadores/urina , Feminino , Humanos , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/urina , Medição de Risco , Volume Sistólico , Fatores de Tempo
14.
Adv Clin Exp Med ; 27(12): 1671-1676, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30074307

RESUMO

BACKGROUND: Hemolysis during cardiopulmonary bypass may lead to acute kidney injury caused by an excessive amount of iron. The clinical usefulness of the measurement of total iron concentration in the urine with the use of the atomic absorption spectrometry method for early identification of patients with postoperative acute kidney injury is not well-established. OBJECTIVES: An observational, prospective study was conducted on a group of 88 pre-selected adult patients undergoing a planned coronary artery bypass grafting (CABG) procedure. MATERIAL AND METHODS: The amount and concentrations of total iron, creatinine and neutrophil gelatinaseassociated lipocalin (NGAL) were evaluated in urine samples. A comparative analysis of the evaluated biochemical parameters was performed in regard to the occurrence of acute kidney injury 48 h postoperatively. RESULTS: Patients in the acute kidney injury group presented more advanced age (p = 0.01), preoperative myocardial infarction (p = 0.02), diuresis reduction (p = 0.04), and lower total iron levels in the 48-hour urine sample (p = 0.01). There was no difference when considering iron concentration in single urine samples in the study group. CONCLUSIONS: The sole result of total iron concentration in single urine samples is unreliable for the diagnosis of acute kidney injury after cardiac surgery. Decreased excretion of iron in the urine seems to be an important additional element in the multifactorial pathogenesis of acute postoperative kidney failure.


Assuntos
Lesão Renal Aguda/etiologia , Proteínas da Fase Aguda/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Creatinina/sangue , Ferro/urina , Lipocalina-2/urina , Proteínas Proto-Oncogênicas/urina , Lesão Renal Aguda/sangue , Lesão Renal Aguda/urina , Adulto , Biomarcadores/sangue , Biomarcadores/urina , Ponte Cardiopulmonar/efeitos adversos , Humanos , Testes de Função Renal , Lipocalina-2/sangue , Lipocalina-2/metabolismo , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/urina , Valor Preditivo dos Testes , Estudos Prospectivos , Proteínas Proto-Oncogênicas/sangue
15.
Biomark Med ; 12(9): 975-985, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30088425

RESUMO

AIM: To assess weather doctors' clinical risk-assessment for major adverse kidney events (MAKE) and acute kidney injury (AKI) after open-heart surgery would improve when being informed about neutrophil gelatinase-associated lipocalin (NGAL) test result at ICU admission. PATIENTS & METHODS: Clinical risk-assessment for MAKE and AKI were performed with and without providing NGAL test result and compared in an exploratory- and a validation-cohort using reclassification metrics, exemplary category-free net reclassification improvement (cfNRI). RESULTS: Exploratory cohort: doctors' prediction of MAKE (cfNRI = 0.750 [0.130-1.370]; p = 0.018) and AKI (cfNRI = 0.565 [0.001-1.129]; p = 0.049) improved being provided with NGAL test information. This finding was confirmed in the validation-cohort (MAKE cfNRI = 0.930 [0.188-1.672]; p = 0.014) and the combined-cohort (MAKE: cfNRI = 0.847 [0.371-1.323], p < 0.001); AKI: cfNRI = 0.468 [0.099-0.836; p = 0.013]). Improvements mostly generated from correctly reclassifying patients who not developed events (p < 0.001). CONCLUSION: Biomarker informed risk-assessment is superior in predicting MAKE and AKI after open-heart surgery.


Assuntos
Lesão Renal Aguda/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Lipocalina-2/urina , Complicações Pós-Operatórias/urina , Lesão Renal Aguda/etiologia , Idoso , Biomarcadores/urina , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco
16.
Gac Med Mex ; 154(3): 275-282, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30047932

RESUMO

Introducción: Estudios recientes sugieren que la lipocalina asociada con la gelatinasa del neutrófilo urinaria (NGALu) es superior a la creatinina para la detección temprana de la disfunción del injerto renal, pero son pocos los estudios que evalúan su utilidad como predictor a largo plazo de dicha función. Objetivo: Explorar si los valores de NGALu en las primeras 48 horas después del trasplante renal predicen la función del injerto a largo plazo. Método: Cohorte prospectiva en la que se evaluaron los valores de NGALu a las 2, 12, 24 y 48 horas postrasplante renal. Resultados: Se valoraron 79 pacientes trasplantados renales. Al año de seguimiento, 30.4 de los pacientes presentó disfunción del injerto. No se encontraron diferencias estadísticamente significativas entre los valores de NGALu y la función a un año del injerto renal (p = 0.65); el análisis multivariado mostró que ningún valor de NGALu fue un marcador predictor de disfunción del injerto a un año del trasplante renal. Conclusión: Los valores de NGALu obtenidos en las primeras 48 horas postrasplante no se asociaron con disfunción del injerto a un año del trasplante renal. Introduction: Recent studies suggest that urinary neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for renal graft dysfunction early detection, but there are only few studies assessing its usefulness as long-term predictor of said function. Objective: To explore if uNGAL values within the first 48 hours after kidney transplantation predict graft function on the long term. Method: Prospective cohort, where uNGAL values were assessed at 2, 12, 24 and 48 hours post-kidney transplantation. Results: Seventy-nine kidney transplant recipients were evaluated. At one year of follow-up, 30.4% of patients had graft dysfunction. No statistically significant differences were found between the uNGAL values and the renal graft function at one year (p = 0.65); the multivariate analysis showed that no uNGAL value was a predictor marker of graft dysfunction at one year of kidney transplantation. Conclusion: The uNGAL values obtained within the first 48 hours post-transplant were not associated with graft dysfunction at one year of kidney transplantation.


Assuntos
Transplante de Rim , Lipocalina-2/urina , Complicações Pós-Operatórias/urina , Adulto , Feminino , Humanos , Testes de Função Renal , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo
17.
Pediatr Nephrol ; 33(12): 2363-2370, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30022312

RESUMO

BACKGROUND: Early detection of acute kidney injury (AKI) after cardiac surgery has improved recently with the discovery and validation of novel urinary biomarkers. However, objective tools to predict the risk of AKI before the insult are still missing. We tested the hypothesis that pre-operative serum fibroblast growth factor 23 (FGF23) concentrations would be elevated in children who develop AKI after heart surgery with cardiopulmonary bypass (CPB). We also compared post-operative FGF23 concentrations to other biomarkers for early detection of AKI. METHODS: Blood and urine samples were collected in a prospective observational study from 83 children with congenital heart disease. Severe AKI (sAKI) development (KDIGO stages II-III) in the first seven days after surgery was the primary outcome. RESULTS: Thirty of 76 (39.5%) and 11/76 (14.5%) of patients developed AKI and sAKI, respectively. Pre-operative serum creatinine, cystatin C, and urine biomarker concentrations did not differ between sAKI patients and controls. Pre-operative serum FGF23 levels were higher in patients who developed sAKI (median [IQR] value of 819 RU/ml [397.7, 1196.8] vs. 324.3 RU/ml [124.6, 679.8] (p = 0.02). FGF23 12-24 h after the termination of CPB was also associated with sAKI in the first week after surgery (498 RU/ml [226, 928] vs. 1435 RU/ml [831, 12,996]). CONCLUSIONS: Pre- and post-operative FGF23 levels are higher in children who develop sAKI after cardiac surgery. We suggest FGF23 may be able to detect sub-clinical kidney injury and can be used with demographic AKI risk factors to enhance post-operative sAKI risk prediction.


Assuntos
Lesão Renal Aguda/diagnóstico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fatores de Crescimento de Fibroblastos/sangue , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Fatores Etários , Biomarcadores/sangue , Biomarcadores/urina , Ponte Cardiopulmonar/efeitos adversos , Pré-Escolar , Creatinina/sangue , Cistatina C/sangue , Diagnóstico Precoce , Feminino , Cardiopatias Congênitas/sangue , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/urina , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco/métodos , Índice de Gravidade de Doença , Fatores Sexuais
18.
Clin Chim Acta ; 485: 205-209, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29940146

RESUMO

INTRODUCTION: Acute kidney injury (AKI) is a common occurrence after pediatric cardiac surgery. Plasma syndecan-1 is a biomarker of endothelial glycocalyx damage and it is associated with AKI. Syndecan-1 is also expressed in renal tubular cells but there is no study evaluating urinary syndecan-1 in predicting AKI. METHODS: Prospective cohort study with 86 patients ≤18 years submitted to cardiac surgery at one reference institution. Postoperative urinary syndecan-1 was collected within the first 2 h after cardiac surgery. Severe AKI - defined according to KDIGO as stage 2 or 3 - doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization was the main outcome. Analyses were adjusted for clinical cofounders. RESULTS: Postoperative urinary syndecan-1 levels were higher in patients with severe AKI and even after adjustment for several clinical variables; the fourth quartile was significantly associated with severe AKI. The AUC-ROC for postoperative urinary syndecan-1 showed good discriminatory capacity (AUC-ROC = 0.793). The addition of urinary syndecan-1 improved the discrimination capacity of a clinical model (0.78 to 0.84). It also improved risk prediction, as measured by net reclassification improvement (NRI). CONCLUSION: Urinary syndecan-1 predicts severe AKI after pediatric cardiac surgery. Moreover, it appears to add capacity to predict severe AKI into a clinical model.


Assuntos
Lesão Renal Aguda/urina , Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias/urina , Sindecana-1/urina , Adolescente , Biomarcadores/urina , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
19.
Pediatr Transplant ; 22(5): e13226, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29855144

RESUMO

Chronic kidney allograft damage is characterized by IFTA and GS. We sought to identify urinary metabolite signatures associated with severity of IFTA and GS in pediatric kidney transplant recipients. Urine samples (n = 396) from 60 pediatric transplant recipients were obtained at the time of kidney biopsy and assayed for 133 metabolites by mass spectrometry. Metabolite profiles were quantified via PLS-DA. We used mixed-effects regression to identify laboratory and clinical predictors of histopathology. Urine samples (n = 174) without rejection or AKI were divided into training/validation sets (75:25%). Metabolite classifiers trained on IFTA severity and %GS showed strong statistical correlation (r = .73, P < .001 and r = .72; P < .001, respectively) and remained significant on the validation sets. Regression analysis identified additional clinical features that improved prediction: months post-transplant (GS, IFTA); and proteinuria, GFR, and age (GS only). Addition of clinical variables improved performance of the %GS classifier (AUC = 0.9; 95% CI = 0.85-0.96) but not for IFTA (AUC = 0.82; 95% CI = 0.71-0.92). Despite the presence of potentially confounding phenotypes, these findings were further validated in samples withheld for rejection or AKI. We identify urine metabolite classifiers for IFTA and GS, which may prove useful for non-invasive assessment of histopathological damage.


Assuntos
Transplante de Rim , Metaboloma , Complicações Pós-Operatórias/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Índice de Gravidade de Doença , Aloenxertos/metabolismo , Aloenxertos/patologia , Biomarcadores/urina , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Rim/patologia , Masculino , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/urina , Análise de Regressão , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/urina
20.
Pediatr Crit Care Med ; 19(9): 816-830, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29912813

RESUMO

OBJECTIVES: Micro-RNA, small noncoding RNA fragments involved in gene regulation, and microvesicles, membrane-bound particles less than 1 µm known to regulate cellular processes including responses to injury, may serve as disease-specific biomarkers of acute kidney injury. We evaluated the feasibility of measuring these signals as well as other known acute kidney injury biomarkers in a mixed pediatric cardiac surgery population. DESIGN: Single center prospective cohort feasibility study. SETTING: PICU. PATIENTS: Twenty-four children (≤ 17 yr) undergoing cardiac surgery with cardiopulmonary bypass without preexisting inflammatory state, acute kidney injury, or extracorporeal life support. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Acute kidney injury was defined according to modified Kidney Diseases Improving Global Outcomes criteria. Blood and urine samples were collected preoperatively and at 6-12 and 24 hours. Microvesicles derivation was assessed using flow cytometry and NanoSight analysis. Micro-RNAs were isolated from plasma and analyzed by microarray and quantitative real-time polymerase chain reaction. Data completeness for the primary outcomes was 100%. Patients with acute kidney injury (n = 14/24) were younger, underwent longer cardiopulmonary bypass, and required greater inotrope support. Acute kidney injury subjects had different fractional content of platelets and endothelial-derived microvesicles before surgery. Platelets and endothelial microvesicles levels were higher in acute kidney injury patients. A number of micro-RNA species were differentially expressed in acute kidney injury patients. Pathway analysis of candidate target genes in the kidney suggested that the most often affected pathways were phosphatase and tensin homolog and signal transducer and activator of transcription 3 signaling. CONCLUSIONS: Microvesicles and micro-RNAs expression patterns in pediatric cardiac surgery patients can be measured in children and potentially serve as tools for stratification of patients at risk of acute kidney injury.


Assuntos
Lesão Renal Aguda/sangue , Lesão Renal Aguda/urina , Lipocalina-2/urina , MicroRNAs/sangue , Lesão Renal Aguda/etiologia , Adolescente , Distribuição por Idade , Biomarcadores/sangue , Biomarcadores/urina , Ponte Cardiopulmonar/efeitos adversos , Micropartículas Derivadas de Células/genética , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/urina , Estudos Prospectivos
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