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      Discriminatory Precision of Renal Angina Index in Predicting Acute Kidney Injury in Children; a Systematic Review and Meta-Analysis

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          Abstract

          Introduction:

          There is still controversy over the value of renal angina index (RAI) in predicting acute renal failure (AKI) in children. Therefore, the present study aims to provide evidence by conducting a systematic review and meta-analysis on the value of RAI in this regard.

          Methods:

          An extensive search of Medline, Embase, Scopus and Web of Science databases was conducted by the end of January 2020 using words related to RAI and AKI. Two independent reviewers screened and summarized the related studies. Data were analysed using STATA 14.0 statistical program and discriminatory precision of RAI was assessed.

          Results:

          Data from 11 studies were included. These studies included data from 3701 children (60.41% boys). There were 752 children with AKI and 2949 non-AKI children. Pooled analysis showed that the area under the ROC curve of RAI in prediction of AKI was 0.88 [95% confidence interval (CI): 0.85 to 0.91]. Sensitivity and specificity of this tool in predicting AKI were 0.85% (95% CI: 0.74% to 0.92%) and 0.79% (95% CI: 0.69% to 0.89%), respectively. The diagnostic odds ratio of RAI was 20.40 (95% CI: 9.62 to 43.25).

          Conclusion:

          The findings of the present meta-analysis showed that RAI is a reliable tool in predicting AKI in children.

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          Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review.

          S Coca, R Yalavarthy, J Concato … (2008)
          The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, but such measurements are a poor marker of acute deterioration in kidney function. We performed a systematic review of publications that evaluated the accuracy and reliability of serum and urinary biomarkers in human subjects when used for the diagnosis of established AKI or early AKI, or to risk stratify patients with AKI. Two reviewers independently searched the MEDLINE and EMBASE databases (January 2000-March 2007) for studies pertaining to biomarkers for AKI. Studies were assessed for methodologic quality. In total, 31 studies evaluated 21 unique serum and urine biomarkers. Twenty-five of the 31 studies were scored as having 'good' quality. The results of the studies indicated that serum cystatin C, urine interleukin-18 (IL-18), and urine kidney injury molecule-1 (KIM-1) performed best for the differential diagnosis of established AKI. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin, IL-18, glutathione-S-transferase-pi, and gamma-glutathione-S-transferase performed best for early diagnosis of AKI. Urine N-acetyl-beta-D-glucosaminidase, KIM-1, and IL-18 performed the best for mortality risk prediction after AKI. In conclusion, published data from studies of serum and urinary biomarkers suggest that biomarkers may have great potential to advance the fields of nephrology and critical care. These biomarkers need validation in larger studies, and the generalizability of biomarkers to different types of AKI as well as the incremental prognostic value over traditional clinical variables needs to be determined.
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            Review: neutrophil gelatinase-associated lipocalin: a troponin-like biomarker for human acute kidney injury.

            Prasad Devarajan (2010)
            Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which currently depends on functional markers such as serum creatinine measurements. Unfortunately, creatinine is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury (akin to troponin in acute myocardial injury) has hampered our ability to translate promising experimental therapies to human AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed. NGAL is emerging as an excellent stand-alone troponin-like structural biomarker in the plasma and urine for the early diagnosis of AKI, and for the prediction of clinical outcomes such as dialysis requirement and mortality in several common clinical scenarios. The approach of using NGAL as a trigger to initiate and monitor therapies for AKI, and as a safety biomarker when using potentially nephrotoxic agents, is also promising. In addition, it is hoped that the use of sensitive and specific biomarkers such as NGAL as endpoints in clinical trials will result in a reduction in required sample sizes, and hence the cost incurred. Furthermore, predictive biomarkers like NGAL may play a critical role in expediting the drug development process. However, given the complexity of AKI, additional biomarkers (perhaps a panel of plasma and urinary biomarkers) may eventually need to be developed and validated for optimal progress to occur.
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              Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit.

              James Schneider, Robinder G. Khemani, Carl M. Grushkin … (2010)
              To evaluate the ability of the RIFLE criteria to characterize acute kidney injury in critically ill children. Retrospective analysis of prospectively collected clinical data. Multidisciplinary, tertiary care, 20-bed pediatric intensive care unit. All 3396 admissions between July 2003 and March 2007. None. A RIFLE score was calculated for each patient based on percent change of serum creatinine from baseline (risk = serum creatinine x1.5; injury = serum creatinine x2; failure = serum creatinine x3). Primary outcome measures were mortality and intensive care unit length of stay. Logistic and linear regressions were performed to control for potential confounders and determine the association between RIFLE score and mortality and length of stay, respectively.One hundred ninety-four (5.7%) patients had some degree of acute kidney injury at the time of admission, and 339 (10%) patients had acute kidney injury develop during the pediatric intensive care unit course. Almost half of all patients with acute kidney injury had their maximum RIFLE score within 24 hrs of intensive care unit admission, and approximately 75% achieved their maximum RIFLE score by the seventh intensive care unit day. After regression analysis, any acute kidney injury on admission and any development of or worsening of acute kidney injury during the pediatric intensive care unit stay were independently associated with increased mortality, with the odds of mortality increasing with each grade increase in RIFLE score (p < .01). Patients with acute kidney injury at the time of admission had a length of stay twice that of those with normal renal function, and those who had any acute kidney injury develop during the pediatric intensive care unit course had a four-fold increase in pediatric intensive care unit length of stay. Also, other than being admitted with RIFLE risk score, an independent relationship between any acute kidney injury at the time of pediatric intensive care unit admission, any acute kidney injury present during the pediatric intensive care unit course, or any worsening RIFLE scores during the pediatric intensive care unit course and increased pediatric intensive care unit length of stay were identified after controlling for the same high-risk covariates (p < .01). RIFLE criteria serves well to describe acute kidney injury in critically ill pediatric patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Acad Emerg Med
                Journal ID (iso-abbrev): Arch Acad Emerg Med
                Journal ID (publisher-id): AAEM
                Title: Archives of Academic Emergency Medicine
                Publisher: Shahid Beheshti University of Medical Sciences (Tehran, Iran )
                ISSN (Electronic): 2645-4904
                Publication date Collection: 2020
                Publication date (Electronic): 26 March 2020
                Volume: 8
                Issue: 1
                Electronic Location Identifier: e39
                Affiliations
                [1 ]Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
                [2 ]Department of Pediatrics, Division of Nephrology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
                [3 ]Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
                [4 ]College of Medicine, University of Sulaimani, Sulaimani, Iraq.
                [5 ]Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
                [6 ]Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
                Author notes
                [* ]Corresponding Authors: Mahmoud Yousefifard, Assistant Professor of Physiology, Physiology Research Center, Hemmat Highway, Tehran, Iran. E-mail: yousefifard.m@iums.ac.ir. Mostafa Hosseini, Department of Epidemiology and Biostatistics School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran; Email: mhossein110@yahoo.com
                Article
                Publisher ID: aaem-8-e39
                PMC ID: 7130445
                PubMed ID: 32259128
                SO-VID: b8112449-0f36-4574-9def-611b2844bd35
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : February 2020
                Date accepted : February 2020
                Categories
                Subject: Review Article

                Keywords: acute kidney injuries,renal insufficiency,severity of illness index,child
                Data availability:
                Keywords: acute kidney injuries, renal insufficiency, severity of illness index, child

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