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      Kinetic eGFR and Novel AKI Biomarkers to Predict Renal Recovery

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          Abstract

          Background and objectives

          Prompt recognition of severe renal impairment could improve the early management of critically ill patients. We compared the value of kinetic eGFR, plasma neutrophil gelatinase–associated lipocalin (NGAL), and urine tissue inhibitor of metalloproteinase-2 and urine insulin-like growth factor–binding protein 7 ([TIMP-2]*[IGFBP7]) in predicting short-term recovery from AKI and major adverse kidney events.

          Design, setting, participants, & measurements

          During the 6-month study period, 245 patients were admitted to our intensive care unit. This study included 57 consecutive patients presenting with AKI within the first 24 hours after admission. AKI markers were evaluated at inclusion (day 0) and 24 hours later (day 1). Kinetic eGFR was calculated on day 1 according to serum creatinine evolution. Renal recovery was defined as normalization of serum creatinine with reversal of oliguria within 48 hours. Major adverse kidney events included death, need for RRT, or persistence of renal dysfunction at hospital discharge.

          Results

          Plasma NGAL and [TIMP-2]*[IGFBP7] predicted renal recovery, with area under the receiver-operating characteristic curve (AUC-ROC) values between 0.70 and 0.79 at inclusion. Although plasma NGAL values frequently reached the maximal measurement range, their decrease on day 1 predicted recovery. The kinetic eGFR calculation after initial resuscitation provided the best AUC-ROC value for renal recovery, at 0.87. The best predictions for major adverse kidney events were provided by [TIMP-2]*[IGFBP7] and kinetic eGFR (equal AUC-ROCs of 0.81). Combining AKI markers in addition to clinical prediction models improved the discrimination and reclassification of patients who will recover from AKI or suffer from major adverse kidney events.

          Conclusions

          Biomarkers of kidney damage predicted short-term renal recovery and major adverse kidney events for an unselected cohort of critically ill patients. Calculating the kinetic eGFR imposed a delay after initial resuscitation but provided a good diagnostic and prognostic approach. The utility of functional and damage AKI marker combinations in addition to clinical information requires validation in larger prospective studies.

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          Author and article information

          Journal
          Clin J Am Soc Nephrol
          Clin J Am Soc Nephrol
          clinjasn
          cjn
          CJASN
          Clinical Journal of the American Society of Nephrology : CJASN
          American Society of Nephrology
          1555-9041
          1555-905X
          06 November 2015
          04 September 2015
          : 10
          : 11
          : 1900-1910
          Affiliations
          Departments of [* ]Anesthesia and Intensive Care II,
          []Biochemistry, and
          []Nephrology, Transplantation, Dialysis, University Hospital, Bordeaux, France;
          []French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France;
          [§ ]Biofortis, Mérieux NutriSciences Company, Saint-Herblain, France; and
          []INSERM U1034, Cardiovascular Adaptation to Ischemia, University of Bordeaux, Pessac, France
          Author notes
          Correspondence: Dr. Antoine Dewitte, Service d'Anesthésie-Réanimation II, Hôpital Haut Lévêque, CHU de Bordeaux, Avenue Magellan, 33 600 Pessac, France. Email: antoine.dewitte@ 123456chu-bordeaux.fr
          Article
          PMC4633802 PMC4633802 4633802 12651214
          10.2215/CJN.12651214
          4633802
          26342047
          f0a46791-23bb-43be-a0dd-b8fc6a0c2d07
          Copyright © 2015 by the American Society of Nephrology
          History
          : 21 December 2014
          : 27 January 2015
          Page count
          Pages: 11
          Categories
          Original Articles
          Acute Kidney Injury
          Custom metadata
          November 06, 2015

          AKI,biomarkers,neutrophil gelatinase–associated lipocalin,NGAL,[TIMP-2]*[IGFBP7],Doppler ultrasonography

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