Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion

Aim: To investigate transient early acute kidney injury (AKI) that occur in high risk patients. Background: Cardiac arrest resulted in interruption of renal blood flow to end organ including the kidney. AKI was reported to occur in up to 49% of patients following cardiac arrest. Several studies...

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Main Authors:	Md Ralib, Azrina, Pickering, John W., Shaw, Geoffrey M., Thann, Martin, Endre, Zoltan H.
Format:	Article
Language:	English
Published:	Wiley-Blackwell Publishing 2012
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/37396/ http://irep.iium.edu.my/37396/ http://irep.iium.edu.my/37396/1/9._Nephrology_ANZSN_2012_T-AKI.pdf

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spelling	iium-373962014-08-11T07:31:34Z http://irep.iium.edu.my/37396/ Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Thann, Martin Endre, Zoltan H. R Medicine (General) Aim: To investigate transient early acute kidney injury (AKI) that occur in high risk patients. Background: Cardiac arrest resulted in interruption of renal blood flow to end organ including the kidney. AKI was reported to occur in up to 49% of patients following cardiac arrest. Several studies demonstrated a transient early elevation of serum creatinine after the first few hours following cardiac arrest. Serum creatinine level then dropped over the next few days until ICU discharged in those with a better outcome. Whether this changes resulted from altered glomerular filtration rate following cardiac arrest, or due to other factors is unclear. We aimed to investigate this, by correlating it with alternative marker of function, plasma cystatin C and marker of injury by measurement of plasma and urinary biomarker of injury. We hyposthesize that following cardiac arrest, there is a rapid decline in glomerular filtration rate, and injury to epithelial cells secondary to reduced perfusion. Methods: A sub-cohort of patients with transient AKI on ED admission from the Early Detection of Acute Kidney Injury (EDAKI) Study was analyzed. The EDAKI Study was a prospective observational trial of plasma and urine biomarkers of AKI in high-risk patients, which include survivor of cardiac arrest, sustained or profound hypotension, and ruptured abdominal aortic aneurysm. Plasma creatinine, cystatin C (CysC), neutrophil-gelatinase associated lipocalin (NGAL), and urinary alkaline phosphatase (AP), gamma glutamyl transpeptidase (GGT), CysC, and NGAL were measured on admission to the emergency department (ED), on admission to the ICU, and 4, 8, 16 hours, day 2, 4, and 7 were measured. Results: 45 patients were included in this analysis, of which 54% developed AKI. Serum creatinine increased rapidly from baseline on ED admission and gradually decreased within 24 hours. Serum creatinine on ED correlated with arrest time, dose of adrenaline, and amount of defibrillation. There was no correlation with creatinine kinase. Similar pattern of increase level on ED admission were shown in plasma cystatin C, and other plasma and urinary biomarkers of injury. Conclusions: Early elevation of serum creatinine following cardiac arrest is associated with reduced perfusion which contributes to reduced kidney filtration, and kidney tubular dysfunction. Wiley-Blackwell Publishing 2012-08 Article PeerReviewed application/pdf en http://irep.iium.edu.my/37396/1/9._Nephrology_ANZSN_2012_T-AKI.pdf Md Ralib, Azrina and Pickering, John W. and Shaw, Geoffrey M. and Thann, Martin and Endre, Zoltan H. (2012) Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion. Nephrology, 17 (Supp.2). p. 54. ISSN 1440-1797 http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1797
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Thann, Martin Endre, Zoltan H. Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion
description	Aim: To investigate transient early acute kidney injury (AKI) that occur in high risk patients. Background: Cardiac arrest resulted in interruption of renal blood flow to end organ including the kidney. AKI was reported to occur in up to 49% of patients following cardiac arrest. Several studies demonstrated a transient early elevation of serum creatinine after the first few hours following cardiac arrest. Serum creatinine level then dropped over the next few days until ICU discharged in those with a better outcome. Whether this changes resulted from altered glomerular filtration rate following cardiac arrest, or due to other factors is unclear. We aimed to investigate this, by correlating it with alternative marker of function, plasma cystatin C and marker of injury by measurement of plasma and urinary biomarker of injury. We hyposthesize that following cardiac arrest, there is a rapid decline in glomerular filtration rate, and injury to epithelial cells secondary to reduced perfusion. Methods: A sub-cohort of patients with transient AKI on ED admission from the Early Detection of Acute Kidney Injury (EDAKI) Study was analyzed. The EDAKI Study was a prospective observational trial of plasma and urine biomarkers of AKI in high-risk patients, which include survivor of cardiac arrest, sustained or profound hypotension, and ruptured abdominal aortic aneurysm. Plasma creatinine, cystatin C (CysC), neutrophil-gelatinase associated lipocalin (NGAL), and urinary alkaline phosphatase (AP), gamma glutamyl transpeptidase (GGT), CysC, and NGAL were measured on admission to the emergency department (ED), on admission to the ICU, and 4, 8, 16 hours, day 2, 4, and 7 were measured. Results: 45 patients were included in this analysis, of which 54% developed AKI. Serum creatinine increased rapidly from baseline on ED admission and gradually decreased within 24 hours. Serum creatinine on ED correlated with arrest time, dose of adrenaline, and amount of defibrillation. There was no correlation with creatinine kinase. Similar pattern of increase level on ED admission were shown in plasma cystatin C, and other plasma and urinary biomarkers of injury. Conclusions: Early elevation of serum creatinine following cardiac arrest is associated with reduced perfusion which contributes to reduced kidney filtration, and kidney tubular dysfunction.
format	Article
author	Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Thann, Martin Endre, Zoltan H.
author_facet	Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Thann, Martin Endre, Zoltan H.
author_sort	Md Ralib, Azrina
title	Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion
title_short	Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion
title_full	Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion
title_fullStr	Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion
title_full_unstemmed	Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion
title_sort	transient acute kidney injury (aki) is common following significant kidney hypoperfusion
publisher	Wiley-Blackwell Publishing
publishDate	2012
url	http://irep.iium.edu.my/37396/ http://irep.iium.edu.my/37396/ http://irep.iium.edu.my/37396/1/9._Nephrology_ANZSN_2012_T-AKI.pdf
first_indexed	2023-09-18T20:53:39Z
last_indexed	2023-09-18T20:53:39Z
_version_	1777410160731357184

Transient Acute Kidney Injury (AKI) is common following significant kidney hypoperfusion

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