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Prevention and Treatment of Acute Kidney Injury

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (15 September 2020) | Viewed by 41933

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Dr. José António Lopes

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Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
Interests: acute kidney injury; sepsis; critical care; renal replacement therapy

Special Issue Information

Dear Colleagues,

Acute kidney injury (AKI) is a complex syndrome with multiple etiologies, whose incidence has increased in the past decades. AKI is a frequent complication in hospitalized patients, which is associated with increased hospital mortality, cardiovascular events, progression to chronic kidney disease, long-term mortality, and increased healthcare costs.
AKI has been increasingly recognized as a global health issue, considering its importance as a risk factor for morbidity and mortality and the lack of therapies which could modify its adverse outcomes. It is crucial to develop methods to identify patients at risk for AKI, to prevent AKI, and to diagnose subclinical AKI in order to improve patient outcomes.
In this Special Issue, we invite researchers and clinicians to submit their works, including original clinical research studies, meta-analyses, systematic reviews, that will provide additional knowledge for AKI prevention and treatment.

Dr. José António Lopes
Guest Editor

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Keywords

Acute Kidney Injury
Risk Factors
Biomarkers
Prevention
Treatment

Published Papers (11 papers)

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12 pages, 294 KiB

Open AccessArticle

Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

by Filipe Marques, Joana Gameiro, João Oliveira, José Agapito Fonseca, Inês Duarte, João Bernardo, Carolina Branco, Claúdia Costa, Carolina Carreiro, Sandra Braz and José António Lopes

J. Clin. Med. 2021, 10(19), 4599; https://doi.org/10.3390/jcm10194599 - 06 Oct 2021

Cited by 18 | Viewed by 2172

Abstract

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

11 pages, 266 KiB

Open AccessArticle

Delayed Fever and Acute Kidney Injury in Patients with Urinary Tract Infection

by Kun-Lin Lu, Chih-Yen Hsiao, Chao-Yi Wu, Chieh-Li Yen, Chung-Ying Tsai, Chang-Chyi Jenq, Hsing-Lin Lin, Yu-Tung Huang and Huang-Yu Yang

J. Clin. Med. 2020, 9(11), 3486; https://doi.org/10.3390/jcm9113486 - 28 Oct 2020

Cited by 2 | Viewed by 3589

Abstract

The presence of fever has long been a warning sign of severe urinary tract infection (UTI). However, we previously identified that inpatients with afebrile UTI had an increased risk of developing acute kidney injury (AKI). After expanding this cohort, 1132 inpatients with UTI diagnosed between January 2006 and April 2019 were analyzed. Overall, 159 (14%) of these patients developed AKI; bacteremia, urolithiasis, septic shock, hypertension, lower baseline renal function, marked leukocytosis, and the absence of fever were independently linked to AKI. When we further studied the cohort of inpatients with fever during hospitalization, we identified a group of “delayed fever” UTI inpatients who did not have fever as their initial presentation. Compared to patients presenting with fever at the emergency department, patients with delayed fever tended to be younger and have less frequent infection with Escherichia coli, more frequent AKI, upper tract infection, and a longer hospital stay. Despite the initial absence of fever, these patients demonstrated larger extents of elevations in both serum white blood cell counts and C-reactive protein levels. In short, besides UTI patients with lower baseline renal function that remain afebrile during their hospital stay, clinical awareness of the increased incidence of AKI in younger patients with “delayed fever” should also be noted. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

14 pages, 1003 KiB

Open AccessArticle

Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

by Tsai-Jung Wang, Ching-Heng Lin, Hao-Ji Wei and Ming-Ju Wu

J. Clin. Med. 2020, 9(8), 2455; https://doi.org/10.3390/jcm9082455 - 31 Jul 2020

Cited by 12 | Viewed by 2753

Abstract

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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12 pages, 1671 KiB

Open AccessArticle

A Retrospective Propensity Score Matched Analysis Reveals Superiority of Hypothermic Machine Perfusion over Static Cold Storage in Deceased Donor Kidney Transplantation

by Silvia Gasteiger, Valeria Berchtold, Claudia Bösmüller, Lucie Dostal, Hanno Ulmer, Christina Bogensperger, Thomas Resch, Michael Rudnicki, Hannes Neuwirt, Rupert Oberhuber, Benno Cardini, Stefan Scheidl, Gert Mayer, Dietmar Öfner, Annemarie Weissenbacher and Stefan Schneeberger

J. Clin. Med. 2020, 9(7), 2311; https://doi.org/10.3390/jcm9072311 - 21 Jul 2020

Cited by 8 | Viewed by 2528

Abstract

Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage (SCS) in kidney transplantation, but its true benefit in the clinical routine remains incompletely understood. The aim of this study was to assess the effect of HMP vs. SCS in kidney transplantation. All kidney transplants performed between 08/2015 and 12/2019 (n = 347) were propensity score (PS) matched for cold ischemia time (CIT), extended criteria donor (ECD), gender mismatch, cytomegalovirus (CMV) mismatch, re-transplantation and Eurotransplant (ET) senior program. A total of 103 HMP and 103 SCS instances fitted the matching criteria. Prior to PS matching, the CIT was longer in the HMP group (17.5 h vs. 13.3 h; p < 0.001), while the delayed graft function (DGF) rates were 29.8% and 32.3% in HMP and SCS, respectively. In the PS matched groups, the DGF rate was 64.1% in SCS vs. 31.1% following HMP: equivalent to a 51.5% reduction of the DGF rate (OR 0.485, 95% CI 0.318–0.740). DGF was associated with decreased 1- and 3-year graft survival (100% and 96.3% vs. 90.8% and 86.7%, p = 0.001 and p = 0.008) or a 4.1-fold increased risk of graft failure (HR = 4.108; 95% CI: 1.336–12.631; p = 0.014). HMP significantly reduces DGF in kidney transplantation. DGF remains a strong predictor of graft survival. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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10 pages, 426 KiB

Open AccessArticle

Hematuria Is Associated with More Severe Acute Tubulointerstitial Nephritis

by Raquel Esteras, Jonathan G. Fox, Colin C. Geddes, Bruce Mackinnon, Alberto Ortiz and Juan Antonio Moreno

J. Clin. Med. 2020, 9(7), 2135; https://doi.org/10.3390/jcm9072135 - 07 Jul 2020

Cited by 3 | Viewed by 2164

Abstract

Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury. Although haematuria is a risk factor for the development of renal disease, no previous study has analyzed the significance of haematuria in ATIN. Retrospective, observational analysis of 110 patients with biopsy-proven ATIN was conducted. Results: Haematuria was present in 66 (60%) ATIN patients. A higher percentage of ATIN patients with haematuria had proteinuria than patients without haematuria (89.4% vs. 59.1%, p = 0.001) with significantly higher levels of proteinuria (median (interquartile range) protein:creatinine ratio 902.70 (513–1492) vs. 341.00 (177–734) mg/g, p <0.001). Moreover, those patients with more haematuria intensity had a higher urinary protein:creatinine ratio (1352.65 (665–2292) vs. 849.60 (562–1155) mg/g, p = 0.02). Those patients with higher proteinuria were more likely to need renal replacement therapy (22.7 vs. 0%, p = 0.03) and to suffer relapse (4 vs. 0%, p = 0.03). At the end of follow up, haematuric ATIN patients had higher serum creatinine levels (3.19 ± 2.91 vs. 1.91 ± 1.17 mg/dL, p = 0.007), and a trend towards a higher need for acute dialysis (7 vs. 1%, p = 0.09) and renal replacement therapy (12.1 vs. 2.3%, p = 0.12). Haematuria is common in ATIN and it is associated with worse renal function outcomes. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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11 pages, 392 KiB

Open AccessArticle

High Incidence of Amoxicillin-Induced Crystal Nephropathy in Patients Receiving High Dose of Intravenous Amoxicillin

by Anne-Sophie Garnier, Juliette Dellamaggiore, Benoit Brilland, Laurence Lagarce, Pierre Abgueguen, Alain Furber, Erick Legrand, Jean-François Subra, Guillaume Drablier and Jean-François Augusto

J. Clin. Med. 2020, 9(7), 2022; https://doi.org/10.3390/jcm9072022 - 27 Jun 2020

Cited by 17 | Viewed by 4162

Abstract

Background: Amoxicillin (AMX)-induced crystal nephropathy (AICN) is considered as a rare complication of high dose intravenous (IV) AMX administration. However, recently, its incidence seems to be increasing based on French pharmacovigilance centers. Occurrence of AICN has been observed mainly with IV administration of AMX and mostly under doses over 8 g/day. Given that pharmacovigilance data are based on declaration, the real incidence of AICN may be underestimated. Thus, the primary objective of the present study was to determine the incidence of AICN in the current practice. Materials and Methods: We conducted a retrospective study between 1 January 2015 and 31 December 2017 in Angers University Hospital. Inclusion criteria were age over 18 years-old and IV AMX administration of at least 8 g/day for more than 24 h. Patients admitted directly into the intensive care units were excluded. Medical records of patients that developed Kidney Disease:Improving Global Outcome (KDIGO) stage 2–3 acute kidney injury (AKI) were reviewed by a nephrologist and a specialist in pharmacovigilance. AICN was retained if temporality analysis was conclusive, after exclusion of other causes of AKI, in absence of other nephrotoxic drug administration. Results: A total of 1303 patients received IV AMX for at least 24 h. Among them, 358 (27.5%) were exposed to AMX doses of at least 8 g/day and were included. Patients were predominantly males (68.2%) with a mean age of 69.1 years-old. AMX was administered for a medical reason in 78.5% of cases. Patients received a median dose of AMX of 12 g/day (152.0 mg/kg/day). Seventy-three patients (20.4%) developed AKI, 42 (56.8%) of which were KDIGO stage 2 or 3. Among the latter, AICN diagnosis was retained in 16 (38.1%) patients, representing an incidence of 4.47% of total patients exposed to high IV AMX doses. Only female gender was associated with an increased risk of AICN. AMX dose was not significantly associated with AICN development. Conclusion: This study suggests a high incidence of AICN in patients receiving high IV AMX doses, representing one third of AKI causes in our study. Female gender appeared as the sole risk factor for AICN in this study. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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10 pages, 240 KiB

Open AccessArticle

Low Ejection Fraction Predisposes to Contrast-Induced Nephropathy after the Second Step of Staged Coronary Revascularization for Acute Myocardial Infarction: A Retrospective Observational Study

by Michał Chyrchel, Przemysław Hałubiec, Agnieszka Łazarczyk, Olgerd Duchnevič, Michał Okarski, Monika Gębska and Andrzej Surdacki

J. Clin. Med. 2020, 9(6), 1812; https://doi.org/10.3390/jcm9061812 - 10 Jun 2020

Cited by 6 | Viewed by 1869

Abstract

Patients who develop contrast-induced nephropathy (CIN) are at an increased short-term and long-term risk of adverse cardiovascular (CV) events. Our aim was to search for patient characteristics associated with changes in serum creatinine and CIN incidence after each step of two-stage coronary revascularization in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease undergoing staged coronary angioplasty during hospitalization for AMI. We retrospectively analyzed medical records of 138 patients with acute myocardial infarction without hemodynamic instability, in whom two-stage coronary angioplasty was performed during the initial hospital stay. In-hospital serum creatinine levels were recorded before the 1st intervention (at admission), within 72 h after the 1st intervention (before the 2nd intervention), and within 72 h after the 2nd intervention. The incidence of CIN was 2% after the 1st intervention (i.e., primary angioplasty) and 8% after the 2nd intervention. Patients with significant left ventricular systolic dysfunction after the 1st intervention (ejection fraction (EF) ≤35%) exhibited higher relative rises in creatinine levels after the 2nd intervention (18 ± 29% vs. 2 ± 16% for EF ≤35% and >35%, respectively, p = 0.03), while respective creatinine changes after the 1st revascularization procedure were comparable (−1 ± 14% vs. 2 ± 13%, p = 0.4). CIN after the 2nd intervention was over five-fold more frequent in subjects with low EF (28% vs. 5%, p = 0.007). The association between low EF and CIN incidence or relative creatinine changes after the 2nd intervention was maintained upon adjustment for baseline renal function, major CV risk factors, and the use of renin-angiotensin axis antagonists prior to admission. In conclusion, low EF predisposes to CIN after second contrast exposure in patients undergoing two-stage coronary angioplasty during the initial hospitalization for AMI. Our findings suggest a need of extended preventive measures against CIN or even postponement of second coronary intervention in patients with significant left ventricular dysfunction scheduled for the second step of staged angioplasty. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

13 pages, 853 KiB

Open AccessArticle

The Marker of Tubular Injury, Kidney Injury Molecule-1 (KIM-1), in Acute Kidney Injury Complicating Acute Pancreatitis: A Preliminary Study

by Justyna Wajda, Paulina Dumnicka, Witold Kolber, Mateusz Sporek, Barbara Maziarz, Piotr Ceranowicz, Marek Kuźniewski and Beata Kuśnierz-Cabala

J. Clin. Med. 2020, 9(5), 1463; https://doi.org/10.3390/jcm9051463 - 13 May 2020

Cited by 10 | Viewed by 3497

Abstract

Acute pancreatitis (AP) may be associated with severe inflammation and hypovolemia leading to organ complications including acute kidney injury (AKI). According to current guidelines, AKI diagnosis is based on dynamic increase in serum creatinine, however, creatinine increase may be influenced by nonrenal factor and appears late following kidney injury. Kidney injury molecule-1 (KIM-1) is a promising marker of renal tubular injury and it has not been studied in AP. Our aim was to assess if urinary KIM-1 may be used to diagnose AKI complicating the early stage of AP. We recruited 69 patients with mild to severe AP admitted to a secondary care hospital during the first 24 h from initial symptoms of AP. KIM-1 was measured in urine samples collected on the day of admission and two subsequent days of hospital stay. AKI was diagnosed based on creatinine increase according to Kidney Disease: Improving Global Outcomes 2012 guidelines. Urinary KIM-1 on study days 1 to 3 was not significantly higher in 10 patients who developed AKI as compared to those without AKI and did not correlate with serum creatinine or urea. On days 2 and 3, urinary KIM-1 correlated positively with urinary liver-type fatty acid-binding protein, another marker of tubular injury. On days 2 and 3, urinary KIM-1 was higher among patients with systemic inflammatory response syndrome, and several correlations between KIM-1 and inflammatory markers (procalcitonin, urokinase-type plasminogen activator receptor, C-reactive protein) were observed on days 1 to 3. With a limited number of patients, our study cannot exclude the diagnostic utility of KIM-1 in AP, however, our results do not support it. We hypothesize that the increase of KIM-1 in AKI complicating AP lasts a short time, and it may only be observed with more frequent monitoring of the marker. Moreover, urinary KIM-1 concentrations in AP are associated with inflammation severity. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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Review

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16 pages, 509 KiB

Open AccessReview

Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

by Joana Gameiro, José Agapito Fonseca, Filipe Marques and José António Lopes

J. Clin. Med. 2020, 9(8), 2679; https://doi.org/10.3390/jcm9082679 - 18 Aug 2020

Cited by 14 | Viewed by 3886

Abstract

Acute kidney injury (AKI) is a frequent occurrence following major abdominal surgery and is independently associated with both in-hospital and long-term mortality, as well as with a higher risk of progressing to chronic kidney disease (CKD) and cardiovascular events. Postoperative AKI can account for up to 40% of in-hospital AKI cases. Given the differences in patient characteristics and the pathophysiology of postoperative AKI, it is inappropriate to assume that the management after noncardiac and nonvascular surgery are the same as those after cardiac and vascular surgery. This article provides a comprehensive review on the available evidence on the management of postoperative AKI in the setting of major abdominal surgery. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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21 pages, 316 KiB

Open AccessReview

Acute Kidney Injury: From Diagnosis to Prevention and Treatment Strategies

by Joana Gameiro, José Agapito Fonseca, Cristina Outerelo and José António Lopes

J. Clin. Med. 2020, 9(6), 1704; https://doi.org/10.3390/jcm9061704 - 02 Jun 2020

Cited by 53 | Viewed by 10785

Abstract

Acute kidney injury (AKI) is characterized by an acute decrease in renal function that can be multifactorial in its origin and is associated with complex pathophysiological mechanisms. In the short term, AKI is associated with an increased length of hospital stay, health care costs, and in-hospital mortality, and its impact extends into the long term, with AKI being associated with increased risks of cardiovascular events, progression to chronic kidney disease (CKD), and long-term mortality. Given the impact of the prognosis of AKI, it is important to recognize at-risk patients and improve preventive, diagnostic, and therapy strategies. The authors provide a comprehensive review on available diagnostic, preventive, and treatment strategies for AKI. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

11 pages, 273 KiB

Open AccessReview

Timing of Initiation of Renal Replacement Therapy in Sepsis-Associated Acute Kidney Injury

by José Agapito Fonseca, Joana Gameiro, Filipe Marques and José António Lopes

J. Clin. Med. 2020, 9(5), 1413; https://doi.org/10.3390/jcm9051413 - 10 May 2020

Cited by 14 | Viewed by 3860

Abstract

Sepsis-associated acute kidney injury (SA-AKI) is a major issue in medical, surgical and intensive care settings and is an independent risk factor for increased mortality, as well as hospital length of stay and cost. SA-AKI encompasses a proper pathophysiology where renal and systemic inflammation play an essential role, surpassing the classic concept of acute tubular necrosis. No specific treatment has been defined yet, and renal replacement therapy (RRT) remains the cornerstone supportive therapy for the most severe cases. The timing to start RRT, however, remains controversial, with early and late strategies providing conflicting results. This article provides a comprehensive review on the available evidence on the timing to start RRT in patients with SA-AKI. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

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