Search Results (263)

Acute kidney injury (AKI) is a serious clinical condition that is linked to markedly higher rates of morbidity and mortality in cirrhosis patients. Its diagnosis is challenging due to overlapping clinical and laboratory features among causes such as hepatorenal syndrome (HRS), acute tubular injury (ATI), and prerenal hypovolemia. In order to address the distinct pathophysiology and clinical context of cirrhosis, the definitions and classification of AKI have changed over time, moving from RIFLE and AKIN to KDIGO and ICA-AKI. Because cirrhosis patients have altered muscle mass and fluid retention, traditional markers like serum creatinine (sCr) and urine output have significant limitations. Neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and cystatin C (CysC) are some of the new biomarkers that have shown promise in early AKI detection and in differentiating structural from functional kidney injury. NGAL and KIM-1 are sensitive indicators of tubular damage with potential prognostic implications. IL-18 reflects inflammatory injury, and CysC offers a more reliable measure of glomerular filtration. Incorporating these markers may improve early diagnosis, risk stratification, and treatment decisions, representing a key direction for future research in managing AKI in cirrhosis. Full article

Background: Patients in Intensive Care Units (ICUs) often develop non-thyroidal illness syndrome. Potentially, thyroid hormones may be removed during continuous veno-venous hemodiafiltration (CVVHDF), as their molecular size is smaller than the filter pores’ cutoff. The study’s main aim was to assess whether the serum concentration of thyroid hormones changes over time during CVVHDF. Methods: This was a prospective observational trial that included 30 patients treated in an ICU. All patients developed acute kidney injury (AKI) and had clinical indications for implementation of CVVHDF. Blood samples were collected before initiation of CVVHDF and at 1, 2, 3, 6, 9 and 12 days after. The last sample was collected three days after CVVHDF withdrawal. Thyroid function was evaluated by determining the serum concentration of TSH, thyrotropin-releasing hormone (TRH), free triiodothyronine (fT₃), free thyroxine (fT₄), total triiodothyronine (tT₃), total thyroxine (tT₄) and reverse triiodothyronine (rT₃). We additionally calculated the total activity of peripheral deiodinases (G_D) using a mathematical model. Results: TRH and TSH levels remained mostly within normal ranges. fT4 and tT4 were in normal range or slightly below. In contrast, fT3 and tT3 were undetectably low in most patients throughout. Reverse T3 levels remained within normal limits. There were no statistically significant changes in any thyroid hormone levels over the CVVHDF treatment period. The calculated peripheral G_D activity was lower than normal, but importantly, it did not change significantly over time. Conclusions: Thyroid hormones are not lost due to hemodiafiltration. Decreased deiodinases activity is responsible for alterations in serum concentrations of thyroid hormones in patients during CVVHDF. Full article

Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop a predictive score for postoperative AKI and assess the associations between AKI, chronic kidney disease (CKD), and 1-year mortality. Methods: This was a retrospective study in a cancer referral center in Marseille, France, from 2018 to 2022. Results: Among 169 patients, 55 (32.5%) experienced AKI. Multivariate analysis revealed several independent risk factors for postoperative AKI, including age, body mass index, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, time to liver resection, intraoperative shock, and bile duct reconstruction. Neoadjuvant chemotherapy was protective. The AKIMEBO score was developed, with a threshold of ≥15.6, demonstrating a sensitivity of 89.5%, specificity of 76.4%, positive predictive value of 61.8%, and negative predictive value of 94.4%. AKI was associated with increased postoperative morbidity and one-year mortality following major hepatectomy. Conclusion: AKI is a common complication post-hepatectomy. Factors such as time to liver resection and intraoperative shock management present potential clinical intervention points. The AKIMEBO score can provide a valuable tool for postoperative risk stratification. Full article

Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease (CKD) in up to 60% of patients, and 10 to 30% develop end-stage kidney disease (ESKD). This retrospective study examines the importance of specific factors, including baseline demographic and clinical data, kidney biopsy PH findings, and selected biochemical parameters, influencing MN outcomes after 10 years of follow-up. The cohort included 94 individuals in whom a diagnosis of MN was established by percutaneous biopsy of the left kidney’s lower pole at the University Clinical Center of Serbia (UCCS) between 2008 and 2013. According to the outcomes, patients were divided into three groups: the recovery (Rec) group, with complete remission, including normal serum creatinine (Scr) and proteinuria (Prt), the group with development of chronic kidney disease (CKD), and the group with development of end-stage kidney disease (ESKD). Nephropathologists graded pathohistological (PH) results from I to III based on the observed PH findings. During the follow-up period, 33 patients were in the Rec group, CKD developed in 53 patients, and ESKD developed in 8 patients. Baseline creatinine clearance levels (Ccr), Scr, and uric acid (urate) were found to be significantly associated with the outcomes (p < 0.001). The lowest values of baseline Scr and urate were observed in the Rec group. The presence of acute kidney injury (AKI) or CKD at the time of kidney biopsy was associated with the more frequent development of ESKD (p = 0.02). Lower Ccr was associated with a higher likelihood of progressing to CKD (B = −0.021, p = 0.014), whereas older age independently predicted progression to ESKD (B = 0.02, p = 0.032). Based on this study, it was concluded that the most important biochemical and clinical factors that are associated with the outcomes of this disease are the values of Scr, Ccr, and urate and the existence of CKD at the time of kidney biopsy. Unlike most previous studies, the presence of HTN had no statistical significance in the outcome of the disease. Full article

Background and Aims: Sepsis-associated acute kidney injury (S-AKI) is common and is associated with poor outcomes. This prospective observational study aimed to assess the predictive value of four novel biomarkers—syndecan-1 (SDC1), neutrophil gelatinase-associated lipocalin (NGAL), proenkephalin (PENK), and presepsin (PSPN)—for renal outcomes and mortality in septic ICU patients. Methods: Serum biomarker levels were measured in serum samples collected at the time of sepsis diagnosis on the basis of the Sepsis-3 criteria. Acute kidney injury (AKI) was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, and patients were grouped by the presence of AKI, renal replacement therapy requirement (RRT), and intensive care unit (ICU) survival. Demographic, clinical, laboratory, and severity score data were compared between groups to evaluate the predictive performance of biomarkers and clinical parameters. Results: Of the 140 septic patients included, 55.0% developed AKI, 17.2% required RRT, and the ICU mortality rate was 50.0%. SDC1 was independently associated with both AKI (OR: 1.201; p = 0.024) and RRT initiation (OR: 1.260; p = 0.004). It also demonstrated the highest predictive performance for RRT (AUC: 0.715; p = 0.001) and a significant AUC for AKI evaluation (AUC: 0.659; p = 0.002). NGAL levels were significantly elevated in patients with AKI and higher SOFA scores but were not independently predictive. PENK and PSPN were not significantly associated with any renal outcome or mortality. The combined SOFA–SDC1 model improved discrimination for both AKI (AUC: 0.770) and RRT (AUC: 0.737), surpassing individual predictors. Conclusions: SDC1 emerged as the most reliable biomarker for assessing AKI and predicting the need for RRT, highlighting its potential role in early renal risk stratification among critically ill patients. Full article

Japan’s 8.5 million vacant homes (Akiyas) represent a paradox of scarcity amid surplus: while rural depopulation leaves properties abandoned, housing shortages and bureaucratic inefficiencies hinder their reuse. This study proposes AKI2ALL, an AI-blockchain framework designed to automate the circular repurposing of Akiyas into ten high-value community assets—guesthouses, co-working spaces, pop-up retail and logistics hubs, urban farming hubs, disaster relief housing, parking lots, elderly daycare centers, exhibition spaces, places for food and beverages, and company offices—through smart contracts and data-driven workflows. By integrating circular economy principles with decentralized technology, AKI2ALL streamlines property transitions, tax validation, and administrative processes, reducing operational costs while preserving embodied carbon in existing structures. Municipalities list properties, owners select uses, and AI optimizes assignments based on real-time demand. This work bridges gaps in digital construction governance, proving that automating trust and accountability can transform systemic inefficiencies into opportunities for community-led, low-carbon regeneration, highlighting its potential as a scalable model for global vacant property reuse. Full article

Background: While postoperative acute kidney injury (AKI) in patients with hip fracture has been investigated, the relationship between fracture morphology and the incidence of preoperative AKI remains unclear. This study aimed to investigate the association between fracture morphology and the incidence of preoperative AKI, as well as its impact on in-hospital mortality and length of hospital stay. Methods: A retrospective analysis was conducted on 462 patients with intertrochanteric fractures treated at a single university hospital between January 2018 and December 2023. The fractures were categorized based on radiographic morphology into two groups: simple fractures and comminuted fractures. Preoperative AKI was diagnosed using KDIGO criteria based on serum creatinine levels measured at the time of emergency department admission. Demographic characteristics and comorbidities were collected. Clinical outcomes included time to surgery, length of hospital stay, and in-hospital mortality. Multivariable logistic regression was used to identify independent risk factors for preoperative AKI. Results: Among 462 patients, 66 (14.3%) developed preoperative AKI. The incidence of AKI was significantly higher in the comminuted fracture group than in the simple fracture group (17.5% vs. 10.2%, p = 0.037). Multivariable analysis identified comminuted fracture morphology as an independent risk factor for preoperative AKI (OR 2.44, 95% CI 1.19–5.00, p = 0.015). Preoperative AKI was also significantly associated with increased in-hospital mortality (OR 4.56, CI 1.40–14.81, p = 0.018). Conclusions: Comminuted intertrochanteric fracture is significantly associated with an increased risk of preoperative AKI. Preoperative AKI is linked to worse clinical outcomes, including higher in-hospital mortality. These findings emphasize the importance of close monitoring of renal function and proper management of AKI in comminuted fracture group. Full article

Sepsis-associated acute kidney injury (S-AKI) represents a significant health problem associated with adverse outcomes. Our study aimed to assess the value of serum cystatin-C (sCysC) and TNF-α (rs361525) in combination for diagnosing S-AKI patients and predicting their adverse outcomes. The study included 100 critically ill neonates and 100 controls. Patients were categorized into an S-AKI group and a non-AKI group. TNF-α (−238, rs361525) genotyping was performed using RT-PCR, and sCysC was assessed using ELISA. Our study showed a fundamental difference in the genotype frequencies of TNF-α (−238, rs361525) and SNP between S-AKI and non-AKI patients. Furthermore, there was a significant relationship between cystatin C and TNF-α (−238, rs361525), where cystatin C was higher in patients with AA alleles than in patients with GA and GG alleles. Combining GA + AA genotypes with elevated serum cystatin-C levels can serve as a potential diagnostic and prognostic biomarker for AKI development in this population. The GA/AA genotypes independently predicted S-AKI risk (OR = 6.64, p < 0.001). At the same time, elevated sCysC (>9.4 mg/L) emerged as a sensitive biomarker (AUC = 0.848) and independent predictor of adverse outcomes. Collectively, these findings contribute to the growing field of personalized medicine and represent a strategic advantage, enabling prevention-focused care rather than the treatment of established disease. Full article

Background and Objectives: Acute kidney injury (AKI) is common in intensive-care unit (ICU) patients and is associated with increased mortality. Elderly patients tend to have more comorbid chronic diseases and are more prone to AKI than younger populations, resulting in higher rates of hospitalization and a higher incidence of AKI. Our aim in this study was to investigate the prognostic utility of BUN/albumin ratio (BAR) in predicting mortality in elderly critically ill patients with AKI. Materials and Methods: This study was conducted retrospectively on 154 elderly patients with AKI who were admitted to the ICU between October 2023 and September 2024.Data on the following demographic, clinical, and laboratory parameters were retrospectively collected from medical cards and electronic records. Results: In the non-survivor group, among comorbidities, lung disease was higher (p < 0.05), GCS was lower, and APACHE II was higher among clinical scores (p < 0.001). In the non-survivor group, diuretic use (p = 0.03), oliguria, RRT, vasopressor requirement, sepsis, and MV rates (p < 0.001),as well as BUN, phosphate, LDH, Crp, APTT, INR, and BAR rates, were higher (all p < 0.05) and albumin was lower (p = 0.01). Cut-off values of BUN, albumin, and BAR variables according to mortality status were determined by an ROC curve analysis, as follows:48.4 for BUN (p = 0.013), 31.5 for albumin (p = 0.001), and 1.507 for BAR (p = 0.001).According to the results of the ROC analysis performed to predict in-hospital mortality, the BAR level reached an AUC value of 0.655. A BAR value above 1.507 increases mortality by 3.944 times (p = 0.023). Conclusions: BAR is a simple and accessible biomarker that may serve as a predictor of in-hospital mortality in elderly patients with AKI. Its use may aid early risk stratification and decisionmaking in the ICU. Full article

Exercise training in extreme temperatures concurrent with hypohydration status may potentiate the development of acute kidney injury (AKI) in young, healthy persons. Background/Objectives: It is unknown how repeated training bouts in ambient higher temperatures and humidity may influence measures of AKI. The purpose of this study was to investigate hydration status and renal biomarkers related to AKI in NCAA Division I female soccer athletes during preseason conditioning. Methods: A convenience sample of n = 21 athletes were recruited (mean ± SEM; age: 19.3 ± 0.25 y; height: 169.6 ± 1.36 cm; mass: 68.43 ± 2.46 kg; lean body mass: 45.91 ± 1.13 kg; fat mass: 22.51 ± 1.69 kg; body fat %: 32.22 ± 1.32%). The average temperature was 27.43 ± 0.19 °C, and the humidity was 71.69 ± 1.82%. Body composition, anthropometric, workload, and 14 urine samples were collected throughout the preseason training period for urine specific gravity (USG), creatinine (uCr), cystatin C (uCyst-C), and neutrophil gelatinase-associated lipocalin (uNGAL) analyses. Results: Our investigation showed that, when compared to baseline (D0), the athletes maintained a USG-average euhydrated status (1.019 ± 0.001) and were euhydrated prior to each exhibition game (D5-Pre: p = 0.03; 1.011 ± 0.001; D10-Pre: p = 0.0009; 1.009 ± 0.001); uCr was elevated on D8 (p = 0.001; 6.29 ± 0.44 mg·dL⁻¹·LBM⁻¹) and D10-Post (p = 0.02; 6.61 ± 0.44 mg·dL⁻¹·LBM⁻¹); uCyst-C was elevated on D6 through D10 (p = 0.001; ~0.42 ± 0.01 mg·dL⁻¹); no differences were found in uNGAL concentration. The highest distance (m) displaced was found during exhibition games (D5: p = <0.0001; ~8.6 km and D10: p = <0.0001; ~9.6 km). During the preseason conditioning, the athletes maintained a euhydrated status (~1.019) via USG, an increase in uCr that averaged within a normal range (208 mg·dL⁻¹), and an increase in uCyst-C to near AKI threshold levels (0.42 mg·L⁻¹) for several practice sessions, followed by an adaptive decline. No differences were found in uNGAL, which may be explained by athlete variation, chosen time sample collection, and variation in training and hydration status. Conclusions: The athletes maintained a euhydrated status, and this may help explain why urinary markers did not change or meet the reference threshold for AKI. Full article

Background: Proton pump inhibitors (PPIs) are frequently used after endoscopic variceal ligation (EVL) to reduce post-procedural bleeding, though studies have shown mixed results regarding their efficacy. While some suggest benefits, others report no significant advantage and highlight potential risks, including infection, kidney injury, and hepatic complications in cirrhotic patients. This study utilizes the TriNetX global health research network to evaluate the outcomes of PPI use following elective EVL for primary prophylaxis. Methods: This retrospective cohort study was conducted using the TriNetX database to evaluate adult patients with cirrhosis and esophageal varices who underwent EVL for primary prophylaxis. Patients who received at least two weeks of PPI therapy following EVL were compared to those who did not receive PPI within one month post-procedure. Outcomes assessed included esophageal bleeding, adverse events such as acute kidney injury (AKI), pneumonia, spontaneous bacterial peritonitis (SBP), Clostridioides difficile infection, hepatic encephalopathy, and all-cause mortality at 4 weeks and 8 weeks. Results: Of 6196 patients with cirrhosis and esophageal varices who underwent EVL, 12% (n = 764) received adjuvant PPI post-procedure, while 88% (n = 5432) did not receive PPI. After 1:1 propensity score matching, two well-balanced cohorts of 618 patients each were analyzed. PPI use was not associated with a reduction in esophageal bleeding at either 4 weeks (1.8% vs. 1.7%, p = 0.89) or 8 weeks (2.3% vs. 1.9%, p = 0.60). However, the composite adverse event rate—including SBP, hepatic encephalopathy, pneumonia, C. difficile, and acute kidney injury (AKI)—was significantly higher in the PPI group at both 4 weeks (7.9% vs. 3.0%, p < 0.01) and 8 weeks (13.2% vs. 3.0%, p < 0.01). Subgroup analysis showed no significant differences in pneumonia, SBP, or C. difficile infection at either time point. Hepatic encephalopathy was significantly more frequent in the PPI group at 8 weeks (4.9% vs. 2.0%, p = 0.01), and AKI occurred more often at both 4 weeks (5.7% vs. 2.0%, p < 0.01) and 8 weeks (9.6% vs. 2.1%, p < 0.01). Mortality was similar at 4 weeks but significantly higher in the PPI group at 8 weeks (4.3% vs. 1.7%, p < 0.01). Conclusions: PPI use after prophylactic EVL did not reduce bleeding risk and was linked to higher rates of adverse events. These findings suggest routine use may not be beneficial and should be reconsidered in cirrhotic patients who undergo EVL for primary prophylaxis. Full article

Background: Acute kidney injury (AKI) in critically ill patients is often complicated by arrhythmias, potentially affecting outcomes. This study aimed to develop predictive models for arrhythmias in AKI patients and assess the impact of antiarrhythmic drugs on in-hospital mortality. Methods: We conducted a multi-database retrospective cohort study using MIMIC-IV and eICU databases. XGBoost and Bayesian Information Criterion (BIC) models were employed to identify key predictors of arrhythmias. Weighted log-rank and Cox analysis evaluated the effect of amiodarone and metoprolol on in-hospital mortality. Results: Among 14,035 critically ill AKI patients, 5614 individuals (40%) developed arrhythmias. Both XGBoost and BIC showed predictive power for arrhythmias. The XGBoost model identified HR_max, HR_min, and heart failure as the most important features, while the BIC model highlighted heart failure had the highest odds ratio (OR 1.18, 95% CI 1.16–1.20) as a significant predictor. Patients experiencing arrhythmia is associated with in-hospital mortality (arrhythmia group: 636 (11.3%) vs. non-arrhythmia group: 587 (7.0%), p < 0.01). Antiarrhythmic medications showed a statistically significant effect on in-hospital mortality (amiodarone: HR 0.28, 95% CI 0.19–0.41, p < 0.01). Conclusions: Our predictive models demonstrated a robust discriminatory ability for identifying arrhythmia occurrence in critically ill AKI patients, with identified risk factors showing strong clinical relevance. The significant association between arrhythmia occurrence and increased in-hospital mortality underscores the clinical importance of early identification and management. Furthermore, amiodarone therapy effectively reduced the risk of in-hospital mortality in these patients, even after accounting for time-dependent biases. The findings highlight the necessity of precise arrhythmia definition, careful consideration of time-dependent covariates, and comprehensive model validation for clinically actionable insights. Full article

Background and Objectives: Rhabdomyolysis is a disorder in which skeletal muscle tissues are damaged, resulting in the escape of their internal substances into the blood circulation. Acute kidney injury (AKI) is a serious complication of rhabdomyolysis that necessitates early recognition to ensure effective clinical management. The objective of this research was to create a practical scoring tool for forecasting AKI in patients experiencing rhabdomyolysis due to trauma or excessive exercise. Materials and Methods: A novel scoring system, termed the growth differentiation factor-15-trauma-creatine kinase acute kidney injury score (GDF-TRACK-AKI score), was established. The model integrates serum levels of growth differentiation factor-15 (GDF-15), creatine kinase (CK), and occurrence of rhabdomyolysis associated with trauma. Clinical and biochemical data were prospectively collected, and the model’s predictive performance was evaluated using receiver operating characteristic ROC curve analysis. Results: Among patients with rhabdomyolysis, those who developed AKI had significantly higher GDF-TRACK-AKI scores (median: 3.00 (IQR: 2.00)) compared to patients without AKI (median: 0.48 (IQR 0.89); p < 0.001). Serum CK and GDF-15 levels were also markedly elevated in the AKI group (p < 0.001). ROC analysis identified a cut-off value of 2.5, providing 67% sensitivity and 98% specificity. Patients with scores ≥ 2 demonstrated a significantly increased risk of AKI. Conclusions: Designed as a practical and dependable tool, the GDF-TRACK-AKI score facilitates prompt identification of kidney injury in patients whose rhabdomyolysis is linked to either trauma or vigorous activity. The integration of trauma history with GDF-15 and CK biomarker data improves risk stratification precision and supports timely treatment decisions. To verify its practical utility and prognostic capabilities, the GDF-TRACK-AKI score should undergo additional evaluation across expansive and demographically varied clinical populations. Full article

Background: Acute phosphate nephropathy (APN) is an underrecognized cause of acute kidney injury (AKI), typically associated with the use of oral sodium phosphate (OSP)-based bowel preparations. It is characterized by calcium phosphate crystal deposition within the renal tubules and may result in permanent renal impairment. Despite known risks, phosphate-containing solutions are still widely used without sufficient risk stratification. Methods: We retrospectively evaluated 517 native kidney biopsies performed in our nephrology clinic between 2017 and 2022. Among these, 12 patients with unexplained AKI and recent colonoscopy history were identified. In nine cases, non-specific tubular deposits on routine staining prompted further histochemical analysis. All had a history of recent OSP-based bowel cleansing. The use of von Kossa staining confirmed calcium phosphate deposition, consistent with APN. Results: Out of 517 kidney biopsies performed during the study period, 9 patients were diagnosed with APN based on histopathological findings following recent colonoscopy and OSP-based bowel cleansing. The mean age was 58.7 years, and three were female. Hypertension was present in seven patients, diabetes mellitus in three, and epilepsy in two; one patient had no comorbidities. Baseline renal function was normal (mean serum creatinine 0.86 mg/dL) and increased to 1.76 mg/dL at three months post-exposure. All biopsies revealed tubulointerstitial calcium phosphate deposits and interstitial inflammation; mesangial hypercellularity was observed in five cases, tubular atrophy in three, and acute tubular necrosis in one. All samples stained positive with von Kossa staining. Over time, all patients developed chronic kidney disease, and one progressed to end-stage renal disease requiring dialysis. Conclusions: In patients presenting with unexplained AKI and recent OSP-based bowel preparation, APN should be considered in the differential diagnosis. When routine histology is inconclusive, definitive diagnosis may require special histochemical staining. Risk-based restrictions on phosphate-containing agents are warranted to reduce preventable kidney injury. Full article

Objectives: Contrast-induced acute kidney injury (CI-AKI) remains a frequent and serious complication after cardiac catheterization. Sirtuin-1 (SIRT1), a NAD+-dependent deacetylase, plays a central role in renal protection against ischemia-reperfusion injury, inflammation, and vascular dysfunction. We aimed to investigate whether serum SIRT1 levels could serve as an early diagnostic biomarker for CI-AKI. Methods: This prospective case-control study included 50 patients undergoing elective percutaneous coronary intervention (PCI) for stable angina. Serum SIRT1 levels were measured at baseline, 24 h, and 72 h post-PCI. The occurrence of CI-AKI was defined by a standard rise in serum creatinine, and patients were stratified accordingly. Results: Although SIRT1 levels tended to be lower in patients who developed CI-AKI (n = 17) compared to those without (n = 33), the differences were not statistically significant at any time point (p > 0.05). However, a significant between-group difference was observed in the 72-h change in SIRT1 levels (Δ0–72 h, p = 0.037), with a greater decline in the CI-AKI group. Multivariable logistic regression also revealed a trend-level inverse association between 72-h SIRT1 levels and CI-AKI (β = −0.536, p = 0.099). Conclusions: While SIRT1 is biologically plausible as a renal protective factor, our findings suggest that serial SIRT1 measurement may offer added value as a dynamic biomarker rather than a static diagnostic tool. Confirmatory trials incorporating serial SIRT1 measurements may help translate this molecular signal into clinically actionable tools for early detection of CI-AKI. Full article