Browsing by Subject "Acute kidney injury (AKI)"

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    Caregiver Awareness and Knowledge of Acute Kidney Injury in Hospitalized Children
    (American Medical Association, 2024-10-01) Starr, Michelle C.; Vanderkolk, Julia; Goswami, Shrea; Slagle, Cara L.; Soranno, Danielle E.; Pediatrics, School of Medicine
    This cross-sectional analyzes knowledge of acute kidney disease (AKI) diagnosis and associated risks among caregivers of hospitalized children.
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    Development and Validation of a Model to Predict Acute Kidney Injury in Hospitalized Patients With Cirrhosis
    (Wolters Kluwer, 2019-09) Patidar, Kavish R.; Xu, Chenjia; Shamseddeen, Hani; Cheng, Yao-Wen; Ghabril, Marwan S.; Mukthinuthalapati, V.V. Pavan K.; Fricker, Zachary P.; Akinyeye, Samuel; Nephew, Lauren D.; Desai, Archita P.; Anderson, Melissa; El-Achkar, Tarek M.; Chalasani, Naga P.; Orman, Eric S.; Medicine, School of Medicine
    OBJECTIVES: Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis which contributes to morbidity and mortality. Improved prediction of AKI in this population is needed for prevention and early intervention. We developed a model to identify hospitalized patients at risk for AKI. METHODS: Admission data from a prospective cohort of hospitalized patients with cirrhosis without AKI on admission (n = 397) was used for derivation. AKI development in the first week of admission was captured. Independent predictors of AKI on multivariate logistic regression were used to develop the prediction model. External validation was performed on a separate multicenter cohort (n = 308). RESULTS: In the derivation cohort, the mean age was 57 years, the Model for End-Stage Liver Disease score was 17, and 59 patients (15%) developed AKI after a median of 4 days. Admission creatinine (OR: 2.38 per 1 mg/dL increase [95% CI: 1.47-3.85]), international normalized ratio (OR: 1.92 per 1 unit increase [95% CI: 1.92-3.10]), and white blood cell count (OR: 1.09 per 1 × 10/L increase [95% CI: 1.04-1.15]) were independently associated with AKI. These variables were used to develop a prediction model (area underneath the receiver operator curve: 0.77 [95% CI: 0.70-0.83]). In the validation cohort (mean age of 53 years, Model for End-Stage Liver Disease score of 16, and AKI development of 13%), the area underneath the receiver operator curve for the model was 0.70 (95% CI: 0.61-0.78). DISCUSSION: A model consisting of admission creatinine, international normalized ratio, and white blood cell count can identify patients with cirrhosis at risk for in-hospital AKI development. On further validation, our model can be used to apply novel interventions to reduce the incidence of AKI among patients with cirrhosis who are hospitalized.
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    Pos-067 Utility Of Neutrophil Gelatinase-Associated Lipocalin (Ngal) In Diagnosis Of Acute Kidney Injury Among Children With Sickle Cell Anemia Hospitalised With Vaso-Occlusion
    (Elsevier, 2021) Batte, A.; Menon, S.; John, C. C.; Opoka, O. R.; Ssenkusu, M. J.; Kiguli, S.; Kalyesubula, R.; Conroy Leigh, A.; Pediatrics, School of Medicine
    Introduction: Diagnosis of acute kidney injury (AKI) in low-income settings is challenging as creatinine testing is not routinely available and serum creatinine is affected by age, nutritional status and glomerular hyperfiltration, a feature of sickle cell anemia (SCA). Alternative point-of-care biomarkers are needed to facilitate early detection of AKI in at-risk populations. We evaluated the diagnostic accuracy of a semi-quantitative point-of-care test of urine neutrophil gelatinase-associated lipocalin (uNGAL) to diagnose AKI in SCA at hospital admission. Methods: We enrolled 185 Ugandan children with SCA 2 to 18 years of age admitted with vaso-occlusive crises (VOC) and age-matched controls in steady state. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines based on a ≥1.5-fold change in creatinine within seven days or an absolute change of ≥0.3mg/dl within 48 hours excluding children with 1.5-fold change in creatinine from 0.2mg/dL to 0.3mg/dL. Creatinine was measured using the handheld iSTAT blood analyzer and CHEM8+ cartridges based on an enzymatic assay with amperometric detection. Urine NGAL was measured using a semi-quantitative point-of-care lateral flow uNGAL test on fresh urine (uNGALPOC) or quantitatively assessed by ELISA (uNGALELISA) on cryopreserved urine at the end of the study. The diagnostic accuracy of uNGAL was evaluated by comparing the area under receiver operating characteristic (AUROC) curves. Results: A total of 50 children (27.0%) had AKI over hospitalization. Urine NGAL levels were significantly higher in children with AKI compared to children without AKI irrespective of test methodology (uNGALELISA p<0.001, uNGALPOC p<0.001) and there was a significant increase in uNGAL levels across stages of AKI (p<0.0001 for both uNGALELISA and uNGALPOC). Levels of uNGALELISA and uNGALPOC were strongly correlated with a Spearman's rho of 0.805. When evaluating the diagnostic accuracy to identify AKI over hospitalization, the semi-quantitative lateral flow test of uNGALPOC had an equivalent AUROC to uNGALELISA with AUROCs of 0.71 for both tests. The uNGALPOC had the best performance in diagnosing AKI in children <5 years of age with an AUC of 0.95 (95% CI 0.85, 1.00) as well as children with evidence of an acute inflammatory event (hyperleukocytosis, AUC 0.76, 95% CI 0.65, 0.87) and hemoglobinuria on admission with an AUC of 0.79 (95% CI 0.68, 0.90). Conclusions: These results demonstrate that a point-of-care semi-quantitative uNGAL test had comparable ability to identify AKI compared to quantitative ELISA. Additional studies are needed to evaluate the utility of the point-of-care test across different patient populations.
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    Pos-173 Acute Kidney Injury And Renal Recovery In Ugandan Children With Severe Malaria
    (Elsevier, 2021) Conroy, A.; Namazzi, R.; Batte, A.; Ssenkusu, J.; Opoka, O. R.; John, C.; Pediatrics, School of Medicine
    Introduction: Acute kidney injury (AKI) is increasingly recognized as an important clinical complication in children with severe malaria associated with increased morbidity and mortality, including long-term neurocognitive and behavioral problems in surviving children. The objective of this study was to evaluate AKI and renal recovery in a prospective cohort study of children with severe malaria admitted to two hospitals in Uganda: Mulago National Referral Hospital in Kampala in Central Uganda and Jinja Regional Referral Hospital in Eastern Uganda. Methods: 598 children hospitalized with Plasmodium falciparum with clinical features of severe malaria and at least one creatinine measure were enrolled in the study and followed for 12 months. 118 healthy community children were enrolled to assess normal kidney function. Serum creatinine was measured using a Beckman Coulter AU5822 chemistry analyzer using the modified Jaffe colorimetric method on cryopreserved samples. Study definitions are described in Figure 1. Results: The prevalence of AKI was 45.3% and was more common in Jinja (57.5%) compared to Kampala (35.5%) (p<0.0001). The maximum AKI stage was Stage 1 in 23.9% of children, Stage 2 in 10.0% of children and Stage 3 in 11.4% of children. AKI was more common in children who reported use of herbal medications (Odds Ratio (OR), 3.64 95% CI 1.52 to 8.75, p=0.004), but was not associated with reported use of anti-malarial medications, antibiotics, or non-steroidal anti-inflammatory medications prior to admission (p>0.05 for all). Clinically, children with AKI were more likely to present with coma, retinal hemorrhages, jaundice, hemoglobinuria, respiratory distress, and a history of vomiting (p<0.05 for all). AKI was associated with a significant increase in in-hospital mortality (OR, 7.98 95% CI 3.14, 20.32, p<0.0001), neurologic deficits at discharge in survivors (OR, 1.83 95% CI 1.06 to 3.15, p=0.031) and a higher incidence of subsequent hospitalization (Incidence Rate Ratio (IRR), 1.26 95% CI, 1.02 to 1.56, p=0.031) adjusting for child age, sex, level of consciousness, presence of severe anemia and study site. At one month follow-up, 60 children (13.0%) had acute kidney disease (AKD) while 34 (7.4%) had hyperfiltration, defined as an estimated Glomerular filtration rate (eGFR)>185mL/min/1.73m2. There were distinct differences in the pattern of kidney injury over follow-up by site with hyperfiltration occurring in 12.4% of children from Kampala vs. 1.8% of children from Jinja while AKD occurred in 1.2% of children from Kampala compared to 26.0% of children from Jinja. The presence of AKD at one-month follow-up was associated with 4.74 fold increased odds of post-discharge mortality (95% CI, 1.33 to 16.98) adjusting for age, sex, and site. Conclusions: Additional research is needed to understand how AKI impacts long-term kidney function and to understand regional differences in kidney function in malaria-endemic settings.