Rule Out Acute Kidney Injury in the Emergency Department With a Urinary Dipstick
| Autor: | Lena A. Kheir, Katherine Xu, Rebecca K. Breheney, John R. Burton, Britney A. Hatcher, Ariel E. Felman, Juliana N. Gamino, Hayley A. Giordano, Eddie F. Guerrero Herrera, Andrew Beenken, Aileen Gozali, Siddarth Arumugam, Jae I. Nha, Yaagnik D. Kosuri, Saul V. Lincoln, Anjali Gehani, Jacob S. Stevens, Osman R. Sayan, Jonathan Barasch, Tejashree S. Gopal, Erika K. Mitsui, Erin P. Geraghty, Miriam P. Callahan, Samuel J. Spaiser, Yuanji Li, Kristen L. King, Alexander T. Sayan, Alexa Corker, Andrew Yaeh, Samuel K. Sia, Sumit Mohan |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
emergency department Urinary system 030232 urology & nephrology Urology 030204 cardiovascular system & hematology dipstick 03 medical and health sciences chemistry.chemical_compound AKI 0302 clinical medicine Clinical Research medicine NGAL Prospective cohort study Creatinine business.industry Acute kidney injury Dipstick Emergency department medicine.disease chemistry Nephrology Cohort biomarker Biomarker (medicine) business |
| Zdroj: | Kidney International Reports |
| ISSN: | 2468-0249 |
| Popis: | Introduction The identification of acute injury of the kidney relies on serum creatinine (SCr), a functional marker with poor temporal resolution as well as limited sensitivity and specificity for cellular injury. In contrast, urinary biomarkers of kidney injury have the potential to detect cellular stress and damage in real time. Methods To detect the response of the kidney to injury, we have tested a lateral flow dipstick that measures a urinary protein called neutrophil gelatinase-associated lipocalin (NGAL). Analysis of urine was performed in a prospective cohort of 479 patients (final cohort N = 426) entering an emergency department in New York City and subsequently admitted for inpatient care. Results Colorimetric development had high interrater reliability (88% concordance rate) and correlated with traditional enzyme-linked immunosorbent assay (ELISA) measurements (ρ = 0.732, P < .0001). Of the 14% of the cohort who met Acute Kidney Injury Network (AKIN) SCr criteria for acute kidney injury (AKI), 67% demonstrated transient (2 days) elevation of SCr. Comparing the outcomes of patients with sustained versus transient or undetectable changes in SCr revealed that the urinary NGAL (uNGAL) dipstick had high specificity and negative predictive value (NPV) (high- vs. low-intermediate readings, sensitivity = 0.55, specificity = 0.91, positive predictive value = 0.24, NPV = 0.97, χ2 = 20.39, P < 0.001). Conclusion We show that the introduction of a bedside uNGAL dipstick permits accurate triage by identifying individuals who do not have tubular injury. In an era of shortening length of stay and rapid decisions based on isolated SCr measurements, real-time exclusion of kidney injury by a dipstick will be particularly useful to overcome the retrospective, insensitive, and nonspecific attributes of SCr. Graphical abstract |
| Databáze: | OpenAIRE |
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