Timely Diagnosis of Acute Kidney Injury Using Kinetic eGFR and the Creatinine Excretion to Production Ratio, E/eG - Creatinine Can Be Useful!
| Autor: | Zoltan H. Endre, John W. Pickering, Timothy J. Pianta |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Urinary system 030232 urology & nephrology Urology Renal function 030230 surgery 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Lipocalin-2 Predictive Value of Tests Proto-Oncogene Proteins Internal medicine medicine Humans Adverse effect Kidney transplantation Retrospective Studies Creatinine Receiver operating characteristic business.industry Acute kidney injury Acute Kidney Injury medicine.disease Kidney Transplantation Lipocalins Endocrinology chemistry Predictive value of tests business Biomarkers Acute-Phase Proteins |
| Zdroj: | Nephron. 132:312-316 |
| ISSN: | 2235-3186 1660-8151 |
| DOI: | 10.1159/000444456 |
| Popis: | Post transplant repeated measurements of urine volume and serum creatinine (sCr) are used to assess kidney function. Under non-steady state conditions, repeated measurement of sCr allows calculation of the kinetic estimated GFR (KeGFR). Additional measurement of urinary creatinine allows the calculation of the creatinine excretion to (estimated) production ratio (E/eG). We hypothesized that post-transplant KeGFR and E/eG would predict delayed graft function (DGF), as early as 4 h and outperform a validated clinical model at 12 h. This was a retrospective analysis of prospectively acquired data in a study of 56 recipients of deceased-donor kidney transplant. We assessed predictive performance with the area under the receiver operator characteristic curve (AUC) and the added value to a clinical model with integrated discrimination improvement analysis. At 4 h, the AUC for E/eG was 0.87 (95% CI 0.77-0.96) and for KeGFR 0.69 (95% CI 0.56-0.83). Both E/eG and KeGFR improved the risk prediction of a clinical model for DGF by 32 and 18%, and for non-DGF by 17 and 10%, respectively. While E/eG had better predictive performance of DGF than KeGFR, KeGFR might also facilitate perioperative management including drug dosing after kidney transplantation. Together these measurements may facilitate the possibility of conducting trials of early intervention to ameliorate the adverse effects of ischaemia-reperfusion injury on long-term DGF. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|