Acute kidney injury (AKI) is a consequence of several diseases that can severely damage kidney function. It is a frequent complication of hospitalization and very common in critically ill patients because of other serious illnesses, such as septic conditions. New diagnostic options, including renal biomarkers, may help in early diagnosis. Our study included 46 patients, 31 with AKI and 15 without AKI on admission. Blood samples were collected on the first, fourth, and seventh days of treatment, and in addition to basic biochemical parameters, neutrophil gelatinase-associated lipocalin (NGAL) levels in serum were also examined. Data from the first and seventh day were used for statistical analysis. On the first follow-up day, NGAL values were categorized according to an optimal cut-off value of 290 µg/l. We demonstrated that if NGAL levels were higher, the risk of renal injury increased approximately 16 times. Other results showed that NGAL levels were moderately correlated with serum creatinine (r = 0.613, p < 0.0001), procalcitonin (PCT) (r = 0.627, p < 0.0001), and AKI stage (r = 0.589, p < 0.0001). There was also a significant positive correlation with SOFA (Sequential Organ Failure Assessment) score (r = 0.395, p = 0.007). Early diagnosis and treatment are crucial in managing AKI and preventing further kidney damage. NGAL levels can increase within a few hours after injury, making it a useful tool for early AKI detection and diagnosis. Key words: Acute kidney injury, Biomarker, NGAL, Sepsis.

• MeSH
• akutní poškození ledvin * krev   diagnóza   MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• kritický stav * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipokalin-2 * krev   MeSH
• prediktivní hodnota testů MeSH
• senioři MeSH
• sepse * krev   diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery * MeSH
• LCN2 protein, human MeSH Prohlížeč
• lipokalin-2 * MeSH

BACKGROUND AND OBJECTIVES: Renal elimination of amikacin and other aminoglycosides is slowed down in sepsis-induced acute kidney injury increasing the risk of adverse effects. Since neutrophil gelatinase-associated lipocalin (NGAL) and aminoglycosides share the mechanisms for renal excretion, the predictive power of NGAL was examined towards the changes in amikacin pharmacokinetics during early endotoxemia in anesthetized Wistar rats. METHODS: Endogenous biomarkers of inflammation and acute kidney injury were assessed including NGAL in saline-injected controls and two groups of rats challenged with an intravenous injection of bacterial lipopolysaccharide (5 mg/kg)-a fluid-resuscitated group (LPS) and a fluid-resuscitated group infused intravenously with 8 μg/kg/h terlipressin (LPS-T). Sinistrin and amikacin were infused to measure glomerular filtration rate (GFR) and amikacin clearance (CLam). The investigations included blood gas analysis, chemistry and hematology tests and assessment of urine output, creatinine clearance (CLcr) and sinistrin clearance (CLsini). RESULTS: Within 3 h of injection, systemic and renal inflammatory responses were induced by lipopolysaccharide. Gene and protein expression of NGAL was increased in the kidneys and the concentrations of NGAL in the plasma (pNGAL) and urine rose 4- to 38-fold (P < 0.01). The decreases in CLam and the GFR markers (CLcr, CLsini) were proportional, reflecting the extent to which endotoxemia impaired the major elimination mechanism for the drug. Terlipressin attenuated lipopolysaccharide-induced renal dysfunction (urine output, CLcr, CLsini) and accelerated CLam. The pNGAL showed a strong association with the CLsini (rs = - 0.77, P < 0.0005). Concerning prediction of CLam, pNGAL was comparable to CLcr (mean error - 24%) and inferior to CLsini (mean error - 6.4%), while the measurement of NGAL in urine gave unsatisfactory results. CONCLUSIONS: During early endotoxemia in the rat, pNGAL has a moderate predictive ability towards CLam. Clinical studies should verify whether pNGAL can support individualized dosing of aminoglycosides to septic patients.

• MeSH
• akutní poškození ledvin krev   MeSH
• amikacin krev   metabolismus   farmakokinetika   MeSH
• biologické markery krev   MeSH
• cytokiny MeSH
• endotoxemie chemicky indukované   MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• krysa rodu Rattus MeSH
• ledviny patofyziologie   MeSH
• lipokalin-2 krev   metabolismus   moč   MeSH
• lipopolysacharidy farmakologie   MeSH
• metabolická clearance MeSH
• moč MeSH
• modely u zvířat MeSH
• oligosacharidy farmakokinetika   MeSH
• potkani Wistar * MeSH
• prediktivní hodnota testů MeSH
• sepse farmakoterapie   metabolismus   MeSH
• zánět MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• amikacin MeSH
• biologické markery MeSH
• cytokiny MeSH
• lipokalin-2 MeSH
• lipopolysacharidy MeSH
• oligosacharidy MeSH
• sinistrin MeSH Prohlížeč

OBJECTIVE: We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients. MATERIAL AND METHODS: Single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients (total burned body surface >20%) from January 2012 until January 2015 with a pNGAL dosage at admission. Reclassification of patients was assessed by Integrated Discrimination Improvement (IDI). MEASUREMENTS AND RESULTS: 87 patients were included. Mean age was 47.7 (IQ 25-75: 33.4-65.2) years; total burn body surface area was 40 (IQ 25-75: 30-55) % and ICU mortality 36%. 39 (44.8%) patients presented a MAKE, 32 (88.9%) patients died at day 90. pNGAL was higher in the MAKE group (423 [IQ 25-75: 327-518]pg/mL vs 184 [IQ 25-75: 147-220]pg/mL, p<0.001). In multivariate analysis, pNGAL and abbreviated burn severity index (ABSI) remained associated with MAKE (OR 1.005 [CI 95% 1.0005-1.009], p=0.03 and OR 1.682 [CI95%1.038-2.726], p=0.035 respectively). Adding pNGAL to abbreviated burn severity index, simplified organ failure assessment and the simplified acute physiology score 2 did outperform clinical scores for the prediction of MAKE and AKI and for most severe forms of AKI and allowed a statistically significant reclassification of patients compared to ABSI for MAKE, RRT, AKI at Day 7 and AKI during hospitalization with a number of patients needed to screen to detect one extra episode of MAKE was 44, 13 for severe AKI and 15 for AKI. CONCLUSIONS: pNGAL at admission is associated with the risk of MAKE in this population, and outperform severity scores when associated. Interventional studies are now needed to assess if impact of biomarkers-guided strategies would improve outcome.

• Klíčová slova
• Acute kidney injury, Burn patients, Major adverse kidney event, Plasmatic Neutrophil Gelatinase-Associated Lipocain,
• MeSH
• akutní poškození ledvin krev   epidemiologie   metabolismus   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• jednotky intenzivní péče MeSH
• kohortové studie MeSH
• kreatinin metabolismus   MeSH
• kritický stav * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipokalin-2 krev   MeSH
• mortalita * MeSH
• náhrada funkce ledvin statistika a číselné údaje   MeSH
• obnova funkce * MeSH
• popálení krev   metabolismus   mortalita   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kreatinin MeSH
• LCN2 protein, human MeSH Prohlížeč
• lipokalin-2 MeSH

• Klíčová slova
• Excretion fraction of uric acid *, Hypouricemia *, SLC22A12 *, URAT1 *, Urate transport *,
• MeSH
• akutní poškození ledvin krev   prevence a kontrola   moč   MeSH
• alopurinol aplikace a dávkování   MeSH
• antioxidancia aplikace a dávkování   MeSH
• cystinóza krev   diagnóza   moč   MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• Fanconiho syndrom krev   diagnóza   moč   MeSH
• genetické testování MeSH
• kyselina močová krev   metabolismus   moč   MeSH
• ledvinové kanálky metabolismus   MeSH
• lidé MeSH
• močové kameny krev   diagnóza   genetika   moč   MeSH
• přenašeče organických aniontů genetika   MeSH
• proteiny přenášející organické kationty genetika   MeSH
• proteiny usnadňující transport glukosy genetika   MeSH
• renální reabsorpce MeSH
• syndrom nepřiměřené sekrece ADH krev   diagnóza   moč   MeSH
• vrozené poruchy tubulárního transportu krev   diagnóza   genetika   moč   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• alopurinol MeSH
• antioxidancia MeSH
• kyselina močová MeSH
• přenašeče organických aniontů MeSH
• proteiny přenášející organické kationty MeSH
• proteiny usnadňující transport glukosy MeSH
• SLC22A12 protein, human MeSH Prohlížeč
• SLC2A9 protein, human MeSH Prohlížeč

BACKGROUND: The regional citrate anticoagulation (RCA) induces changes in total (Catot) and ionized (Ca2+) calcium. As of now, we do not have much information about parallel changes of total (Mgtot) and ionized (Mg2+) magnesium. METHODS: The authors compared changes of Mg2+ and Mgtot with changes of Ca2+ and Catot in 32 critically ill patients on 4% trisodium citrate (4% TSC) with calcium-free fluids. RESULTS: The median continuous venovenous hemodiafiltration balance of Mgtot was -0.91 (-1.18 to -0.53) mmol/h compared to the median balance of Catot 0.86 (0.08-1.55) mmol/h. Postfilter Mg2+ decreased by 68.3% (70.8-65.6) in parallel (r = 0.41, p = 0.03) to decrease of postfilter Ca2+ (by 70.2% (73.0-66.1)) and was significantly related to the postfilter Ca2+ (r = 0.50, p < 0.001). The decrease of prefilter to postfilter Ca2+ correlated to a dosage of 4% TSC per blood flow (r = 0.37, p = 0.04). CONCLUSIONS: The loss of Mgtot during RCA is not covered by magnesium concentration in ordinary dialysis/substitution fluid and may lead to the depletion of total body magnesium. The postfilter Mg2+ is significantly related to the postfilter Ca2+. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi = 440972.

• MeSH
• akutní poškození ledvin krev   patologie   terapie   MeSH
• antikoagulancia aplikace a dávkování   škodlivé účinky   MeSH
• citráty aplikace a dávkování   škodlivé účinky   MeSH
• hemodiafiltrace * MeSH
• hemofiltrace MeSH
• hořčík krev   MeSH
• jednotky intenzivní péče MeSH
• kationty dvojmocné MeSH
• kritický stav MeSH
• lidé středního věku MeSH
• lidé MeSH
• nedostatek hořčíku krev   etiologie   patologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• tekutinová terapie škodlivé účinky   metody   MeSH
• umělé dýchání MeSH
• vápník krev   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antikoagulancia MeSH
• citráty MeSH
• hořčík MeSH
• kationty dvojmocné MeSH
• trisodium citrate MeSH Prohlížeč
• vápník MeSH

BACKGROUND Acute kidney injury (AKI) is a risk factor for adverse hospital outcomes in recipients of a heart transplantation (HTx). Timely recognition of AKI is crucial for the initiation of proper treatment. We hypothesized that serum or urine biomarkers can predict AKI. MATERIAL AND METHODS In this prospective study we evaluated 117 consecutive patients after HTx. AKI was defined as an increase of the serum creatinine level by ≥50% or a worsening of the renal function requiring renal replacement therapy during the first post-HTx week. We serially sampled serum cystatin C (S-cystatin C) as a marker of glomerular filtration and urinary neutrophil gelatinase-associated lipocalin (U-NGAL) as a marker of tubular damage. RESULTS A cohort of 30 patients (25.6%) fulfilled the criteria of AKI. S-cystatin C allowed the earliest separation between the AKI and non-AKI groups, with a significant difference present as soon as 3 h after surgery and it persisted on days 7, 10, and 30. The increase in S-cystatin C preceded the serum creatinine elevation by 4 days. In a multivariate analysis, S-cystatin C >1.6 mg/L at 3 h after HTx predicted AKI with OR 4.3 (95% CI: 1.6-11.5). U-NGAL was significantly higher at day 3 in the AKI group (p=0.003) and elevated S-cystatin C (≥2.54 mg/L on day 7) could predict 1-year mortality in these HTx recipients. CONCLUSIONS Our study showed that the measurement of S-cystatin C at 3 h after surgery may help to identify patients with high risk for renal complications. A persistent elevation of S-cystatin C also predicts 1-year mortality.

• MeSH
• akutní poškození ledvin krev   diagnóza   etiologie   MeSH
• antilymfocytární sérum terapeutické užití   MeSH
• biologické markery krev   MeSH
• časná diagnóza MeSH
• cystatin C krev   MeSH
• dospělí MeSH
• imunosupresiva terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• kreatinin krev   MeSH
• kyselina mykofenolová terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipokalin-2 krev   MeSH
• senioři MeSH
• takrolimus terapeutické užití   MeSH
• transplantace srdce škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antilymfocytární sérum MeSH
• biologické markery MeSH
• cystatin C MeSH
• imunosupresiva MeSH
• kreatinin MeSH
• kyselina mykofenolová MeSH
• lipokalin-2 MeSH
• takrolimus MeSH

AIMS: To assess the influence of continuous venovenous hemofiltration (CVVH) at a filtration rate of 45 mL/kg/h on vancomycin pharmacokinetics in critically ill septic patients with acute kidney injury (AKI). METHODS: Seventeen adult septic patients with acute kidney injury treated with CVVH and vancomycin were included. All patients received first dose of 1.0 g intravenously followed by 1.0 g/12 h if not adjusted. In sixteen patients vancomycin was introduced on the day of the start of CRRT therapy. Blood samples and ultrafiltrates were obtained before and 0.5, 1, 6 and 12 h after vancomycin administration. RESULTS: On the first day, the median total vancomycin clearance (Cltot) was 0.89 mL/min/kg (range 0.31 - 2.16). CRRT clearance accounted for around 50-60% of the total clearance of vancomycin found in a population with normal renal function (0.97 mL/min/kg). Vancomycin serum concentrations after the first dose were below the required target of 10 mg/L as early as 6 h in 10 patients, AUC0-24/MIC ≥ 400 ratio was achieved in 10 patients on the first day. CONCLUSIONS: CVVH at a filtration rate of 45 mL/kg/h leads to high and rapid extracorporeal removal of vancomycin in critically ill patients. Due to the rapid change in patient clinical status it was impossible to predict a fixed dosage regimen. We recommend blood sampling as early as 6 h after first vancomycin dose with maintenance dose based on vancomycin serum level monitoring.

• MeSH
• akutní poškození ledvin krev   terapie   MeSH
• antibakteriální látky krev   farmakokinetika   MeSH
• dospělí MeSH
• hemofiltrace * MeSH
• kritický stav MeSH
• lidé středního věku MeSH
• lidé MeSH
• monitorování léčiv MeSH
• plocha pod křivkou MeSH
• prospektivní studie MeSH
• senioři MeSH
• sepse krev   farmakoterapie   MeSH
• vankomycin krev   farmakokinetika   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antibakteriální látky MeSH
• vankomycin MeSH

• MeSH
• akutní poškození ledvin krev   diagnóza   etiologie   prevence a kontrola   MeSH
• alopurinol aplikace a dávkování   terapeutické užití   MeSH
• antiuratika aplikace a dávkování   terapeutické užití   MeSH
• biologické markery krev   MeSH
• lidé MeSH
• mladiství MeSH
• močové kameny krev   farmakoterapie   genetika   MeSH
• rozvrh dávkování léků MeSH
• sekundární prevence MeSH
• sportovní úrazy diagnóza   prevence a kontrola   MeSH
• vrozené poruchy tubulárního transportu krev   farmakoterapie   genetika   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• alopurinol MeSH
• antiuratika MeSH
• biologické markery MeSH

BACKGROUND: Placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A), soluble receptor for advanced glycation end products (sRAGE), extracellular newly identified receptor for RAGE binding protein (EN-RAGE) and high mobility group box 1 (HMGB-1) are novel biomarkers in chronic kidney disease (CKD). However, their clinical significance in acute kidney injury (AKI) is unknown. The aim of this cross-sectional study was to determine whether selected biomarkers are changed in AKI patients. METHODS: Serum PlGF, PAPP-A, sRAGE, EN-RAGE and HMGB-1 levels were assessed in 40 patients with AKI, 42 CKD 5 patients, 31 haemodialysis patients (HD) and 39 age-matched healthy controls. RESULTS: PAPP-A was elevated in AKI (20.6 ± 16.9 mIU/L) compared with controls (9.1 ± 2.3 mIU/L, p < 0.001). PlGF was not increased in AKI (11.7 ± 7.4 pg/mL) versus controls (8.5 ± 2.4 pg/mL, n.s.), as well as sRAGE was not elevated in AKI (2400 ± 1400 pg/mL) compared with controls (1760 ± 730 pg/mL, n.s), but was lower compared with CKD 5 (3200 ± 1500 pg/mL, p < 0.05); EN-RAGE was elevated in AKI 480 ± 450 ng/mL in comparison with controls (60 ± 62 ng/mL), CKD 5 (190 ± 120 ng/mL), and HD (120 ± 100 ng/mL), all p < 0.001. Similarly, HMGB-1 was increased in AKI (5.8 ± 7.5 ng/mL) versus controls (1.7 ± 1.4 ng/mL), CKD 5 (3.2 ± 3.1 ng/mL) and HD (2.5 ± 2.1 ng/mL), all p < 0.001.In AKI group, in multivariate regression analysis: PAPP-A levels were associated with transferrin (p <0.001), negatively with albumin (p < 0.01) and prealbumin (p < 0.05); PlGF levels were associated with C--reactive protein (p < 0.001). EN-RAGE levels were associated with ferritin (p < 0.01) and orosomucoid (p = 0.02), and HMGB-1 levels with leukocyte count (p < 0.01) and negatively with proteinuria (p = 0.02). CONCLUSIONS: In AKI patients, PAPP-A, EN-RAGE and HMGB1 are elevated, but sRAGE and PlGF are not increased. Whereas PAPP-A correlates with markers of nutrition; PlGF, EN-RAGE and HMGB-1 are related to inflammatory parameters.

• MeSH
• akutní poškození ledvin krev   epidemiologie   MeSH
• chronická renální insuficience krev   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• placentární růstový faktor MeSH
• prevalence MeSH
• protein HMGB1 krev   MeSH
• průřezové studie MeSH
• receptor pro konečné produkty pokročilé glykace MeSH
• receptory imunologické krev   MeSH
• reprodukovatelnost výsledků MeSH
• rizikové faktory MeSH
• senzitivita a specificita MeSH
• těhotenské proteiny krev   MeSH
• těhotenský plazmatický protein A analýza   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• HMGB1 protein, human MeSH Prohlížeč
• PAPPA protein, human MeSH Prohlížeč
• PGF protein, human MeSH Prohlížeč
• placentární růstový faktor MeSH
• protein HMGB1 MeSH
• receptor pro konečné produkty pokročilé glykace MeSH
• receptory imunologické MeSH
• těhotenské proteiny MeSH
• těhotenský plazmatický protein A MeSH

BACKGROUND: We studied the influence of acute renal failure (ARF) on the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and hemodynamic parameters. METHODS: The echocardiographic parameters and NT-proBNP levels were compared between 26 mechanically ventilated patients with ARF requiring continuous hemodiafiltration and 44 control patients. RESULTS: The relationships between NT-proBNP and left ventricular ejection fraction (p = 0.001), left ventricular end-diastolic volume (p = 0.03), tricuspid annular plane systolic excursion (p = 0.008), and pulmonary artery pressure (p = 0.01) were found only in the control group. The median and interquartile range of NT-proBNP (1,717.5, 389.5-4,138 ng/l) were significantly higher (p < 0.001) in the low diuresis subgroup than the levels (748.8, 384.2-2,217 ng/l) in the subgroup where daily diuresis increased and both had significantly higher levels than controls (350.7, 130.2-661.2 ng/l, p < 0.001). CONCLUSION: The high levels of NT-proBNP >1,000 ng/l seem to be typical, particularly for oliguric ARF. It seems that ARF precludes its utilization for any hemodynamic diagnosis.

• MeSH
• akutní poškození ledvin krev   komplikace   MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   MeSH
• hemodynamika * MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretický peptid typu B krev   MeSH
• peptidové fragmenty krev   MeSH
• prospektivní studie MeSH
• senioři MeSH
• srdeční komory diagnostické zobrazování   MeSH
• ultrasonografie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• natriuretický peptid typu B MeSH
• peptidové fragmenty MeSH
• pro-brain natriuretic peptide (1-76) MeSH Prohlížeč