FIVE URINARY BIOMARKERS: EARLY DETECTION AND MANAGEMENT OF ACUTE KIDNEY INJURY IN SEPTIC PATIENTS
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Abstract
Background: Acute kidney injury (AKI) is a complex clinical syndrome characterized by a sudden loss of kidney function, leading to the accumulation of waste products, electrolyte imbalances, and fluid disturbances. AKI frequently occurs in septic patients, affecting up to 50% of critically ill individuals, and is linked to high rates of morbidity, mortality, and healthcare costs. The pathophysiology of AKI in sepsis involves multiple interconnected mechanisms, including: (1) endothelial dysfunction and microvascular damage, (2) inflammation and oxidative stress, (3) renal ischemia and reduced blood flow, and (4) apoptosis and necrosis of kidney cells.
Traditional diagnostic methods for acute kidney injury (AKI), such as serum creatinine (S. Cr) and urine output (U. Op.), have limitations in sensitivity, specificity, and timeliness. Serum creatinine levels often do not increase until there is substantial kidney damage, and urine output can be affected by various factors like fluid administration and the use of diuretics. New urinary biomarkers have emerged as promising tools for the early detection of AKI, offering several potential advantages over traditional methods, including: (1) improved sensitivity and specificity, (2) earlier detection of kidney damage, (3) non-invasive and easy measurement, and (4) the potential to guide early intervention and management strategies. Several urinary biomarkers have been studied for AKI detection, including:
- Neutrophil gelatinase-associated lipocalin (NGAL)
- Kidney injury molecule-1 (KIM-1)
- Liver-type fatty acid-binding protein (L-FABP)
- Interleukin-18 (IL-18)
- Cystatin C
Objectives: Our study aims to provide clarity about the following objectives.
- To determine the diagnostic accuracy of urinary biomarkers, such as NGAL, KIM-1, and L-FABP, in detecting acute kidney injury (AKI) in patients with sepsis.
- To evaluate the prognostic value of urinary biomarkers in predicting patient outcomes, including mortality, the need for renal replacement therapy, and the length of hospital stay.
- To investigate the clinical utility of urinary biomarkers in guiding early intervention and management strategies for AKI in septic patients.
- To identify the most effective biomarker or combination of biomarkers for detecting AKI in patients with sepsis.
- To determine the optimal timing and frequency of biomarker measurements for the accurate detection of AKI.
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Dr Maham Javed Malik
FMH College of Medicine and Dentistry, Lahore Pakistan.
Dr Rawda Ahmed Mehanna
Clinical Sciences Department, Dubai Medical Collage for Girls, UAE.
Dr Fiza Majeed
Islam Medical College, Sialkot Pakistan.
Dr Afeera Muqeem Khan
Shifa International Hospital MICU.
Dr Rawan Ahmed Mehanna
Clinical Sciences Department, Dubai Medical College for Girls, Dubai, UAE
Dr Uswa Tahir
FMH College of Medicine and Dentistry, Lahore.
Dr Siddiqua Shahul Hameed
General practitioner, Doctor Plus Star Home Health Care.
Dr Dhoha Mohamed Ahmed Alsalmi
University of Sharjah.
Dr Ashtar Kariem
Trainee Physician, SGH, Dubai, UAE.
Dr Aya Albalooshi
Gulf Medical University, UAE.