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Non-resolution of acute kidney injury in the first week portends the development of chronic kidney disease in critically ill patients with cirrhosis.
Maiwall, Rakhi; Pasupuleti, Samba Siva Rao; Hidam, Ashini Kumar; Rastogi, Archana; Thomas, Sherin; Kumar, Guresh; Kumar, Anupam; Sarin, Shiv Kumar.
Afiliación
  • Maiwall R; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
  • Pasupuleti SSR; Department of Statistics, Mizoram University (A Central University), Pachhunga University College Campus, Aizawl, India.
  • Hidam AK; Department of Applied Mathematics and Statistics, Mizoram University (A Central University), Pachhunga University College Campus, Aizawl, India.
  • Rastogi A; Department of Clinical and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.
  • Thomas S; Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
  • Kumar G; Department of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
  • Kumar A; Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
  • Sarin SK; Department of Clinical and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.
Aliment Pharmacol Ther ; 58(6): 593-610, 2023 09.
Article en En | MEDLINE | ID: mdl-37455381
BACKGROUND: Renal tubular epithelial cells (RTECs) cause maladaptive repair and perpetuate renal fibrosis. AIM: To evaluate urinary neutrophil gelatinase-associated lipocalin (NGAL) and RTEC as risk factors for non-resolution of acute kidney injury (AKI-NR) at day seven and chronic kidney disease (CKD) in critically ill patients with cirrhosis. METHODS: We performed urinary NGAL and microscopy at enrolment and day 7 in all patients. We assessed 17 renal injury, endothelial injury and repair markers, genes for mitochondrial biogenesis by qRT-PCR in RTEC, and post-mortem renal biopsies for understanding mechanisms of AKI non-resolution (n = 30). RESULTS: We enrolled 310 patients, aged 48.1 ± 11.6 years, 87% male, 90% alcoholic. Of these, 36% had RTEC at enrolment, and 53% had AKI-NR on day 7. On mean follow-up of 136 days (range 43-365), 150 (48.3%) developed CKD. The presence of RTEC or granular casts, NGAL and AKI-NR were independent predictors of CKD development on competing risk analysis. Higher MCP-1, renal endothelial injury, decrease in tubular repair markers and failure of mitochondrial biogenesis in RTEC were seen in patients with AKI-NR compared with AKI-R (p < 0.05). Renal biopsies showed infiltration with monocyte-macrophage, increased α-SMA, and tubulointerstitial fibrosis. CONCLUSION: Almost two-thirds of critically ill patients with cirrhosis have AKI, which resolves in only one-half at day seven and predicts the development of CKD. Higher NGAL, RTEC, or granular casts were independent predictors of AKI-NR and CKD development. Enhanced tubular and endothelial injury, decreased repair, monocyte-macrophage infiltration and mitochondrial dysfunction in RTEC are associated with AKI non-resolution and risk of renal fibrosis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: Aliment Pharmacol Ther Asunto de la revista: FARMACOLOGIA / GASTROENTEROLOGIA / TERAPIA POR MEDICAMENTOS Año: 2023 Tipo del documento: Article País de afiliación: India Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: Aliment Pharmacol Ther Asunto de la revista: FARMACOLOGIA / GASTROENTEROLOGIA / TERAPIA POR MEDICAMENTOS Año: 2023 Tipo del documento: Article País de afiliación: India Pais de publicación: Reino Unido