Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers
Acute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) pro...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | International Journal of Molecular Sciences |
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| Online Access: | https://www.mdpi.com/1422-0067/24/3/1826 |
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| author | Sandra M. Sancho-Martínez Alfredo G. Casanova Annette G. Düwel Karen Rivero-García Tamara García-Garrido Ana I. Morales Carlos Martínez-Salgado Francisco J. López-Hernández Pilar Fraile |
| author_facet | Sandra M. Sancho-Martínez Alfredo G. Casanova Annette G. Düwel Karen Rivero-García Tamara García-Garrido Ana I. Morales Carlos Martínez-Salgado Francisco J. López-Hernández Pilar Fraile |
| author_sort | Sandra M. Sancho-Martínez |
| collection | DOAJ |
| description | Acute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) provide no etiological distinction, anamnestic and additional biochemical criteria complement AKI diagnosis. Traditional, etiology-defining biochemical parameters, including the fractional excretion of sodium, the urinary-to-plasma creatinine ratio and the renal failure index are individually limited by confounding factors such as diuretics. To minimize distortion, we generated a composite biochemical criterion based on the congruency of at least two of the three biochemical ratios. Patients showing at least two ratios indicative of intrinsic AKI were classified within this category, and those with at least two pre-renal ratios were considered as pre-renal AKI patients. In this study, we demonstrate that the identification of intrinsic AKI by a collection of urinary injury biomarkers reflective of tubular damage, including NGAL and KIM-1, more closely and robustly coincide with the biochemical than with the anamnestic classification. Because there is no gold standard method for the etiological classification of AKI, the mutual reinforcement provided by the biochemical criterion and urinary biomarkers supports an etiological diagnosis based on objective diagnostic parameters. |
| first_indexed | 2024-03-11T09:43:35Z |
| format | Article |
| id | doaj.art-2d860be3a3674e1a9587657653114a8a |
| institution | Directory Open Access Journal |
| issn | 1661-6596 1422-0067 |
| language | English |
| last_indexed | 2024-03-11T09:43:35Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | International Journal of Molecular Sciences |
| spelling | doaj.art-2d860be3a3674e1a9587657653114a8a2023-11-16T16:48:19ZengMDPI AGInternational Journal of Molecular Sciences1661-65961422-00672023-01-01243182610.3390/ijms24031826Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury BiomarkersSandra M. Sancho-Martínez0Alfredo G. Casanova1Annette G. Düwel2Karen Rivero-García3Tamara García-Garrido4Ana I. Morales5Carlos Martínez-Salgado6Francisco J. López-Hernández7Pilar Fraile8Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainInstitute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainInstitute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainServicio de Nefrología, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, SpainServicio de Nefrología, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, SpainInstitute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainInstitute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainInstitute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainInstitute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainAcute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) provide no etiological distinction, anamnestic and additional biochemical criteria complement AKI diagnosis. Traditional, etiology-defining biochemical parameters, including the fractional excretion of sodium, the urinary-to-plasma creatinine ratio and the renal failure index are individually limited by confounding factors such as diuretics. To minimize distortion, we generated a composite biochemical criterion based on the congruency of at least two of the three biochemical ratios. Patients showing at least two ratios indicative of intrinsic AKI were classified within this category, and those with at least two pre-renal ratios were considered as pre-renal AKI patients. In this study, we demonstrate that the identification of intrinsic AKI by a collection of urinary injury biomarkers reflective of tubular damage, including NGAL and KIM-1, more closely and robustly coincide with the biochemical than with the anamnestic classification. Because there is no gold standard method for the etiological classification of AKI, the mutual reinforcement provided by the biochemical criterion and urinary biomarkers supports an etiological diagnosis based on objective diagnostic parameters.https://www.mdpi.com/1422-0067/24/3/1826acute kidney injurypre-renalintrinsicinjury biomarkersanamnesisetiopathology |
| spellingShingle | Sandra M. Sancho-Martínez Alfredo G. Casanova Annette G. Düwel Karen Rivero-García Tamara García-Garrido Ana I. Morales Carlos Martínez-Salgado Francisco J. López-Hernández Pilar Fraile Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers International Journal of Molecular Sciences acute kidney injury pre-renal intrinsic injury biomarkers anamnesis etiopathology |
| title | Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers |
| title_full | Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers |
| title_fullStr | Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers |
| title_full_unstemmed | Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers |
| title_short | Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers |
| title_sort | identification of pre renal and intrinsic acute kidney injury by anamnestic and biochemical criteria distinct association with urinary injury biomarkers |
| topic | acute kidney injury pre-renal intrinsic injury biomarkers anamnesis etiopathology |
| url | https://www.mdpi.com/1422-0067/24/3/1826 |
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