View clinical trials related to Acute Kidney Injury.
Filter by:Acute kidney injury (AKI) is a common heterogeneous disease that complicates several medical and surgical conditions. Recent studies have demonstrated that the occurrence of AKI significantly increase the risk of adverse outcomes. Despite the advanced in modern medicine, the interventions for AKI are not improved. One major reason of the failure to shift therapeutic progress is the clinicians' widespread dependence upon serum creatinine, an unreliable marker during acute changes of renal function, for the diagnosis of AKI. In the past decade, over 20 unique biomarkers of AKI had been explored. Among them, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) have received the most interest. None of them, however, is an idea one. Cysteine-rich protein 61 (Cyr61), a secreted matrix-associated heparin-binding protein, belongs to the "CCN" family. It regulates a broad spectrum of cellular activities, including cell adhesion, migration, proliferation, survival, differentiation, apoptosis, angiogenesis, and extracellular matrix production of multiple cell types. By the kidney ischemic/reperfusion injury animal model, Cyr61 gene was found to be rapidly up-regulated in the renal outer medulla. That portion of the kidney is corresponding to the area of marginally oxygenated under normal condition and most tubular injury following renal ischemic/reperfusion injury.18 Elevation of Cyr61 protein was detected in the kidney and also in urine following injury, making it a potential marker of AKI. Additionally, pulse diagnosis is an integrative part of traditional Chinese medicine. With spectral analysis of the pulse waves, researchers started to observe the pulse wave harmonics. An in vivo study of rats revealed that ligating one or both of the renal arteries significantly reduced the second harmonic component of the pressure pulse at the caudate artery. Ligating the artery toward the spleen prominently reduced the third harmonics component of the pulse. Analysis of the harmonics in the spectrum of the arterial pressure wave revealed that individual organs might have their own natural frequencies. These observations suggested that individual vascular beds exert independent, frequency-specific, effects on the peripheral pressure wave. Among different etiologies, cardiac surgery is an important cause of AKI. It has been shown that AKI after cardiac surgery is relatively highly prevalent and prognostically important. Cardiac surgery is usually performed with the use of extracorporeal cardiopulmonary bypass machine ('on-pump'). Based on the evidence from cell culture study and animal study in the literature, we hypothesize that Cyr61 is rapidly increased in the urine after AKI. We thus design this project to evaluate study the diagnostic role and clinical application of Cyr61 in AKI. We will conduct a prospective cohort study to evaluate the changes of urinary Cyr61 in patients undergoing cardiac surgery. Cyr61 may serve a good biomarker for the early diagnosis of patients with AKI, either singly or in combination with NGAL. By the way, we also try to correlate the changes in those biomarker with a potential new tool：harmonic analysis of arterial pressure pulse waves. We have special interest in following the time course of changes in biomarker and correlate with changes in pulse analysis. Physiological parameters of vascular compliance and regional blood oxygen saturation will be correlated concurrently. It is hoped that early detection of AKI will lead to earlier intervention, thus enhancing our ability to develop beneficial therapies.
The aim of the project is to compare the nephro-protective effects of high-dose atorvastatin and high-dose rosuvastatin on the incidence of Contrast Induced-Acute Kidney Injury in patients with non-ST-elevation acute coronary syndromes scheduled for early invasive strategy.
This study is to collect blood and urine samples to help identify and validate protein biomarkers of recovery from moderate or severe acute kidney injury (AKI).
Evaluating whether forced diuresis with matched hydration will reduce the risk of contrast induced nephropathy in patients undergoing Transcatheter Aortic Valve Implantation (TAVI).
Cidofovir is an acyclic nucleotide analog with broad-spectrum antiviral activity against herpesviruses. Its potency in inhibiting HCMV has been shown in conventional in vitro studies. It is approved for the systemic treatment of human cytomegalovirus (HCMV) retinitis in patients with AIDS and as a second line therapy for HCMV infections not responding to ganciclovir or foscarnet. In intensive care patients continuous venovenous haemofiltration (CVVH) is a well-established extracorporal renal replacement therapy with a high clearance rate. Pharmacokinetic studies of antifungal agents in critically ill patients treated with CVVH are rare. Elimination of any given drug by renal replacement therapy is determined by several major factors which are membrane specific, due to physico-chemical properties of the drug and characteristics of the renal replacement technique used. Study objective The trial is conducted to investigate the pharmacokinetics of cidofovir during CVVH in critically ill patients. It is suspected that Hemofiltration will influence cidofovir plasma levels.
Record the renal resistive index and hemodynamic parameters ( record the cardiac output and stroke volume if the patient's next to kin agree to undertake a PiCCO monitoring ) before and after resuscitation for severe sepsis or septic shock patients, to determine whether the changes of resistive index or hemodynamic parameters, especially the cardiac output can be a better parameter to predict AKI
This study will randomize hospitalized patients with acute kidney injury (AKI) to usual care, or an electronic alert intervention. The electronic alert will be in the form of a text page that will be sent to the covering clinician and unit pharmacist once per patient with AKI at the time lab results are uploaded. The investigators hypothesize that such an alert will improve outcomes in these patients.
Obstructive sleep apnea (OSA) is a common and undertreated condition in patients with chronic kidney disease (CKD). Both physiologic and empiric data suggest that renal hypoxia due to OSA is associated with worsening kidney function. Hospitalized patients are often exposed to multiple nephrotoxins such as antibiotics, contrast agents, and diuretics, which place them at risk for acute worsening of kidney function. This study aims to determine whether immediate diagnosis and treatment of OSA in CKD patients will decrease the incidence of acute kidney injury during hospitalization. The investigators will evaluate the extent to which this effect can be attributed to a decrease in nocturnal hypoxia and improved blood pressure control. Secondary endpoints include hospital length of stay, and a composite outcome comprised of hemodialysis initiation, major cardiovascular events, and mortality.
Compared to chronic dialysis, kidney transplantation provides recipients with longer survival and better quality of life at a lower cost. In order to meet increasing demands for kidney allografts, kidneys from older and sicker donors are being procured. This has led to greater discard rates of donated kidneys as well as more complications for recipients, including shorter allograft survival. Available clinical models to predict kidney allograft quality have poor prognostic ability and do not asses the degree of kidney allograft injury. However, allograft injury near the time of procurement can lead to major consequences for the transplant recipient: greater risks of delayed graft function, poor allograft function and premature loss of the transplant. Our proposal is based on the hypotheses that novel biomarkers measured in donor urine and transport media at the time of procurement can assess acute and chronic kidney injury and that distinct biomarker patterns will predict allograft survival. In collaboration with five organ procurement organizations, we will collect urine samples from consecutive deceased donors and samples of transport solution for every pumped kidney. We will measure markers of injury, repair, inflammation and fibrosis. We will determine mortality and allograft survival in all patients by linkage to the United Network for Organ Sharing (UNOS) database (Overall Cohort). Additionally, we will perform a detailed chart review of a subset of recipients (detailed cohort) and will also examine associations between biomarkers and longitudinal graft function over five years after transplant. Early, non-invasive and rapid assessment of donor kidney injury could drive better allocation decisions and potentially reduce the rates of post-transplant complications. Further, these new tools could provide a platform for clinical trials of therapies for allografts and kidney transplant recipients aimed at ameliorating allograft injury.
To collect and process urine samples from critically ill subjects for use in assessing the effects of various urine sample freezing and storage conditions on biomarker test results.