Acute Kidney Injury Clinical Trial
The study aims to evaluate the diagnostic value of urinary indices in differentiating pre-renal and renal acute kidney injury among critically ill patients.
Critically ill patients with acute kidney injury (AKI) will be included. Urinary indices
will be obtained immediately after defining AKI, including specific gravity (SG), urine
osmolarity (Uosm), urine sodium (UNa), fractional excretion of sodium (FENa), and fractional
excretion of urea (FEurea).
The patterns of renal function and hemodynamic status serve as the clinical definition of
pre-renal and renal AKI. Hemodynamic status will be evaluated at inclusion and followed
during patients' ICU stay. Those who are hemodynamically stable at inclusion are classified
as renal AKI. Those who are hemodynamically unstable at inclusion are followed until
hemodynamic stabilization. Those with AKI recovery after hemodynamic stabilization are
classified as pre-renal AKI. Those without AKI recovery are defined as renal AKI.
Urinary indices are measured again after hemodynamic stability. One of the investigators
objectives is to evaluate the diagnostic value of urinary indices using recovery of renal
function after hemodynamic stabilization as the definition of pre-renal AKI.
Transesophageal echocardiography (TEE) has been proved to be a reliable method of measuring
left renal blood flow during surgical operation. Decreased renal blood flow measured by TEE
may serve as an objective definition of pre-renal AKI. The mesurement will be conducted at
inclusion if the patient is sedated, intubated, and without TEE contraindication. If the
patient is hemodynamically unstable at inclusion, the measurement will be repeated after
hemodynamic stabilization. The investigators study also serves the following aims: (1)
feasibility of measuring renal blood flow by TEE among critically ill patients; (2) the
correspondence between renal blood flow measured by TEE and clinical definition of pre-renal
and renal AKI; (3) the diagnostic value of urinary indices in differentiating pre-renal and
renal AKI, which is judged by renal blood flow measured by TEE.
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Observational Model: Cohort, Time Perspective: Prospective
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