Identification of pre-renal and intrinsic acute kidney injury by anamnestic and biochemical criteria: Distinct association with urinary injury biomarkers

[EN]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)...

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Autores: Casanova, Alfredo G., Düwel, Annette Guisela, Rivero-García, Karen, García-Garrido, Tamara, Morales Martín, Ana Isabel, Martínez Salgado, José Carlos, López Hernández, Francisco José, Fraile Gómez, María Pilar, Düwel, Annette G., Morales, Ana I., López-Hernández, Francisco J., Sancho Martínez, Sandra María
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad de Salamanca (USAL)
Repositorio:GREDOS. Repositorio Institucional de la Universidad de Salamanca
OAI Identifier:oai:gredos.usal.es:10366/161566
Acceso en línea:http://hdl.handle.net/10366/161566
Access Level:acceso abierto
Palabra clave:acute kidney injury
pre-renal
intrinsic
injury biomarkers
anamnesis
etiopathology
Acute Kidney Injury
Creatinine
Humans
Kidney
3205.06 Nefrología
riñón
humanos
lesión renal aguda
creatinina
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spelling Identification of pre-renal and intrinsic acute kidney injury by anamnestic and biochemical criteria: Distinct association with urinary injury biomarkersCasanova, Alfredo G.Düwel, Annette GuiselaRivero-García, KarenGarcía-Garrido, TamaraMorales Martín, Ana IsabelMartínez Salgado, José CarlosLópez Hernández, Francisco JoséFraile Gómez, María PilarCasanova, Alfredo G.Düwel, Annette G.Morales, Ana I.López-Hernández, Francisco J.Sancho Martínez, Sandra Maríaacute kidney injurypre-renalintrinsicinjury biomarkersanamnesisetiopathologyAcute Kidney InjuryCreatinineHumansKidney3205.06 Nefrologíariñónhumanoslesión renal agudacreatinina[EN]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.This study was supported by a grant from the Instituto de Salud Carlos III (ISCIII), Spain: PI18/00996, Cofinanciado FEDER, Fondo Europeo de Desarrollo Regional “Una manera de hacer Europa”), by grant PI21/01226 funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union, by grant RICORS2040 RD21/0005/0004), Financiado por la Unión Europea-NextGeneration EU, Mecanismo para la Recuperación y la Resiliencia (MRR), and a grant from the Consejería de Educación, Junta de Castilla y León (IES160P20), Spain, co-funded by FEDER funds.MDPI202520252023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://hdl.handle.net/10366/161566reponame:GREDOS. Repositorio Institucional de la Universidad de Salamancainstname:Universidad de Salamanca (USAL)InglésAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:gredos.usal.es:10366/1615662026-06-07T06:28:51Z
dc.title.none.fl_str_mv Identification of pre-renal and intrinsic acute kidney injury by anamnestic and biochemical criteria: Distinct association with urinary injury biomarkers
title Identification of pre-renal and intrinsic acute kidney injury by anamnestic and biochemical criteria: Distinct association with urinary injury biomarkers
spellingShingle Identification of pre-renal and intrinsic acute kidney injury by anamnestic and biochemical criteria: Distinct association with urinary injury biomarkers
Casanova, Alfredo G.
acute kidney injury
pre-renal
intrinsic
injury biomarkers
anamnesis
etiopathology
Acute Kidney Injury
Creatinine
Humans
Kidney
3205.06 Nefrología
riñón
humanos
lesión renal aguda
creatinina
title_short 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_sort Identification of pre-renal and intrinsic acute kidney injury by anamnestic and biochemical criteria: Distinct association with urinary injury biomarkers
dc.creator.none.fl_str_mv Casanova, Alfredo G.
Düwel, Annette Guisela
Rivero-García, Karen
García-Garrido, Tamara
Morales Martín, Ana Isabel
Martínez Salgado, José Carlos
López Hernández, Francisco José
Fraile Gómez, María Pilar
Casanova, Alfredo G.
Düwel, Annette G.
Morales, Ana I.
López-Hernández, Francisco J.
Sancho Martínez, Sandra María
author Casanova, Alfredo G.
author_facet Casanova, Alfredo G.
Düwel, Annette Guisela
Rivero-García, Karen
García-Garrido, Tamara
Morales Martín, Ana Isabel
Martínez Salgado, José Carlos
López Hernández, Francisco José
Fraile Gómez, María Pilar
Düwel, Annette G.
Morales, Ana I.
López-Hernández, Francisco J.
Sancho Martínez, Sandra María
author_role author
author2 Düwel, Annette Guisela
Rivero-García, Karen
García-Garrido, Tamara
Morales Martín, Ana Isabel
Martínez Salgado, José Carlos
López Hernández, Francisco José
Fraile Gómez, María Pilar
Düwel, Annette G.
Morales, Ana I.
López-Hernández, Francisco J.
Sancho Martínez, Sandra María
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv acute kidney injury
pre-renal
intrinsic
injury biomarkers
anamnesis
etiopathology
Acute Kidney Injury
Creatinine
Humans
Kidney
3205.06 Nefrología
riñón
humanos
lesión renal aguda
creatinina
topic acute kidney injury
pre-renal
intrinsic
injury biomarkers
anamnesis
etiopathology
Acute Kidney Injury
Creatinine
Humans
Kidney
3205.06 Nefrología
riñón
humanos
lesión renal aguda
creatinina
description [EN]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.
publishDate 2023
dc.date.none.fl_str_mv 2023
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10366/161566
url http://hdl.handle.net/10366/161566
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:GREDOS. Repositorio Institucional de la Universidad de Salamanca
instname:Universidad de Salamanca (USAL)
instname_str Universidad de Salamanca (USAL)
reponame_str GREDOS. Repositorio Institucional de la Universidad de Salamanca
collection GREDOS. Repositorio Institucional de la Universidad de Salamanca
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,228081

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