Early AKI Bio Significance | The University Of Western Ontario

University:
The University Of Western Ontario
Course:
Pathology 3500B | Human Pathology
Academic year:

2023
Views:

166

Pages:

3
Author:

Kyuwon J.

Early AKI Bio significance ● Detection of structural injury prior to dysfunctionality ● Able to identify patient in risk group ○ Overall, higher chance of treatment success, since we will identify and focus our resource on ones who really need treatments ○ Early preventive interventions ● Traditional approach ○ AKI diagnose post creatinine increases ○ Injury that has already been established ○ Limitation on opportunity for prevention ● Biomarkers approach ○ Injury in pink AKI window ■ Early hemodynamic optimizations ■ Avoidance of nephrotoxins ■ Intensive monitoring ■ ICU triage ● Only for high-risk patients Biomarkers vs Creatinine ● Subject of reflections ○ Biomarkers on early injury will reflect structural tubular injury ○ Creatinine GFR decline ● Time of rise ○ Hours after insult ■ Biomarkers ○ 24-48hr ■ Creatinine ● Sensitivity ○ Tends to be higher on early injury for biomarkers ○ Low and late marker for creatinine ● Specificity ○ Moderate (biomarker) ○ High (creatinine) ■ Reduced GFR ● Prognostic value ○ In early injury biomarkers are strong ○ Limited for creatinine Creatinine will increase post-nephron loss Some patients have despite recovery ● Normalization of creatine ● Subclinical fibrosis ● Biomarker in stable or mildly elevated ○ This will explain on delayed CKD developments ● Functional recovery does not mean its structural recovery ● Hidden injury phase ○ Early AKI window ■ Renal tubular cells will be… ● Stressed ● Dedifferentiating ● Cell-cycle arrest ■ Non-measurable changes in creatinine ○ Biomarkers such as NGAL,KIM-1, IL-18, TIMP-2/IGFBP-7 will detect structural injury and cellular stress ■ Increase in hours ■ Revealing AKI on functional decline ○ Biomarkers will sense hidden injury ● Reactive traditional ○ Insult occurs ○ Creatinine increases ○ AKI ○ But damage already done Limited ability on reserving injury ● Preventive model ○ Insult occurs ○ Biomarker increases ○ Early intervention in injury phase ○ Reduced progression