ABSTRACT
BACKGROUND AND AIMS: In hemodialysis patients, monitoring 25-hydroxyvitamin D (25(OH)D) levels is recommended. It is however unclear if monitoring 1,25-dihydroxyvitamin D (1,25(OH)2D) levels is interesting. MATERIALS AND METHODS: We repeatedly measured 1,25(OH)2D (DiaSorin Liaison analyser) and 25(OH)D (LCMS/MS) concentrations in patients newly treated by active or native vitamin D to study the impact of such treatments on serum concentrations. RESULTS: Ten patients were included in the native and 12 in the active vitamin D group. In the native group, a significant increase was observed between the baseline and the last 25(OH)D concentrations available (21.65[17.39;25.26] versus 33.49[28.60;40.30] ng/mL, p = 0.0059). The baseline and last available 1,25(OH)2D concentrations were not different (12.15[4.25;15.40] versus 11.35[9.72;21.85] pg/mL, p = 0.5566). In the active group, no difference was observed between the baseline and the last 25(OH)D concentrations (51.70[42.97;63.95] versus 50.89[42.02;64.49] ng/mL, p = 0.5186). The same observation was made for 1,25 (OH)2D concentrations (25.65[17.05;41.85] versus 28.70[23.36;43.73] pg/mL, p = 0.6221). Using a linear mixed model, a significant change over time was only observed in 25(OH)D serum levels for patients treated by with native vitamin D. CONCLUSION: Measuring 1,25(OH)2D levels in patients newly treated by active vitamin D does not seem useful in monitoring active vitamin D therapy.
Subject(s)
Cholecalciferol , Vitamin D Deficiency , Humans , Vitamin D , Calcifediol , Renal Dialysis , Vitamin D Deficiency/drug therapyABSTRACT
Objective. Neutrophil gelatinase-associated lipocalin (NGAL) measured by a research ELISA is described as an early marker of acute kidney injury (AKI). The aim of this study is to define the usefulness of plasma NGAL (pNGAL) and urine NGAL (uNGAL) measured with platform analysers to detect AKI 3 hours after cardiac surgery in fifty adult patients. Methods and Main Results. pNGAL and uNGAL were measured before and 3 hours after cardiac surgery. AKI, defined following the acute kidney injury network definition, was observed in 17 patients. pNGAL was >149 ng/mL in 8 patients with AKI, two of them died in the follow-up. We also observed elevated pNGAL in 8 patients without AKI. Only one uNGAL was >132 ng/mL among the 15 AKI patients. Sensitivity of pNGAL for prediction of AKI is 47% and specificity is 75.7%. The positive likelihood ratio (LR+) is 1.9 and negative likelihood ratio (LR-) is 0.7. uNGAL performance is slightly improved when reported to urinary creatinine. Following this study, a ratio >62 ng/mg assure a sensitivity of 66.6% and a specificity of 78.5%. LR+ is 3 and a LR- is, 0.42. Conclusions. Three hours after cardiac surgery, pNGAL predicts AKI with a low sensitivity and specificity.
ABSTRACT
Definition and classification of acute renal failure evolved in recent years. The acronym "Acute Kidney Injury" replaces "Acute Renal Failure". The RIFLE classification spreads the AKI in three degrees of severity, and two degrees of disease duration. The group Acute Kidney Injury Network refines this classification into three stages, to improve the sensitivity in detecting moderate forms. The epidemiology of AKI remains imprecise. In the ICU, more than 30% of patients suffered from AKI, often in a context of multiple organs failure. In addition to serum creatinine and urine output, new biomarkers can be assessed. Their early detection should enable a clearer distinction between "acute tubular necrosis" and other causes of AKI, but also to distinguish patients at risk for pejorative evolution of renal function. The management of AKI based on an optimal resuscitation. The administration of loop diuretics or low dose dopamine showed no benefit. Hydration in prevention of the contrast-induced nephropathy is confirmed. The role of acetylcysteine must be determined. The ideal time to initiate a renal replacement therapy and the choice of the technique remain unresolved. The same goes for the dose of dialysis administered. A systematic application of an algorithm, such as proposed by Bagshow would make comparisons easier and the realisation of multicenter studies will help to clarify these points.
