None listed
Conditions
Brief summary
Lay Summary: Acute Kidney Injury (AKI) occures in nearly half of all critically ill patients because of temporary loss of blood to the kidneys or damage from toxins. Currently AKI is diagnosed by observing creatinine in the blood which increases in concentration 2-3 days after injury. This delay in treatment can be fatal. This study measures new biomarkers of AKI which indicate damage to the kidney within a few hours of injury. Each biomarker reacts differently and tells us something different about the injury. For example, albumin comes from the blood into the kidneys and out into the urine only when the filter mechanism is damaged. GGT and NGAL are elevated in urine when there is specific damage to the tubules in which urine is formed in the kidney and neopterin tells us if there is inflammation in these tubules. By measuring these markers in the emergency department we are measuring them as soon as possible after injury. We then compare them to the later traditional clinical diagnosis of AKI. The ultimate goal is to develop a panel of biomarkers which will detect AKI in all cases very soon after injury and so will allow early treatment and the saving of lives.
Interventions
No intervention. Prospective observational study of urinary and plasma biomarkers in the emergency department, intensive care unit, and at a 30 day follow up. Mortality will be assessed at one year.
Urinary biomarkers are taken from urine collected from catheterised patients in the Emergency Department, on entry to the Intensive Care Unit, then 4, 8, 16 hours, and 2, 4, 7 days later. There is no inconvenience to patients.
Plasma biomarkers are taken from blood sampled at the same time points,
No intervention. Prospective observational study of urinary and plasma biomarkers in the emergency department, intensive care unit, and at a 30 day follow up. Mortality will be assessed at one year. Urinary biomarkers are taken from urine collected from catheterised patients in the Emergency Department, on entry to the Intensive Care Unit, then 4, 8, 16 hours, and 2, 4, 7 days later. There is no inconvenience to patients. Plasma biomarkers are taken from blood sampled at the same time points, with the exception of the 4 and 8 hour samples, these samples are taken along with routine clinical blood collections. There is minimal inconvenience to patients.
Sponsors
University of Otago Christchurch
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
On entry to the ED: (1) Cardiac Arrest within the preceding three hours AND/OR (2) Ruptured Abdominal Aortic Aneurysm AND/OR (3) Sustained hypotension (defined as systolic blood pressure (SBP) <90 mmHg or Mean Arterial Pressure (MAP) < 65 mmHg after 1000ml IV fluid challenge / 60 mins (including Intravenous (IV) fluids pre hospital)) AND/OR (4) Profound hypotension (Systolic Blood Pressue (SBP) less than 60mmHg) of any duration.
Exclusion criteria
(1) Age<16 (2) Moribund, not expected to survive 24 hours (3) Likely to be discharged within 24 hours (4) Drug overdose (5) Treatment limitation order (6) Receiving Renal Replacement Therapy (7) More than 4 hours since entry to ED (8) Inter-hospital transfer unless arrival in ED within <3 hours of event (9) Non-consent
Outcome results
None listed